title: The efficacy and safety of 5α-reductase inhibitors in androgenetic alopecia: a network meta-analysis and benefit-risk assessment of finasteride and dutasteride.
abstract: BACKGROUND
  In the light of post-marketing reports of persistent sexual dysfunction with the use of finasteride, analysis of the extent of risk associated with 5α-reductase inhibitor treatment for androgenetic alopecia (AGA) is warranted. This study sought to evaluate the efficacy of 5α-reductase inhibitors using the outcomes hair count, global photographic assessment and patient self-assessment and evaluate the benefits of treatment versus the risk of global sexual dysfunction.
  
  
  METHODS
  A systematic review identified all relevant randomized controlled trials of finasteride 1 mg, 5 mg and dutasteride 0.5 mg. The efficacy outcome hair count was analyzed using pair-wise meta-analysis, while the efficacy outcomes global photographic assessment and patient self-assessment as well as the safety outcome global sexual dysfunction were analyzed through network meta-analyses. A benefit-risk assessment was also performed.
  
  
  RESULTS
  The active interventions were not significantly different than each other in efficacy and were not significantly different from placebo in eliciting sexual dysfunction. Benefit-risk analysis resulted in an arbitrary ranking due to the lack of statistically significant difference between active treatments.
  
  
  CONCLUSIONS
  Analysis results reiterate the efficacy and safety of 5α-reductase inhibitors for the treatment of AGA and may support the approval of dutasteride 0.5 mg as an additional treatment option, following further study.
authors.affiliation: Department of Medicine, Division of Dermatology, University of Toronto , Toronto , Canada.
authors.forename: Aditya K
authors.initials: AK
authors.lastname: Gupta
authors.forename: Andrew
authors.initials: A
authors.lastname: Charrette
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use*; D000505:Alopecia / Q000188:drug therapy*; D001378:Azasteroids / Q000627:therapeutic use*; D000068538:Dutasteride; D018120:Finasteride / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010781:Photography; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D057566:Self Report
chemical_list: D058891:5-alpha Reductase Inhibitors; D001378:Azasteroids; D018120:Finasteride; D000068538:Dutasteride