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The Journal of Dermatological Treatment Nov 2022Androgenetic alopecia (AGA) is the most common cause of hair loss, often challenging to treat. While oral finasteride (1 mg/d) is an FDA-approved treatment for male... (Review)
Review
BACKGROUND
Androgenetic alopecia (AGA) is the most common cause of hair loss, often challenging to treat. While oral finasteride (1 mg/d) is an FDA-approved treatment for male AGA, oral minoxidil and oral dutasteride are not approved yet. However, clinicians have been increasingly using these two drugs off-label for hair loss. Recently, Japan and South Korea have approved oral dutasteride (0.5 mg/d) for male AGA.
EFFICACY AND SAFETY
A probable efficacy ranking, in decreasing order, is - dutasteride 0.5 mg/d, finasteride 5 mg/d, minoxidil 5 mg/d, finasteride 1 mg/d, followed by minoxidil 0.25 mg/d. Oral minoxidil predominantly causes hypertrichosis and cardiovascular system (CVS) symptoms/signs in a dose-dependent manner, whereas oral finasteride and dutasteride are associated with sexual dysfunction and neuropsychiatric side effects.
PHARMACOKINETICS AND PHARMACODYNAMICS
The average plasma half-lives of minoxidil, finasteride, and dutasteride are ∼4 h, ∼4.5 h, and ∼5 weeks, respectively. Minoxidil acts through multiple pathways to promote hair growth. It has been shown as a vasodilator, an anti-inflammatory agent, a Wnt/β-catenin signaling inducer, and an antiandrogen. Finasteride inhibits 5α-reductase (5AR) type II isoenzyme, while dutasteride inhibits both type I and type II. Thus, dutasteride suppresses DHT levels more than finasteride in the serum and scalp.
Topics: Male; Humans; Minoxidil; Finasteride; Dutasteride; Hair; Alopecia; 5-alpha Reductase Inhibitors
PubMed: 35920739
DOI: 10.1080/09546634.2022.2109567 -
Current Clinical Pharmacology 2017Androgenetic alopecia is a common condition characterized by thinning of scalp hair. Conversion of testosterone to dihydrotestosterone, a more potent androgen, by the... (Review)
Review
BACKGROUND
Androgenetic alopecia is a common condition characterized by thinning of scalp hair. Conversion of testosterone to dihydrotestosterone, a more potent androgen, by the enzyme 5-α-reductase is responsible for underlying pathogenesis. Dutasteride, a synthetic 4-azasteroid, is a selective and competitive inhibitor of both type-1 and type-2 isoenzymes of 5-α-reductase. Finasteride and minoxidil are the only approved drugs for androgenetic alopecia. Dutasteride has been demonstrated to be effective in several randomized, double-blind, placebo controlled trials in androgenetic alopecia. In this review, after the pharmacology of dutasteride, the authors have discussed the status of dutasteride in androgenetic alopecia and have compared its efficacy with that of finasteride.
OBJECTIVE
This article aims to review the current status of dutasteride in androgenetic alopecia. The structure, mechanism of action, pharmacokinetics and side effects are discussed along with its comparison with finasteride in androgenetic alopecia.
METHOD
The main sources of our information were Medline Pubmed, Google scholar and Scopus including original articles and review articles. The keywords 'dutasteride', 'dutasteride in androgenetic alopecia' were used for search.
CONCLUSION
Like finasteride, dutasteride is now becoming popular treatment option in AGA, due to its good response shown by various randomized control studies and meta-analysis. Also, in most of these studies, dutasteride was found to be better than finasteride with comparable adverse effects. Therefore, dutasteride could become a treatment of choice for AGA in near future.
Topics: 5-alpha Reductase Inhibitors; Alopecia; Animals; Dihydrotestosterone; Dutasteride; Female; Finasteride; Hair; Humans; Male; Treatment Outcome
PubMed: 28294070
DOI: 10.2174/1574884712666170310111125 -
Sexual side effects of 5-α-reductase inhibitors finasteride and dutasteride: A comprehensive review.Dermatology Online Journal Nov 2017The 5-α-reductase inhibitors finasteride and dutasteride are frequently used in the treatment of androgenetic alopecia and benign prostatichyperplasia. These drugs are... (Review)
Review
The 5-α-reductase inhibitors finasteride and dutasteride are frequently used in the treatment of androgenetic alopecia and benign prostatichyperplasia. These drugs are effective at reducing levels of dihydrotestosterone, the primary androgen responsible for the pathogenesis of both these conditions. However, finasteride and dutasteride have also been shown to produce an increase in the incidence of sexual dysfunction, namely, impotence, decreased libido, and ejaculation disorder. The purpose of this study is to review the existing medical literature with regard to the sexual side effects of 5-α-reductase inhibitor therapy. This review is an extensive look at the sexual effects of 5-α-reductase inhibitors and compares outcomes for finasteride versus dutasteride in addition to comparing sexualside effects for each of the different dosages prescribed of finasteride and dutasteride.
Topics: 5-alpha Reductase Inhibitors; Dose-Response Relationship, Drug; Dutasteride; Ejaculation; Erectile Dysfunction; Finasteride; Humans; Libido; Male; Sexual Dysfunction, Physiological
PubMed: 29447628
DOI: No ID Found -
Journal of Drugs in Dermatology : JDD Jul 20225-alpha inhibitors are an effective treatment for androgenetic alopecia. Mesotherapy with dutasteride has been proposed as an effective method to improve hair loss and...
BACKGROUND
5-alpha inhibitors are an effective treatment for androgenetic alopecia. Mesotherapy with dutasteride has been proposed as an effective method to improve hair loss and reducing systemic absorption.
OBJECTIVE
The main objective was to describe the safety profile of mesotherapy with dutasteride in real clinical practice in a large cohort of patients with androgenetic alopecia. A secondary aim was to describe the effectiveness of this treatment.
METHODS AND MATERIALS
A multicentric retrospective study was designed. Patients treated with at least 6 months of follow-up were included in the study. Side effects and response to the treatment were analyzed.
RESULTS
A total of 541 patients were included. The commonest approach during the first year was to perform the treatment every 3 months. Response to the mesotherapy in monotherapy could be assessed in 86 patients (15.9%) after one year. Most of them presented clinical improvement, being a marked improvement in 33 patients (38.4%). Pain was the most frequent side effect of the treatment (246 patients, 45.5%). No serious or sexual adverse events were detected.
CONCLUSION
Mesotherapy with dutasteride was effective in male and female hair loss in real clinical practice. Side effects related to the treatment were mild and self-limited. This therapy may be an effective option for select patients wishing to avoid oral treatment. J Drugs Dermatol. 2022;21(7):742-747. doi:10.36849/JDD.6610.
Topics: Alopecia; Dutasteride; Female; Hair; Humans; Male; Mesotherapy; Retrospective Studies; Treatment Outcome
PubMed: 35816059
DOI: 10.36849/JDD.6610 -
Journal of the European Academy of... Oct 2022
Randomized Controlled Trial
Topics: Administration, Topical; Alopecia; Double-Blind Method; Dutasteride; Finasteride; Humans; Minoxidil; Treatment Outcome
PubMed: 35648446
DOI: 10.1111/jdv.18285 -
European Journal of Dermatology : EJD Feb 2023
Review
Topics: Humans; Dutasteride; Mesotherapy; Alopecia; Hair; Finasteride; 5-alpha Reductase Inhibitors
PubMed: 37178048
DOI: 10.1684/ejd.2023.4443 -
Acta Dermato-venereologica Jan 2019Treatment of male androgenetic alopecia with 5α-reductase inhibitors is efficacious. However, the risk of adverse sexual effects remains controversial. This systematic... (Meta-Analysis)
Meta-Analysis
Treatment of male androgenetic alopecia with 5α-reductase inhibitors is efficacious. However, the risk of adverse sexual effects remains controversial. This systematic review and meta-analysis investigated the risk of adverse sexual effects due to treatment of androgenetic alopecia in male patients with finasteride, 1 mg/day, or dutasteride, 0.5 mg/day. Fifteen randomized double-blinded placebo-controlled trials (4,495 subjects) were meta-analysed. Use of 5α-reductase inhibitors carried a 1.57-fold risk of sexual dysfunction (95% confidence interval (95% CI) 1.19-2.08). The relative risk was 1.66 (95% CI 1.20-2.30) for finasteride and 1.37 (95% CI 0.81-2.32) for dutasteride. Both drugs were associated with an increased risk, although the increase was not statistically significant for dutasteride. As studies into dutasteride were limited, further trials are required. It is important that physicians are aware of, and assess, the possibility of sexual dysfunction in patients treated with 5α-reductase inhibitors.
Topics: 5-alpha Reductase Inhibitors; Administration, Oral; Alopecia; Dutasteride; Ejaculation; Erectile Dysfunction; Finasteride; Humans; Libido; Male; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Sexual Behavior; Sexual Dysfunction, Physiological
PubMed: 30206635
DOI: 10.2340/00015555-3035 -
Drugs & Aging 2003Dutasteride, a potent inhibitor of type 1 and 2 5alpha-reductase, reduced dihydrotestosterone levels by >90% in 85% of patients following 1 years' administration of oral... (Review)
Review
Dutasteride, a potent inhibitor of type 1 and 2 5alpha-reductase, reduced dihydrotestosterone levels by >90% in 85% of patients following 1 years' administration of oral dutasteride 0.5 mg/day. A combined analysis of three placebo-controlled clinical studies conducted in patients with benign prostatic hyperplasia (BPH) found sustained improvements in American Urological Association- Symptom Index scores and urinary flow rate and a 57% decrease in the risk of acute urinary retention throughout the 2-year treatment period (all p < 0.001 vs placebo). Total prostate and transition zone volume were also reduced (both p < 0.001), as was the risk of BPH-related surgery (by 48%). A nonblind extension study found that dutasteride maintains efficacy for up to 4 years. Dutasteride monotherapy maintained symptom relief following combination treatment with dutasteride and tamsulosin in all patients but those with severe symptoms. Dutasteride was generally well tolerated. Impotence, reduced libido, gynaecomastia and ejaculation disorder occurred significantly more often in dutasteride than placebo recipients, but incidence was generally low. With the exception of gynaecomastia, incidence consistently decreased over time.
Topics: 5-alpha Reductase Inhibitors; Azasteroids; Drug Therapy, Combination; Dutasteride; Humans; Male; Prostate-Specific Antigen; Prostatic Hyperplasia; Randomized Controlled Trials as Topic
PubMed: 14565784
DOI: 10.2165/00002512-200320120-00005 -
Actas Dermo-sifiliograficas Jun 2020
Topics: Alopecia; Dutasteride; Finasteride; Humans; Mesotherapy
PubMed: 32416936
DOI: 10.1016/j.ad.2018.10.030 -
Indian Journal of Dermatology,... 2017Finasteride and dutasteride are inhibitors of the enzyme 5-alpha-reductase which inhibits the conversion of testosterone to dihydrotestosterone. Dutasteride inhibits... (Comparative Study)
Comparative Study Randomized Controlled Trial
Superiority of dutasteride over finasteride in hair regrowth and reversal of miniaturization in men with androgenetic alopecia: A randomized controlled open-label, evaluator-blinded study.
BACKGROUND
Finasteride and dutasteride are inhibitors of the enzyme 5-alpha-reductase which inhibits the conversion of testosterone to dihydrotestosterone. Dutasteride inhibits both type I and type II 5-alpha-reductase while finasteride inhibits only the type II enzyme. As both isoenzymes are present in hair follicles, it is likely that dutasteride is more effective than finasteride.
AIMS
To compare the efficacy, safety and tolerability of dutasteride and finasteride in men with androgenetic alopecia.
METHODS
Men with androgenetic alopecia between 18 and 40 years of age were randomized to receive 0.5 mg dutasteride or 1 mg finasteride daily for 24 weeks. The primary efficacy variables were hair counts (thick and thin) in the target area from modified phototrichograms and global photography evaluation by blinded and non-blinded investigators. The secondary efficacy variable was subjective assessment using a preset questionnaire. Patients were assessed monthly for side effects.
RESULTS
Ninety men with androgenetic alopecia were recruited. The increase in total hair count per cm[2] representing new growth was significantly higher in dutasteride group (baseline- 223 hair; at 24 weeks- 246 hair) compared to finasteride group (baseline- 227 hair; at 24 weeks- 231 hair). The decrease in thin hair count per cm[2] suggestive of reversal of miniaturization was significantly higher in dutasteride group (baseline- 65 hair; at 24 weeks- 57 hair) compared to finasteride group (baseline- 67 hair; at 24 weeks- 66 hair). Both the groups showed a similar side effect profile with sexual dysfunction being the most common and reversible side effect.
LIMITATIONS
Limitations include the short duration of the study (6 months), the small sample size and the fact that it was an open-label study.
CONCLUSIONS
Dutasteride was shown to be more efficacious than finasteride and the side-effect profiles were comparable.
Topics: 5-alpha Reductase Inhibitors; Administration, Oral; Adolescent; Adult; Alopecia; Dutasteride; Erectile Dysfunction; Finasteride; Hair; Humans; Male; Prospective Studies; Single-Blind Method; Young Adult
PubMed: 27549867
DOI: 10.4103/0378-6323.188652