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Spironolactone safe for androgenetic alopecia in cancer survivors

Presented by
Dr Chapman Wei, George Washington University, USA
AAD 2020

The potassium-sparing diuretic spironolactone is a viable treatment option in women with a previous breast cancer diagnosis [1].

In daily practice, spironolactone is often used off-label for the treatment of androgenetic alopecia in women. The agent exerts competitive blockade on androgen receptors in target tissues. It has been shown to arrest hair loss progression; a significant percentage of women even achieve partial hair regrowth [2]. However, limited data is available on its safety in breast cancer survivors. Due to its estrogenic effects, a potential risk for promoting cancer recurrence has been discussed. To clarify this issue, the authors performed a retrospective analysis using the Humana Insurance database.

Breast cancer survivors were identified using ICD-9/10 codes and divided into cohorts by spironolactone prescription. Patient demographics and comorbidities were compared and analysed. Cohorts with and without spironolactone use were further matched using propensity score analysis to assess breast cancer recurrence. This statistical method allows one to design and analyse an observational study so that it mimics some of the characteristics of a randomised controlled trial. The primary outcome was breast cancer recurrence within 2 years.

Included in the analysis were 29,146 females with a previous history of breast cancer, 746 were prescribed spironolactone compared with 28,400 non-users. In the matched cohort 16.5% of spironolactone users compared with 15.8% of non-users had a recurrence of breast cancer (P=0.779). As suspected, spironolactone use was not associated with cancer recurrence. Previous studies have already shown that spironolactone does not affect hormone levels (i.e. oestrogen, progesterone, testosterone) and does not increase the risk of breast cancer in non-cancer patients [3]. In addition, its use did not increase the risk for primary breast and gynaecologic cancers in normal patients [4].

Thus, the authors concluded that spironolactone can be considered a viable treatment option in the armamentarium for hair loss in breast cancer survivors. However, future prospective studies with longer duration should be performed to confirm these results.

  1. Wei C, et al. P15809, AAD Virtual Meeting Experience, 12-14 June 2020.
  2. Rathnayake D, Sinclair R. Dermatol Clin. 2010;28(3):611-618.
  3. Rozner RN, et al. Breast Cancer Res Treat. 2019;174:15-26.
  4. Biggar RJ, et al. Cancer Epidemiol. 2013;37:870-875.

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