Comparative Efficacy of Minoxidil and 5-Alpha Reductase Inhibitors Monotherapy for Male Pattern Hair Loss: Network Meta-Analysis Study of Current Empirical Evidence.

Background: Treatment options for male androgenetic alopecia (AGA) range from pharmacologic agents-such as minoxidil, finasteride, and dutasteride-to newer procedural and experimental therapies.

Aims: We determined the relative effect of the various dosages and administrative routes of minoxidil, finasteride and dutasteride through network meta-analysis (NMA) of relevant outcome measures.

Methods: We conducted a systematic review to identify eligible studies. Our NMAs included studies that investigated monotherapy with minoxidil, finasteride, and dutasteride of any dosage and route on the following 5 outcomes: 24- and 48-week changes in total and terminal hair density, and 24-week change in independent observer assessment (IOA). We assessed evidence quality and performed sensitivity and node-splitting analyses of inconsistency. Each NMA produced estimates for pairwise relative effects and surface under the cumulative ranking curve (SUCRA) values.

Results: Our search found 33 eligible studies across which 19 comparators (18 interventions and 1 control) were identified. The active comparators included minoxidil (oral, topical, sublingual), finasteride (oral, topical, mesotherapy) and dutasteride (oral, mesotherapy). The control node amalgamated placebo and vehicle arms.

Conclusions: We found dutasteride 0.5 mg/day to be the most effective option. Among FDA-approved treatments, topical minoxidil 5% was the most effective topical monotherapy, while finasteride 1 mg/day was the most effective oral option. Dutasteride mesotherapy appears significantly less effective than oral administration (0.5 mg/day).