Systemic treatments for alopecia areata: A systematic review

Abstract

A range of systemic treatments are used for alopecia areata with variable evidence supporting efficacy. In this systematic review, we evaluated the evidence surrounding systemic treatments for alopecia areata, alopecia totalis and alopecia universalis. A systematic search was conducted of the peer-reviewed literature published between 1946 and March 2018 via Medline, Embase, Amed, the Cochrane Central Register of Controlled Trials, PsychINFO and Lilacs. All randomised controlled trials (RCTs) that evaluated the effectiveness of systemic treatments for individuals with alopecia areata, totalis or universalis were included. Sixteen studies were included with a total of 768 participants. We found eight placebo-controlled RCTs, three RCTs comparing two systemic treatments and five RCTs comparing three treatments. A total of 15 different systemic therapies were investigated. The most frequently investigated therapy was oral prednisolone pulse therapy and oral inosiplex. There was significant variability in the definition of treatment success. No study evaluated the impact of pharmacotherapy on quality of life using complete quantitative quality of life instruments. Adverse events were reported in 13 studies and were corticosteroid related or otherwise well tolerated. Relapse rates were considerable in the four studies that reported this outcome. There is currently no specific systemic therapy that is supported by robust body of evidence from RCTs. The current evidence suggests efficacy of oral prednisolone pulse therapy and oral inosiplex. Evidence does not support the use of oral zinc sulphate, alefacept and efalizumab. Future RCTs should be adequately powered and employ clearly defined clinical response endpoints to allow future meta-analyses.

Treatment of chronic alopecia areata with tildrakizumab: an open‐label pilot study

“…A systematic review of systemic treatment for AA did not identify any reliably effective evidence‐based treatments for chronic AA, and a significant number of patients are refractory to all treatment …”

Androgen-associated and androgen-independent causes of alopecia and acne in women. Literature review

“…Лікування ГА переважно полягає в застосуванні місцевих і системних кортикостероїдів, для відновлення волосся можливе застосування міноксидилу місцево, тривають дослідження ефективності різних імуномодулюючих препаратів та компліментарних методів [26,37].…”

Are drug treatment strategies really effective against alopecia areata?

“…AA can present several characteristics, including solitary or multiple welldefined alopecic patches, diffuse or complete scalp hair loss, or body hair loss. Although AA manifests in spontaneous remission, approximately 40% of patients may show recurrence and recalcitrant diseases [2]. The chronic relapsing course of the disease has made AA a difficult-to-treat condition and a significant impact on patients' quality of life.…”