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

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.