This document summarizes a retrospective review of 316 women treated with oral bicalutamide for female pattern hair loss. Bicalutamide is a non-steroidal antiandrogen that does not have estrogenic or androgenic activity. The review found bicalutamide to have a favorable safety profile, with mild increases in liver enzymes in a small number of patients. For patients who took bicalutamide for over 6 months (n=138), there was a mean reduction in hair loss of 28.9% after 2 years based on clinical photographs assessed by dermatologists. The authors conclude that bicalutamide can be considered an effective and safe treatment for female pattern hair loss.
Bicalutamide Shows Promise for Female Pattern Hair Loss
1. BICALUTAMIDE: A POTENTIAL NEW ORAL
ANTIANDROGENIC DRUG FOR
FEMALE PATTERN HAIR LOSS.
JOURNAL CLUB
MIGUEL ARISTIZABAL M.D.
ADEI - AESTHETICS & DERMATOLOGY INSTITUTE
UNIVERSIDAD DEL ROSARIO
BOGOTA - COLOMBIA
2.
3. FPHL
• Androgen mediated miniaturization of the hair follicle: spironolactone,
cyproterone acetate, flutamide.
• Bicalutamide: non-steroidal, pure anti-androgen
• It has no estrogenic, progestational, glucocorticoid, mineralocorticoid or androgenic
activity and does not inhibit steroid 5α- reductase
• Peripherally selective: does not cross the blood-brain-barrier and thus has little effect
on serum LH and testosterone
4.
5. Flutamide:
• Dose-related, marked increases in
serum luteinizing hormone (LH) and
testosterone as a consequence of the central
inhibition of the negative feedback effects of
androgens on the hypothalamic-pituitary-
testes axis.
Flutamide
6. OBJECTIVE
• To evaluate the safety of bicalutamide in FPHL conducting a retrospective review
of all patients prescribed oral bicalutamide at a specialist hair clinic between April
2013 and October 2019.
• Efficacy in the cohort receiving bicalutamide for more than 6 months.
12. EFFICACY COHORT
• n=138
• n=135: bicalutamide + minoxidil.
• n=100: bicalutamide + spironolactone
• n=3: bicalutamide monotherapy.
• Clinical photographs taken at 3-monthly intervals were reviewed by 2
dermatologists to assess the Sinclair stage
13. EFFICACY RESULTS
• The mean Sinclair stage at baseline was 2.77.
• The mean reduction in Sinclair stage was 0.18 (6.5%) at 3 months, 0.47 (17.0%) at
6 months, 0.56 (20.2%) at 9 months, 0.68 (24.5%) at 12 months and 0.80 (28.9%)
at 2 years.
14. CONCLUSIONS
• Oral bicalutamide has a favorable safety profile when used to treat FPHL.
• More than 95% of patients who started treatment with bicalutamide adhered to
treatment.
• Thirteen patients discontinued the medication due to adverse effects, some of which
may have been related to minoxidil rather than bicalutamide.
• In contrast to flutamide, the elevation in liver transaminases was mild in all cases.
• Bicalutamide can be considered as an antiandrogen in the treatment of FPHL.
• The use of concomitant medications and the retrospective design of this
study limit the evaluation of efficacy.
15.
16. OBJECTIVE
• Retrospective review of all patients who were receiving OB for FPHL at the hair
clinic between February 2018 and February 2020. Safety profile was analyzed as
the primary objective.
• As a secondary objective, therapeutic response was assessed by the comparison
of photographs at weeks 0 and 24 by three independent dermatologists, using
the Sinclair scale.
17. M & MS
• A total of 44 women receiving OB 25-50 mg daily were included.
18. RESULTS
• Mild increase of liver transaminases in five patients
(11.4%), with self-resolution without discontinuing
tx.
• Other adverse effects included hair shedding in
three patients, transient amenorrhea in two
patients, and endometrial hyperplasia and
headache in one patient.
• No patient discontinued the treatment.
19. RESULTS
• Bicalutamide > 6months n=32: the mean
reduction in the Sinclair scale was 0.81 (27.5%).
• Of the patients receiving OB in monotherapy
(n=3), two maintained a Sinclair stage 2 and one
changed from stage 2 to stage 1
20. CONCLUSIONS
• Hirsutism is currently treated with doses up to 50 mg daily.
• Authors hypothesize that higher doses of OB between 25-50 mg daily have also a
good safety profile and may increase efficacy.
• The limitations of our analysis are the small sample size and the use of
concomitant therapies.