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[피나스테리드] 프로페시아에 대하여....

27년 전
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Finasteride (Propecia, Proscar)

Finasteride is the generic name for a drug that has recently been hitting the news headlines as a new treatment for androgenetic
alopecia. The trade name Propecia is used for this new hair loss treatment. You may also have heard another trade name
Proscar which is the same thing as Finasteride/Propecia but Proscar is specifically used for men with prostate complications.
Propecia and Proscar are the trade marks of Merck & Co., Inc., USA.

Finasteride was originally developed by Merck as a drug to treat enlarged prostate glands. During the trials on men with
prostate problems an intriguing side effect of hair growth was observed. With Finasteride passed as a prostate drug by the
Federal Drug Administration (FDA), Merck decided to pursue the possibility of developing Finasteride as the hair treatment
Propecia.

As described elsewhere, 5 alpha-reductase is an important enzyme found in and around hair follicles that converts testosterone
into the far more potent dihydrotestosterone. Dihydortestosterone is the single most important hormone that adversely affects
scalp hair follicles and leads to androgenetic alopecia. There are at least two types of the 5 alpha-reductase enzyme. Type one
(I) is believed to be more active than type two (II) in androgenetic alopecia.

Propecia is a type II 5 alpha reductase inhibitor. With reduced production of type II 5 alpha-reductase there seems to be much
less testosterone converted to dihydrotestosterone. With less dihydortestosterone binding to hair follicle androgen receptors so
there seems to be reduced hair follicle miniaturization in androgenetic alopecia. Originally many dermatologists questioned
whether a type II 5 alpha reductase inhibitor would be truly effective in treating androgenetic alopecia. Type I 5 alpha reductase
is generally unaffected by the Propecia drug and is still converting some testosterone to dihydrotestosterone. However, if the
clinical trial results are to be believed then dermatologists concerns were unfounded.

Phase III trials of Propecia have been ongoing for more than two years. According to Propecia manufacturer Merck, a placebo
controlled double blind study of Propecia initially involved 60 dermatology clinics (33 in the USA, 27 non-USA) and 1533
male volunteers in the first year. Of these volunteers 1215 continued in the program for a second year. The men were between
18 to 41 years of age at the start of the study and had androgenetic alopecia defined as type III, IV or V on the
Hamilton/Norwood scale. The men were given either 1mg of Propecia per day or a placebo. Propecia is taken as a tablet
orally and works systemically.

Both subjective and objective tests were used regularly through the study to evaluate hair growth. Subjective analysis involved
each patient answering a validated questionnaire to examine their views on the success/failure of their treatment. Objective
analysis involved observation of a given target scalp area marked in the same place on each patient with tattoo dots. The
evaluation included consideration of terminal hair density and an overall evaluation of scalp skin coverage looking at density,
linear hair growth, diameter, duration of anagen, and hair replacement kinetics. Global photographs were also taken regularly
for semi quantitative analysis of overall cosmetic changes. Both subjective and objective data were analyzed by dermatologists
who were unaware of which individual was receiving Propecia and which was using a placebo.

The first year results of the Phase III trial were; a mean density increase to 86 hairs per inch diameter in the marked area of
scalp (+11%) for those using Propecia. In contrast placebo users had a mean density decrease of 21 hairs (-2.7%). This
apparently resulted in a mean difference of 107 more terminal hairs per inch diameter circular target in the Propecia users
compared to control placebo users. Blind assessment of the global photographs (semi quantitative analysis) after one year
suggested total hair growth improvements in 48% of men using Propecia and 7% of placebo users. 30% of Propecia users
were described as slightly improved and 18% as moderately or greatly improved. 6% on placebo were slightly improved and
1% moderately or greatly improved.

In the second year of study there was no increase in number of hairs growing on the marked scalp area for Propecia users so
hair density remained the same. However, Semi quantitative analysis of global photographs suggested continued improvement in
general hair coverage in the second year of use. The improvement was due to hair follicles present in the first year's analysis
developing a prolonged anagen growth phase and increased hair fiber diameter. Placebo users continued to have gradual
progression of androgenetic alopecia and reduced hair coverage.

Questionnaires showed that diminished sexual function was the most common side effect of Propecia, 0.5% more common than
observed in the placebo group. This side effect resolved if the individual stopped using Propecia. Propecia only worked for as
long as it was used. Any individuals who stopped using the drug reverted to progressive androgenetic hair loss. The studies
indicated that age of the individual made no difference to the success rate and the duration of the hair loss made no difference.
As expected those with least hair loss had the least improvement when using the drug. Caucasians were observed to have a
better response to Finasteride compared to Asians or African-Americans. So, Propecia works for a proportion of men but by
no means all men with androgenetic alopecia. It is most likely to stop further hair loss and for a lucky minority the drug actually
encourages hair regrowth.

Splitting Finasteride pills (Proscar) for use in androgenetic alopecia treatment is common practice in countries like Canada
where Propecia is not yet available. Proscar tablets are each 5mgs Finasteride dose. 5mgs may be optimum dose for
urinogenital treatment but it is more than is necessary for androgenetic alopecia. Propecia tablets are 1mg dose each so splitting
Proscar tablets in 4 or 5 is a common recommendation of non US dermatologists prescribing Finasteride.

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