Wow! A new study with dutasteride for male pattern baldness!!

[Bryan]

I just saw the following post by someone on another site. Here's a copy/paste. There are some unusual aspects to this study, which I'll let everybody see for themselves:

Dutasteride improves male pattern hair loss in a randomized study in identical twins.

Fulltext html:
http://www.blackwell-synergy.com/doi/fu ... 07.00297.x

Fulltext pdf:
http://www.blackwell-synergy.com/doi/pd ... 07.00297.x

 

[Bryan]

You guys know how I just can't resist making haircount comparisons between studies, right? I can't help it...it's a character flaw! Let's do it with this one:

After one full year, there was an average difference between the dutasteride and the placebo groups of 16.5 - (-3.8 ) = 20.3 hairs. That was in an area of scalp consisting of exactly 1 square centimeter.

In the large Phase III Propecia trial, after one full year there was a difference of 86 - (-21) = 107 hairs. That was in an area of scalp consisting of 5.1 square centimeters.

Multiplying the dutasteride number by 5.1 to get a comparable area of scalp, we get 20.3 X 5.1 = 103.53 hairs, which is actually slightly LESS than the Propecia study's result of 107 hairs. It's interesting that dutasteride didn't perform quite as well in this study as it did in Glaxo's own trial from a few years ago.

Bryan

 

[powersam]

do you think 34 people is enough to get accurate results? seems a little small to me.

 

[Bertie]

If I'm reading it right, this new Dutasteride paper used a "1 cm2 circular target area" (emphesis added), and I believe the Merck Finasteride trial used a 1 inch diameter circle. Doesn't that mean the difference in the two scalp areas would be 2.54^2 = 6.45? Or is there some other factor in here to get a 5.1X difference?

 

[Bryan]

do you think 34 people is enough to get accurate results? seems a little small to me.

Yes, it's only a small trial, but that's mitigated a bit by the fact that they used identical twins.

 

[Bryan]

If I'm reading it right, this new Dutasteride paper used a "1 cm2 circular target area" (emphesis added), and I believe the Merck Finasteride trial used a 1 inch diameter circle. Doesn't that mean the difference in the two scalp areas would be 2.54^2 = 6.45? Or is there some other factor in here to get a 5.1X difference?

They clearly stated in this new trial that they used an area consisting of 1 square centimeter, so the proper comparison is as I described.

Bryan

 

[hairwegoagain]

I had an appointment with Dr. Stough back in the mid-90s. He was (might still be) a highly-regarded derm/hair transplant surgeon operating an office in Dallas (among other places). I believe he was the first Doctor who prescribed Proscar for me. Anyway, he was involved in some of the first trials for finasteride as a hairloss treatment.

When I asked about surgery, he told me "don't let a surgeon touch you." I was around 21. I appreciate his words to this day.

 

[JohnnySeville]

Multiplying the dutasteride number by 5.1 to get a comparable area of scalp, we get 20.3 X 5.1 = 103.53 hairs, which is actually slightly LESS than the Propecia study's result of 107 hairs. It's interesting that dutasteride didn't perform quite as well in this study as it did in Glaxo's own trial from a few years ago.

Seems like Dutasteride has lost some of its luster. How can you explain the anectodal evidence of some users obtaining additional benefits with their changeover from Finasteride, is is due to their hair loss being more susceptible to 5AR1, or possibly the placebo effect, whereas they heard it was more potent, therefore it was MIND OVER HAIR???

 

[JWM]

I think the people who benefitted were those who had been long-time finasteride users and were building a sort of 'tolerance' to the drug. Maybe adding a drug that does a similar thing like dutasteride but that has a different chemistry is what their hair needed to recover.

 

[Bryan]

Seems like Dutasteride has lost some of its luster.

Indeed.

Several years ago, I hooted when Marty Sawaya made her famous comment about dutasteride supposedly being a "WOW!" drug. I strongly suspected at the time that she was going more than a little overboard with that judgement. Can anybody blame me for feeling vindicated now? :wink:

How can you explain the anectodal evidence of some users obtaining additional benefits with their changeover from Finasteride, is is due to their hair loss being more susceptible to 5AR1, or possibly the placebo effect, whereas they heard it was more potent, therefore it was MIND OVER HAIR???

