Efficacy of Platelet-Rich Plasma Therapy for Androgenetic Alopecia: A Systematic Review and Meta-analysis

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Brief Title

Efficacy of Platelet-Rich Plasma Therapy for Androgenetic Alopecia: A Systematic Review and Meta-analysis

Official Title

Efficacy of Platelet-Rich Plasma Therapy for Androgenetic Alopecia: A Systematic Review and Meta-analysis

Brief Summary

      assess the literature on PRP outcomes for AGA, with a focus on specific clinical outcomes in
      a comparative view, in accordance with PRISMA statement for reporting this meta-analysis
    

Detailed Description

      Androgenic alopecia (AGA) also known as androgenetic alopecia or male pattern baldness, is a
      common disorder that affects both men and women. Is one of the commonest reasons for
      dermatological consultation worldwide (1). It is characterized by progressive hair loss,
      especially of scalp hair, and has distinct patterns of loss in women versus men. AGA is an
      age-dependent disorder characterized by patterned hair loss. Based on the few prevalence data
      available, Know that by the age of 30 years about 30% of men will have AGA and that this will
      rise to about 50% by the age of 50 years and as many as 90% in their lifetime (2) , Although
      prevalence increases with age in all populations, thinning can begin as early as puberty (3).
      The hair thinning begins between the ages of 12 and 40 years in both sexes and approximately
      half the population expresses this trait to some degree before the age of 50 years (4).
      Androgentic alopecia is familial with a complex polygenic mode of inheritance (5) .
      Polymorphism of the androgen receptor gene, the 5 a reductase gene and 2 other, as yet
      unidentified genes on chromosomes 3 and 21 have been all been associated with premature
      balding (6). There is a family tendency towards androgenetic alopecia and it is thought to
      have a polygenic mode of inheritance. Alopecia causes major discomfort due to altered
      appearance with significant implications in daily living and possible leading to depression
      and anxiety symptoms with a significantly higher prevalence in AGA female compared with male
      subjects (7). Pathophysiology upon entry of testosterone into the hair follicle via dermal
      papilla's capillaries, binding occurs to the androgen receptors (ARs) either directly or
      after its conversion to dihydrotestosterone (DHT) (8). AGA is known to be mediated by the
      conversion of circulating androgens into DHT within the hair follicle .In the hair follicle
      cells, testosterone converts into the biologically more active metabolite; DHT, which is
      considered the key androgen required for the induction of AGA (9). This conversion is
      catalyzed by the enzyme 5α-reductase type-II. Binding of androgens to their ARs leads to
      conformational change of the AR-androgen complex which is then transported into the nucleus
      where it can bind to DNA which has distinctive binding sites: In most men, AGA involves the
      fronto temporal area and the vertex, following a pattern corresponding to the Hamilton-
      Norwood scale (10). In women, typically three patterns have been 1-Diffuse thinning of the
      crown region with preservation of the frontal hairline 2-Thinning and widening of the central
      part of the scalp with breach of frontal hairline, 3- Thinning associated with bitemporal
      recession (Hamilton-Norwood type, diagnostic evaluation form for AGA, including history,
      clinical evaluation like scalp and hair examination and diagnostic techniques and test (Pull
      test, Wash test), and clinical documentation . AGA can be treated medically, surgically or
      cosmetically (11) The most recommended treatment for AGA is composed of local minoxidil,
      hormonal therapy such as local and oral antiandrogens (12).

      Platelet-rich plasma (PRP) is used as an innovative therapy in diverse fields including
      dentistry, surgery, orthopedics, dermatology and aesthetics (13). Currently, PRP preparation
      systems have FDA clearance for use in bone grafts and operative Orthopedics but off-label
      purposes such as for hair restoration have become increasingly common. PRP is a rich source
      of growth factors such as insulin-like growth factor 1 (IGF-1), platelet-derived growth
      factor (PDGF), transforming growth factor-b (TGF-b), vascular endothelial growth factor
      (VEGF), epidermal growth factor (EGF) and fibroblast growth factor (FGF) which together can
      stimulate cell survival, proliferation, differentiation, vascularization and angiogenesis
      (14). Application of these growth factors to dermal papilla (DP) cells can lead to the
      initiation and prolongation of anagen phase in the hair follicle. Alpha granules within the
      platelets contain the growth factors and facilitate release at high concentrations, when the
      PRP preparation is activated. PRP is produced through cell separation by commercial kits or
      manual methods using a laboratory centrifuge and then injected into androgen-dependent areas
      of the scalp ( 15). With more hair restoration clinics choosing to offer PRP therapy, data on
      treatment efficacy have begun to accumulate. The AGA application remains in the early stages
      as treatment protocols are still being refined. At this time, PRP has been used in
      combination with hair transplant surgery and as an injectable therapy alone. Furthermore,
      diverse methods are reported as activators can be used to stimulate growth factor release;
      additional components such as leukocytes and dalteparin and protamine micro particles may be
      included to boost results; and quantity and frequency of treatments have varied widely (16).

      The conduction of a meta-analysis provides systematic assessment of previous research studies
      to derive conclusions about that body of research. Outcomes from a meta-analysis may include
      a more precise estimate of the effect of treatment than any individual study .
    


Study Type

Observational


Primary Outcome

number of hair per square centimeter


Condition

Androgenetic Alopecia



Publications

* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information



Estimated Enrollment

15

Start Date

January 7, 2020

Completion Date

January 30, 2020

Primary Completion Date

January 20, 2020

Eligibility Criteria

        Inclusion Criteria:

          -  1- Search for and assess studies comparing local injections of PRP compared to any
             control for AGA.

             2- Studies to be included in this review will be matched with predetermined criteria
             according to the PICOS (patients, intervention, comparator, outcomes, and study
             design) approach.

             3- These studies must include patients with any age and stage of AGA , with a minimum
             of 10 patients, a minimum of 3 months follow -up.

             4- Local injection of any autologous of PRP preparation into the scalp of AGA patients
             for treatment of AGA.

             5- Measure the efficacy of PRP therapy for treatment of AGA.

        Exclusion Criteria:

          1. Review, expert opinion, comments, letter to editor, case reports, studies on animals,
             conference reports will be excluded from the study.

          2. Studies of other types of alopecia (i.e., alopecia areata or cicatricial alopecia) or
             studies with less than 10 patients, follow up less than 3 months or with no outcome
             reported, will be excluded from the study.

             -
      

Gender

All

Ages

N/A - N/A

Accepts Healthy Volunteers

No

Contacts

Manal mohamed Darwish, ass.professor, 01010730962, [email protected]

Location Countries

Egypt

Location Countries

Egypt

Administrative Informations


NCT ID

NCT04191005

Organization ID

PRP in Androgentic Alopecia


Responsible Party

Sponsor-Investigator

Study Sponsor

Jasim Mohammed Alshammari


Study Sponsor

Manal mohamed Darwish, ass.professor, Study Director, community medicine


Verification Date

January 2020