Monotherapy for Alopecia Areata: A Systematic Review and Network Meta-Analysis

Aditya K. Gupta, Jessie L. Carviel, Kelly A. Foley, Neil H. Shear, Bianca Maria Piraccini, Vincent Piguet, Antonella Tosti

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
JournalSkin Appendage Disorders
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Alopecia Areata
Minoxidil
Adrenal Cortex Hormones
Lasers
Synthetic Prostaglandins
Alopecia
United States Food and Drug Administration
Scalp
Network Meta-Analysis
tofacitinib
squaric acid dibutyl ester

Keywords

  • Calcineurin inhibitors
  • Corticosteroids
  • Minoxidil
  • Prostaglandins
  • Tofacitinib
  • Topical immunotherapy

ASJC Scopus subject areas

  • Dermatology

Cite this

Gupta, A. K., Carviel, J. L., Foley, K. A., Shear, N. H., Piraccini, B. M., Piguet, V., & Tosti, A. (Accepted/In press). Monotherapy for Alopecia Areata: A Systematic Review and Network Meta-Analysis. Skin Appendage Disorders. https://doi.org/10.1159/000501940

Monotherapy for Alopecia Areata : A Systematic Review and Network Meta-Analysis. / Gupta, Aditya K.; Carviel, Jessie L.; Foley, Kelly A.; Shear, Neil H.; Piraccini, Bianca Maria; Piguet, Vincent; Tosti, Antonella.

In: Skin Appendage Disorders, 01.01.2019.

Research output: Contribution to journalReview article

Gupta, Aditya K. ; Carviel, Jessie L. ; Foley, Kelly A. ; Shear, Neil H. ; Piraccini, Bianca Maria ; Piguet, Vincent ; Tosti, Antonella. / Monotherapy for Alopecia Areata : A Systematic Review and Network Meta-Analysis. In: Skin Appendage Disorders. 2019.
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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.",
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AU - Shear, Neil H.

AU - Piraccini, Bianca Maria

AU - Piguet, Vincent

AU - Tosti, Antonella

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AB - 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.

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