Aditya K Gupta1,2, Jessie L Carviel1, Kelly A Foley1, Neil H Shear2,3, Bianca Maria Piraccini4, Vincent Piguet2,5,6, Antonella Tosti7. 1. Mediprobe Research Inc., London, Ontario, Canada. 2. Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada. 3. Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 4. Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy. 5. Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada. 6. Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom. 7. Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, USA.
Abstract
BACKGROUND: There are many treatments available for alopecia areata; however, none are approved by the US Food and Drug Administration. Thus, there is clinician benefit in efficacy comparison. METHODS: A network meta-analysis was used to create direct and indirect comparisons of alopecia areata studies in addition to an inconsistency analysis, risk of bias, and quality of evidence assessment. RESULTS: For mild disease, intralesional corticosteroids were ranked the most likely to produce a response at 78.9% according to SUCRA (surface under the cumulative ranking curve) followed by topical corticosteroids (67.9%), prostaglandin analogs (67.1%), diphenylcyclopropenone (DPCP, 63.4%), topical minoxidil (61.2%), and squaric acid dibutylester (SADBE, 35.0%). In contrast, for moderate to severe disease (>50% scalp hair loss), DPCP was the top-ranked treatment (87.9%), followed by laser (77.9%), topical minoxidil (55.5%), topical corticosteroids (50.1%), SADBE (49.7%), and topical tofacitinib (47.6%). There were insufficient eligible trials to include oral tofacitinib in the network. CONCLUSION: Statistically significant evidence is presented for the use of intralesional and topical corticosteroids for treatment of mild disease and DPCP, laser, SADBE, topical minoxidil and topical corticosteroids for moderate to severe disease. Further controlled trials are required to analyze the relative efficacy of oral tofacitinib.
BACKGROUND: There are many treatments available for alopecia areata; however, none are approved by the US Food and Drug Administration. Thus, there is clinician benefit in efficacy comparison. METHODS: A network meta-analysis was used to create direct and indirect comparisons of alopecia areata studies in addition to an inconsistency analysis, risk of bias, and quality of evidence assessment. RESULTS: For mild disease, intralesional corticosteroids were ranked the most likely to produce a response at 78.9% according to SUCRA (surface under the cumulative ranking curve) followed by topical corticosteroids (67.9%), prostaglandin analogs (67.1%), diphenylcyclopropenone (DPCP, 63.4%), topical minoxidil (61.2%), and squaric acid dibutylester (SADBE, 35.0%). In contrast, for moderate to severe disease (>50% scalp hair loss), DPCP was the top-ranked treatment (87.9%), followed by laser (77.9%), topical minoxidil (55.5%), topical corticosteroids (50.1%), SADBE (49.7%), and topical tofacitinib (47.6%). There were insufficient eligible trials to include oral tofacitinib in the network. CONCLUSION: Statistically significant evidence is presented for the use of intralesional and topical corticosteroids for treatment of mild disease and DPCP, laser, SADBE, topical minoxidil and topical corticosteroids for moderate to severe disease. Further controlled trials are required to analyze the relative efficacy of oral tofacitinib.
Authors: Yong Hyun Jang; Nam-Soo Hong; Sun Young Moon; Dong Hyuk Eun; Won Kee Lee; Seong Geun Chi; Jun Young Kim; Weon Ju Lee; Seok-Jong Lee; Do Won Kim Journal: Dermatology Date: 2017-07-14 Impact factor: 5.366
Authors: Eva M J Peters; Sofia Liotiri; Eniko Bodó; Evelin Hagen; Tamás Bíró; Petra C Arck; Ralf Paus Journal: Am J Pathol Date: 2007-11-30 Impact factor: 4.307