Meta-Analysis on the Efficacy and Safety of Traditional Chinese Medicine as Adjuvant Therapy for Refractory Androgenetic Alopecia

Objective. Traditional Chinese medicine (TCM) therapies have been widely used for the treatment of androgenetic alopecia (AGA) for thousands of years. We conducted a meta-analysis to evaluate the curative efficacy and safety of TCM for treating AGA. Methods. Randomized controlled trials (RCTs) of TCM for the treatment of AGA through March 2019 were systematically identified in 4 English databases, namely, PubMed, Cochrane Library, EMBASE, and Web of Science, and 4 Chinese databases, namely, Sino-Med, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and WanFang. Quality assessment and data analysis were performed by Review Manager 5.3.5, and Stata 15.1 was used to cope with publication bias. Results. 30 RCTs involving 2615 patients were randomly divided into a TCM group and a conventional medicine (CM) group. The results showed that the total efficacy rate (TER) of the TCM group was significantly higher than that of the control group (OR=3.34, 95% CI=2.75-4.05, P<0.00001). The total symptom score (TSS) of the TCM group was markedly reduced when compared with the CM group (SMD=-0.86; 95% CI=-1.19, -0.53; P<0.00001). The microelement levels (Fe2+, Zn2+, and Cu2+) in hair were significantly improved when complemented with TCM therapy. In addition, no significant differences were observed between the two groups in terms of adverse events (OR=0.55, 95% CI=0.29-1.05, P=0.07). Conclusions. In view of the effectiveness and safety of TCM, the present meta-analysis suggests that TCM could be recommended as an effective and safe adjuvant therapy for the treatment of AGA by improving the TER, symptoms, serum testosterone levels, and microelement levels. However, long-term and higher-quality RCTs are needed to overcome the limitations of the selected studies and more precisely interrogate the efficacy and safety of TCM.