Dunno.

 

[JWM]

For years my older sister used Prozac to deal with her anxiety and depression and it worked quite well.

Later on, down the road, her symptoms started to surface more often and despite increasing her dose of Prozac, she did not feel any better.

The doctor then advised her to try Lexapro. She did, 2 years ago, and has felt much better since.

Both drugs are SSRIs and are intended to do the same thing.

 

[powersam]

bryan - if we know for certain that dutasteride inhibits more type2 than propecia, then what could account for it being less effective in treating hair loss?

we either have to doubt this study, or consider that finasteride may work in more than one way, or that duts other detrimental effects like drying out the skin, could impact on hair growth.

or what...?

if you take this study as genuine then it muddies the waters as to 5ar inhibitors and how they work against hair loss does it not?

 

[Old Baldy]

To me Power, it just shows how variable testing can be.

Very frustrating but that's the way it is IMHO.

I mean, how in the heck can finasteride. outperform dutasteride.!? :shock: :?

Anyway, here is a fairly serious problem with that study IMHO. I read it last December and thought this paragraph meant we should discount it a little bit?

However, this did not achieve statistical significance (P = 0.14) because of the large variability and the technical problems encountered with five sets of twins at months 6 and 12.

The testing group had problems with the hair count analysis and made the above statement.

Out of 17 pairs of twins, 5 were problematic and their hair counts couldn't be made. Not a very good average IMHO. Makes you wonder how accurate the hair counting was overall?

But..... oh heck, I don't know what to make of a study where Bryan showed dutasteride. did worse than finasteride. Just doesn't make any sense at all to this layman.

 

[powersam]

this layman also OldBaldy. i'm more inclined to doubt the study than dutasteride honestly. lots of things about it seem a bit odd.

 

[techprof]

powersam, perhaps dutasteride increases testesterone significantly that it affects the hairs?

 

[hair today gone tomorrow]

powersam, perhaps dutasteride increases testesterone significantly that it affects the hairs?

^^^^^^

beat me to it..haha. It really depends on how much of an increase in testosterone there is and how much of an effect testosterone has on hair follicles.

 

[Tau Fat]

dutasteride result better than finasteride -Bryan made (slight) error

A small dot tattoo was placed on the scalp at baseline to identify the center of a 1 cm2 circular target area on the anterior leading edge of the vertex hair loss region to be used for hair counts. (Cut straight from the full text).

Therefore the hair count compared to the square inch in the earlier Merck trial is 130.935 and a better result than Propecia by approximately 12%.

 

[Tau Fat]

CORRECTION

last post should say compared to circular inch in previous Propecia trial

 

[Bryan]

bryan - if we know for certain that dutasteride inhibits more type2 than propecia, then what could account for it being less effective in treating hair loss?

But it's NOT less effective in treating hair loss!

Or are you just referring to this one study? It was just a small study, a statistical fluke.

we either have to doubt this study, or consider that finasteride may work in more than one way, or that duts other detrimental effects like drying out the skin, could impact on hair growth.

or what...?

if you take this study as genuine then it muddies the waters as to 5ar inhibitors and how they work against hair loss does it not?

No, it's just a statistical fluke.

Bryan

 

[Bryan]

Re: dutasteride result better than finasteride -Bryan made (slight) error

A small dot tattoo was placed on the scalp at baseline to identify the center of a 1 cm2 circular target area on the anterior leading edge of the vertex hair loss region to be used for hair counts. (Cut straight from the full text).

Therefore the hair count compared to the square inch in the earlier Merck trial is 130.935 and a better result than Propecia by approximately 12%.

The Phase III Propecia trial didn't use a square inch test area. They used a 1-inch diameter circular test area, which is 5.1 square centimeters. The haircount results per square centimeter were slightly better in the Propecia trial than they were in this small dutasteride trial.

Bryan