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

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.

Keywords: Calcineurin inhibitors; Corticosteroids; Minoxidil; Prostaglandins; Tofacitinib; Topical immunotherapy.

Conflict of interest statement

A.K.G., J.L.C., K.A.F., N.H.S., and B.M.P. have no conflicts of interest to declare. V.P. undertakes advisory work for Pfizer, Abb­Vie, Janssen, UCB, Novartis, Almirall, and Celgene. He has received departmental support from AbbVie, Bausch Health, Celgene, Janssen, LEO Pharma, Lilly, NAOS, Novartis, Pfizer, Pierre-Fabre, and Sanofi. A.T. is a consultant for Pfizer and a primary investigator for Incyte, Aclaris, Eli Lilly, and Nutrifol.

Copyright © 2019 by S. Karger AG, Basel.

Figures

Fig. 1
Fig. 1
The network graph shows the evidence network for all selected interventions. The size of an intervention's circle reflects the total number of patches for that intervention. Lines signify that interventions are connected through at least one study, with thicker lines indicating more connecting studies. a Network graph of moderate to severe disease. b Network graph of mild disease.

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