title: Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis.
abstract: OBJECTIVE
  Two meta-analyses conclude that finasteride treatment of androgenic alopecia (AGA) is safe but do not assess quality of safety reporting.
  
  
  OBJECTIVE
  To assess safety reporting for clinical trial reports of finasteride for AGA.
  
  
  METHODS
  MEDLINE, ClinicalTrials.gov, and a clinical data repository for an academic medical center.
  
  
  METHODS
  Published clinical trial reports for finasteride treatment of AGA.
  
  
  METHODS
  For each trial, we assessed quality of adverse event reporting, extracted the number and type of adverse events in treatment and placebo groups, and assessed duration of safety evaluation and adequacy of blinding. Two observers independently extracted the data; differences were resolved by consensus. We assessed generalizability in a large cohort of men prescribed finasteride, 1.25 mg/d or less, by assessing for eligibility in the finasteride-AGA pivotal trials.
  
  
  METHODS
  Quality was assessed as adequate, partially adequate, inadequate, or no events reported. We used funnel plots of the hazard ratio to assess bias.
  
  
  RESULTS
  Of 34 clinical trials, none had adequate safety reporting, 19 were partially adequate, 12 were inadequate, and 3 reported no adverse events. Funnel plots were asymmetric with a bias toward lower odds ratio for sexual adverse effects, suggesting systematic underdetection. No reports assessed adequacy of blinding, 18 (53%) disclosed conflicts of interest, and 19 (56%) received funding from the manufacturer. Duration of drug safety evaluation was 1 year or less for 26 of 34 trials (76%). Of 5704 men in the clinical data repository who were treated for AGA with finasteride, 1.25 mg/d or less, for AGA, only 31% met inclusion criteria for the pivotal trials referenced in the manufacturer's full prescribing information and 33% took finasteride for more than 1 year.
  
  
  CONCLUSIONS
  Available toxicity information from clinical trials of finasteride in men with AGA is very limited, is of poor quality, and seems to be systematically biased. In a cohort of men prescribed finasteride for routine treatment of AGA, most would have been excluded from the pivotal studies that supported US Food and Drug Administration approval for AGA. Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA.
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois2Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Belknap
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Imran
authors.initials: I
authors.lastname: Aslam
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Tina
authors.initials: T
authors.lastname: Kiguradze
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: William H
authors.initials: WH
authors.lastname: Temps
authors.affiliation: Optimal Data Analysis LLC, Evanston, Illinois.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Yarnold
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois4Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: John
authors.initials: J
authors.lastname: Cashy
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Brannigan
authors.affiliation: Department of Dermatology, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Micali
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Nardone
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: West
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000505:Alopecia / Q000188:drug therapy*; D015982:Bias; D002986:Clinical Trials as Topic / Q000379:methods; D018120:Finasteride / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models
chemical_list: D058891:5-alpha Reductase Inhibitors; D018120:Finasteride