Hair regrowth treatment efficacy and resistance in androgenetic alopecia: A systematic review and continuous Bayesian network meta-analysis.

Peter R Feldman, Pietro Gentile, Charles Piwko, Hendrik M Motswaledi, Samantha Gorun et al.

Systematic Review Frontiers in medicine 2022 14 次引用

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Study Design

研究类型: systematic_review_meta_analysis
持续时间: 24 weeks

干预措施: Hair regrowth treatment efficacy and resistance in androgenetic alopecia: A systematic review and continuous Bayesian network meta-analysis. ALRV5XR, dutasteride 0.5 mg/day, finasteride 1 mg/day, LLLT, minoxidil 2%/5%, Nutrafol, Viviscal
对照组: Placebo
效应方向: Positive
偏倚风险: Low

Abstract

BACKGROUND: 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. OBJECTIVE: To systematically compare the relative efficacy of treatments used for terminal hair (TH) regrowth in women and men with AGA. METHODS: 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. RESULTS: 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/cm2 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. CONCLUSION: 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). SYSTEMATIC REVIEW REGISTRATION: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021268040, identifier CRD42021268040.

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Figures

FIGURE 1

PRISMA flow diagram for the systematic review of androgenetic alopecia treatment efficacy shows the literature search, screening, and selection process across multiple databases. The final analysis includes studies comparing pharmacological and procedural interventions.

flowchart

FIGURE 2

Bayesian network meta-analysis ranking of AGA treatments by hair count change reveals the relative efficacy hierarchy among finasteride, minoxidil, PRP, LLLT, and combination therapies. Surface under the cumulative ranking curve (SUCRA) values are displayed.

forest_plot

FIGURE 3

Forest plot comparing individual treatment effects on hair density in androgenetic alopecia versus placebo, with pooled effect sizes and 95% credible intervals from the Bayesian network meta-analysis.

forest_plot

FIGURE 4

Treatment resistance analysis over time demonstrates declining efficacy of certain AGA interventions with prolonged use. The continuous Bayesian model captures temporal dynamics of treatment response.

chart

FIGURE 5

Network geometry plot displays the connections between compared AGA treatments, with node sizes proportional to sample sizes and edge thicknesses reflecting the number of direct comparisons available.

diagram

FIGURE 6

Risk of bias assessment across included randomized controlled trials in the AGA treatment network meta-analysis, evaluated using the Cochrane Risk of Bias tool domains.

chart

FIGURE 7

Sensitivity analysis results testing the robustness of the Bayesian network meta-analysis findings to different prior specifications and model assumptions for AGA treatment comparisons.

chart

FIGURE 8

Funnel plot assessing publication bias in the included AGA treatment studies shows generally symmetric distribution around the pooled effect estimate, though some asymmetry is noted for smaller trials.

chart