An analysis of the drugs minoxidil, finasteride and dutasteride against baldness in men listed the latter as the one that had the best result to overcome hair loss. The findings are part of a study published in the journal Jama Dermatology, authored by researchers from Canadian institutions.
The disease —technically named androgenetic alopecia— is characterized by affecting the male population.
“For a disease that is so common, there is very little treatment available and we also have little data to evaluate something that impacts the lives of a lot of people”, comments Alessandra Anzai, a dermatologist at Hospital das Clínicas and a specialist in trichology, who did not participate in the survey.
The three remedies already have approval for use in Brazil and all of them are considered effective for the treatment of baldness. Even so, it is recognized that drug mechanisms are different.
According to the article, finasteride and dutasteride have an inhibiting action on baldness-related enzymes and that is where their benefits come from. The mechanism of minoxidil still needs to be better studied, since its effect is not the same as that of the other two drugs.
“As they have these different mechanisms of action, they tend to have different results,” says Anzai.
In the study, researchers analyzed 23 previously published articles and considered some variations of the drugs. For minoxidil, two versions were seen for topical use and two others in an oral model. As for finasteride, two versions were counted and dutasteride only one, all in their oral forms.
To verify the benefits of the drugs, the effects they had in two treatment periods (24 or 48 weeks) and the change in the amount of hair were considered, which were divided into two types: total, which corresponds to the complete hair count, or terminal, observing the growth of those wires that are already thicker and longer.
In this way, the study was able to compare the differences that the drugs had depending on the combination of the four variables.
In the first case, where 24 weeks of drug use and total hair growth were taken into account, 0.5 mg of dutasteride had the best benefit. On the other hand, for the same period of time and increase in terminal hair, 5 mg of minoxidil in its oral form had the best action.
In the case of 48 weeks of treatment and analyzing the total hair growth, 5 mg of finasteride offered the best performance. For the advancement of terminal hair, finasteride was also the best option, but in its 1mg version.
Anzai explains that this difference between total or terminal hair, in the end, does not necessarily mean that one remedy is better than another.
“Actually, both methods [de contagem de aumento de pelo] are important for you to measure results. If it improves in one way or if it improves in another, it kind of doesn’t matter, both will lead to an improvement. [no preenchimento da cabeça].”
At the end, the researchers proposed a ranking, in which the 0.5 mg version of dutasteride was the best placed, followed by the 5 mg model of finasteride and, just below, the 5 mg oral version of minoxidil.
The authors explain that one hypothesis to explain the success of dutasteride compared to finasteride involves its much greater inhibiting action on an enzyme involved in baldness. In addition, the best-placed drug acts on a second enzyme, an action that was not seen with finasteride.
However, the study has a problem: it was not possible to observe the effects that dutasteride had with 48 weeks of treatment nor how it acted in the period of 24 weeks for final hair growth. This happened because there was no such data in the meta-analysis that the scientists made of the 23 publications considered in the study.
“[O artigo] it is a collection of data from other studies and these others did not bring this information [do desempenho da dutasterida com as outras variáveis]. So he worked with the data he had, but it certainly could be better,” says Anzai.
She also points out that there is another detail that diminishes the certainty of the final result: the factor that the researchers did a second statistical method to analyze the performance of the three drugs and the outcome did not find a considerable difference between the drugs.
The researchers themselves point out in the publication the need for new randomized studies to confirm — or not — the research findings.
However, Anzai points out that this new study is not very different from what had already been discovered in other investigations.
What is important to take into account, according to her, is that the person who suffers from baldness chooses an adequate medical follow-up, since the problem must be recognized as a disease and also because it is common to mix different drugs in order to achieve better results—something not analyzed in the research.
“The choice between the profile of each drug depends a lot on the patient’s choice, the moment he is”, he says.
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