Treatments for alopecia areata: a network meta-analysis

• Published in: Cochrane database of systematic reviews 2023-10, Vol.10 (10), p.CD013719
• Main Authors: Mateos-Haro, Miriam, Novoa-Candia, Monica, Sánchez Vanegas, Guillermo, Correa-Pérez, Andrea, Gaetano Gil, Andrea, Fernández-García, Silvia, Ortega-Quijano, Daniel, Urueña Rodriguez, Mayra Gizeth, Saceda-Corralo, David, Bennouna-Dalero, Tayeb, Giraldo, Lucia, Tomlinson, Jaqueline, Vaño-Galván, Sergio, Zamora, Javier
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Alopecia; Alopecia Areata - drug therapy; Betamethasone; Biological Products; Child; Child, Preschool; Cyclosporins; H. DISORDERS OF SKIN APPENDAGES (HAIR, NAILS, SWEAT GLANDS); Humans; Immunosuppressive Agents - therapeutic use; Middle Aged; Minoxidil - therapeutic use; Network Meta-Analysis; Prednisolone; Skin disorders; Young Adult
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD013719.pub2

Alopecia areata is an autoimmune disease leading to nonscarring hair loss on the scalp or body. There are different treatments including immunosuppressants, hair growth stimulants, and contact immunotherapy. To assess the benefits and harms of the treatments for alopecia areata (AA), alopecia totalis (AT), and alopecia universalis (AU) in children and adults. The Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and WHO ICTRP were searched up to July 2022. We included randomised controlled trials (RCTs) that evaluated classical immunosuppressants, biologics, small molecule inhibitors, contact immunotherapy, hair growth stimulants, and other therapies in paediatric and adult populations with AA. We used the standard procedures expected by Cochrane including assessment of risks of bias using RoB2 and the certainty of the evidence using GRADE. The primary outcomes were short-term hair regrowth ≥ 75% (between 12 and 26 weeks of follow-up), and incidence of serious adverse events. The secondary outcomes were long-term hair regrowth ≥ 75% (greater than 26 weeks of follow-up) and health-related quality of life. We could not perform a network meta-analysis as very few trials compared the same treatments. We presented direct comparisons and made a narrative description of the findings. We included 63 studies that tested 47 different treatments in 4817 randomised participants. All trials used a parallel-group design except one that used a cross-over design. The mean sample size was 78 participants. All trials recruited outpatients from dermatology clinics. Participants were between 2 and 74 years old. The trials included patients with AA (n = 25), AT (n = 1), AU (n = 1), mixed cases (n = 31), and unclear types of alopecia (n = 4). Thirty-three out of 63 studies (52.3%) reported the proportion of participants achieving short-term hair regrowth ≥ 75% (between 12 and 26 weeks). Forty-seven studies (74.6%) reported serious adverse events and only one study (1.5%) reported health-related quality of life. Five studies (7.9%) reported the proportion of participants with long-term hair regrowth ≥ 75% (greater than 26 weeks). Amongst the variety of interventions found, we prioritised some groups of interventions for their relevance to clinical practice: systemic therapies (classical immunosuppressants, biologics, and small molecule inhibitors), and local therapies (intralesional corticosteroids, topical small molecule inhibitors, contact immuno