Relative efficacy of minoxidil in combination with other treatments for androgenic alopecia: a network meta-analysis based on randomized controlled trials

Yinfeng Xia; Hong Chen; Yongsong Chen; Zhiyong Chen

doi:10.3389/fmed.2025.1638496

Relative efficacy of minoxidil in combination with other treatments for androgenic alopecia: a network meta-analysis based on randomized controlled trials

Front Med (Lausanne). 2025 Sep 17:12:1638496. doi: 10.3389/fmed.2025.1638496. eCollection 2025.

Authors

Yinfeng Xia¹, Hong Chen², Yongsong Chen¹, Zhiyong Chen¹

Affiliations

¹ Department of Burns, Plastic Surgery and Cosmetology, Chongqing University Fuling Hospital, Chongqing University, Chongqing, China.
² Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Abstract

Background: Androgenetic alopecia is the most prevalent form of progressive hair loss. Minoxidil is widely regarded as a standard treatment for this condition. Consequently, we assessed the effectiveness of minoxidil in combination with other pharmacological agents for the treatment of androgenetic alopecia.

Methods: A comprehensive search was conducted across four databases-PubMed, Embase, Web of Science, and Cochrane Library-on December 10, 2024. Eligible studies were selected based on the PICOS framework. Data extraction and synthesis were carried out using a Bayesian network meta-analysis, focusing on mean difference and sample size data. League tables and Surface Under the Cumulative Ranking (SUCRA) values were employed to evaluate the relative efficacy of the interventions.

Results: Among the 20 study groups analyzed, the combination of platelet-rich plasma and basic fibroblast growth factor with minoxidil demonstrated the highest overall efficacy (SUCRA = 93.06%). This combination resulted in a mean increase in hair density of 35.12 hairs/cm² compared to the group treated with minoxidil alone. In male subgroups, finasteride combined with minoxidil was the most effective treatment (SUCRA = 80.18%). Among seven combination therapies for females, microneedle with minoxidil proved most effective (SUCRA = 87.18%).

Conclusion: This study establishes a clinically actionable hierarchy of minoxidil-based combination therapies, providing evidence-based guidance for dermatologists to optimize androgenetic alopecia management.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024623164, identifier CRD42024623164.

Keywords: androgenic alopecia; female pattern hair loss; male pattern hair loss; minoxidil; minoxidil combination therapy.

Publication types

Systematic Review