# The Association Between 5α-Reductase Inhibitors and the Presence of Subsequent Dry Eye Disease in Androgenetic Alopecia: A TriNetX Database Study

## TL;DR

This study finds that using 5α-reductase inhibitors for androgenetic alopecia is linked to a higher risk of developing dry eye disease.

## Contribution

The study is the first to use a large database to show a significant association between 5α-reductase inhibitors and dry eye disease in androgenetic alopecia patients.

## Key findings

- Patients using 5α-reductase inhibitors had a 2.97% incidence of dry eye disease compared to 2.60% in non-users.
- The adjusted hazard ratio showed a 8.4% higher risk of dry eye disease in users of 5α-reductase inhibitors.
- The risk was consistently higher in users with additional factors like metabolic syndrome.

## Abstract

Purpose

The purpose of this study is to evaluate the association between the application of 5α-reductase inhibitors (5ARI) and the incidence of subsequent dry eye disease (DED) in the androgenetic alopecia population.

Method

A retrospective cohort study was conducted, and patients with androgenetic alopecia were included and classified according to the receipt of 5ARI therapy or not. A total of 77,982 patients were included in the 5ARI group and the non-5ARI group. The prime outcome was the development of DED after 5ARI usage. The Cox proportional hazard regression was applied for the analysis, which yielded the adjusted hazard ratio (aHR) and 95% confidence interval (CI) of the primary outcome.

Results

After the whole follow-up period up to 10 years, there were 2317 (2.97%) and 2026 (2.60%) DED episodes in the 5ARI group and the non-5ARI group, respectively. The incidence rate is 1.08 per 1000 person-month and 0.84 per 1000 person-month in the 5ARI group and the non-5ARI group, respectively. The 5ARI group demonstrated a higher incidence of DED episode compared to the non-5ARI group after adjustment (aHR: 1.084, 95% CI: 1.039-1.129, P < 0.001). The cumulative probability of the DED development was also significantly higher in the 5ARI group than the non-5ARI group (P < 0.001). In the sensitive analysis, the DED incidences were significantly higher in the 5ARI population than in the non-5ARI population, with several characteristics such as the metabolic syndromes.

Conclusions

The application of 5ARI is associated with a higher risk of following DED development, which is related to the application time in the androgenetic alopecia population.