Comparative Efficacy of Non-Transplant Interventions for Female Pattern Hair Loss

OBJECTIVEFemale pattern hair loss (FPHL) imposes significant psychosocial burdens, yet optimal non-transplant strategies remain undefined due to limited comparative evidence. This study aimed to evaluate the comparative efficacy of active non-transplant interventions for FPHL through a systematic review and network meta-analysis (NMA).

METHODSRandomized controlled trials (RCTs) assessing FPHL treatments were identified through systematic searches of PubMed, Embase, Cochrane Library, CNKI, WanFang, VIP, and SinoMed (inception to 1 January 2025). Risk of bias was assessed using the Cochrane tool. NMA was performed in R, with interventions ranked by SUCRA. Evidence certainty was evaluated using GRADE for NMAs. The certainty of the evidence was assessed using the GRADE approach.

RESULTSFourteen RCTs involving 919 patients were included. For hair density, microneedling plus minoxidil (MN + MX) ranked first (SUCRA = 0.93) and was potentially more effective than MX (MD = 21.13; 95% CrI, 15.38 to 27.30) and spironolactone plus minoxidil (SPT + MX) (MD = 14.05; 95% CrI, 5.44 to 22.85). For hair diameter, poly-L-lactic acid threads + minoxidil (PLLA+MX) was more effective than MX (MD = 43.63; 95% CrI, 15.35 to 71.80) and ranked first (SUCRA = 0.97). MN + MX also ranked first in patient satisfaction (SUCRA = 0.98). However, the certainty of all evidence was low to very low due to risk of bias, imprecision, and sparse networks. Importantly, as no placebo or untreated controls were included, findings reflect only relative rankings among active interventions. Subgroup analysis and safety analysis were not performed due to inconsistent reporting and the limited number of studies.

CONCLUSIONMN + MX and PLLA+MX showed the highest relative rankings for hair density and diameter, respectively. Nonetheless, given the substantial uncertainty, these findings are exploratory and necessitate validation in larger, high-quality placebo-controlled trials.

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