Combination Therapy in Androgenetic Alopecia: A Network Meta-Analysis of Minoxidil and Other Pharmacological Agents

This study explored the efficacy of different medications for the treatment of androgenetic alopecia by using network meta-analysis.

The search of PubMed, Embase, web of science, Cochrane library databases for randomized controlled studies on drug treatment of androgenetic alopecia was conducted from database creation to November 1, 2024, using risk of bias for quality assessment, R4.4.1 and Stata15 for Data analysis.

A total of 27 articles (n = 3012) were included in the analysis. The results indicated that in terms of efficacy, Minoxidil_spironolactone ranked highest, followed by Minoxidil_flutamide, Minoxidil_finasteride, and Placebo. SUCRA-based rankings suggest that Minoxidil_spironolactone is most likely the most effective, but these estimates should be interpreted cautiously due to limited study numbers and inherent uncertainty in the network. Regarding hair density, no significant differences were found between the interventions. In terms of hair count, PRPF_Minoxidil ranked highest, followed by PRPF, Dutasteride, and Placebo, with the same caution regarding the uncertainty of SUCRA-based rankings.

Based on the current studies, we found that the combination of Minoxidil with spironolactone, PRPF, flutamide, and finasteride may offer better treatment outcomes for patients with androgenetic alopecia. However, due to the limitations of the existing research, more high-quality, multi-center studies are needed to support our viewpoint.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .