How Safe and Effective are 5ARI to Treat Alopecia?

Frontal fibrosing alopecia (FFA) causes hair loss near the front of the head, and causes scarring due to inflammation as the hair follicles are destroyed. This condition, which mostly affects postmenopausal women, is challenging to treat, and studies have examined the off-label use of 5-alpha-reductase inhibitors (5ARI) as a possible option for more severe cases.

A recent review looked at the available literature to determine how effective and safe 5ARI may be for this use. The authors were able to identify 14 studies that used either finasteride or dutasteride to treat FFA. Between these studies, a total of 121 patients were on finasteride, and 149 patients were on dutasteride. Adverse effects of 5ARI were described in five articles, which involved a total of 79 patients. The authors graded the quality of evidence presented in each studies in accordance with the American College of Physicians (ACP) outcome study grading system where grade 1 represents the highest-quality evidence and grade 4 represents very low quality and/or insufficient evidence to suggest efficacy.

The review showed that no study achieved the top grade, but there were two that met the standard of moderate quality of evidence for efficacy. This included a multicenter retrospective review on 355 patients with FFA where 111 of the patients were treated with 5ARI. Patients showed improvement or stabilization when treated with 5ARI in combination, but only 15% showed improvement when used as a monotherapy.

As for safety, the review showed that the level of evidence for the risks and safety of 5ARI in women is very low. Most studies did not report the risks and safety aspects of this medication.

The authors state that while this review demonstrated that FFA patients treated with 5ARI could achieve either disease stability or reduction in the rate of progression, but there is a need for a well-designed randomized, double-blind, controlled study to reinforce the role of 5ARI as one of treatment tools for FFA.

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