Feldman Peter R, Gentile Pietro, Piwko Charles, Motswaledi Hendrik M, Gorun Samantha, Pesachov Jacob, Markel Michael, Silver Maxwell I, Brenkel Megan, Feldman Oriel J, Kamen Corey L, Uleryk Elizabeth, Guevara-Aguirre Jaime, Fiebig Klaus M
Arbor Life Labs, Toronto, ON, Canada.
Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
Front Med (Lausanne). 2023 Jan 23;9:998623. doi: 10.3389/fmed.2022.998623. eCollection 2022.
Androgenetic alopecia (AGA) affects almost half the population, and several treatments intending to regenerate a normal scalp hair phenotype are used. This is the first study comparing treatment efficacy response and resistance using standardized continuous outcomes.
To systematically compare the relative efficacy of treatments used for terminal hair (TH) regrowth in women and men with AGA.
A systematic literature review was conducted (from inception to August 11, 2021) to identify randomized, Placebo-controlled trials with ≥ 20 patients and reporting changes in TH density after 24 weeks. Efficacy was analyzed by sex at 12 and 24 weeks using Bayesian network meta-analysis (B-NMA) and compared to frequentist and continuous outcomes profiles.
The search identified 2,314 unique articles. Ninety-eight were included for full-text review, and 17 articles met the inclusion criteria for data extraction and analyses. Eligible treatments included ALRV5XR, Dutasteride 0.5 mg/day, Finasteride 1 mg/day, low-level laser comb treatment (LLLT), Minoxidil 2% and 5%, Nutrafol, and Viviscal. At 24 weeks, the B-NMA regrowth efficacy in TH/cm and significance () in women were ALRV5XR: 30.09, LLLT: 16.62, Minoxidil 2%: 12.13, Minoxidil 5%: 10.82, and Nutrafol: 7.32, and in men; ALRV5XR: 21.03, LLLT: 18.75, Dutasteride: 18.37, Viviscal: 13.23, Minoxidil 5%: 13.13, Finasteride: 12.38, and Minoxidil 2%: 10.54. Two distinct TH regrowth response profiles were found; Continuous: ALRV5XR regrowth rates were linear in men and accelerated in women; Resistant: after 12 weeks, LLLT, Nutrafol, and Viviscal regrowth rates attenuated while Dutasteride and Finasteride plateaued; Minoxidil 2% and 5% lost some regrowth. There were no statistical differences for the same treatment between women and men. B-NMA provided more accurate, statistically relevant, and conservative results than the frequentist-NMA.
Some TH regrowth can be expected from most AGA treatments with less variability in women than men. Responses to drug treatments were rapid, showing strong early efficacy followed by the greatest resistance effects from flatlining to loss of regrowth after 12-16 weeks. Finasteride, Minoxidil 2% and Viviscal in men were not statistically different from Placebo. LLLT appeared more efficacious than pharmaceuticals. The natural product formulation ALRV5XR showed better efficacy in all tested parameters without signs of treatment resistance (see Graphical abstract).
www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021268040, identifier CRD42021268040.
雄激素性脱发（AGA）影响着近一半的人口，目前使用了多种旨在使头皮毛发恢复正常表型的治疗方法。这是第一项使用标准化连续结果比较治疗效果反应和耐药性的研究。
系统比较用于治疗男性和女性AGA终毛（TH）再生的各种治疗方法的相对疗效。
进行了一项系统的文献综述（从开始到2021年8月11日），以确定患者人数≥20且报告了24周后TH密度变化的随机、安慰剂对照试验。在第12周和第24周，使用贝叶斯网络荟萃分析（B-NMA）按性别分析疗效，并与频率学派和连续结果概况进行比较。
检索到2314篇独特的文章。98篇文章被纳入全文综述，17篇文章符合数据提取和分析的纳入标准。符合条件的治疗方法包括ALRV5XR、度他雄胺0.5毫克/天、非那雄胺1毫克/天、低能量激光梳疗法（LLLT）、2%和5%的米诺地尔、Nutrafol和Viviscal。在第24周时，女性中B-NMA的TH每平方厘米再生疗效及显著性（）为：ALRV5XR：30.09，LLLT：16.62，2%米诺地尔：12.13，5%米诺地尔：10.82，Nutrafol：7.32；男性中为：ALRV5XR：21.03，LLLT：18.75，度他雄胺：18.37，Viviscal：13.23，5%米诺地尔：13.13，非那雄胺：12.38，2%米诺地尔：10.54。发现了两种不同的TH再生反应概况；持续型：ALRV5XR在男性中的再生率呈线性，在女性中加速；耐药型：在第12周后，LLLT、Nutrafol和Viviscal的再生率减弱，而度他雄胺和非那雄胺趋于平稳；2%和5%的米诺地尔失去了一些再生效果。男女相同治疗方法之间无统计学差异。与频率学派荟萃分析相比，B-NMA提供了更准确、具有统计学相关性且更保守的结果。
大多数AGA治疗方法都能使TH有所再生，女性的变异性小于男性。药物治疗反应迅速，早期疗效显著，随后在12 - 16周后出现从趋于平稳到再生丧失的最大耐药效应。男性中的非那雄胺、2%米诺地尔和Viviscal与安慰剂在统计学上无差异。LLLT似乎比药物更有效。天然产物配方ALRV5XR在所有测试参数中显示出更好的疗效，且无治疗耐药迹象（见图摘要）。
www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021268040，标识符CRD42021268040 。
