Anupam B. Jena, MD, PhD

Credit: hcp.hms.harvard.edu

Media coverage alone may be enough to affect rates of prescribing despite a lack of new research discoveries or large-scale randomized evidence, according to recent findings.¹

Authors of these findings point to an article in The New York Times describing a small observational study of low-dose oral minoxidil as a successful treatment for hair loss in women.² The team found that this coverage was associated with instant increases in prescribing the treatment.

The research team also explained that there is some evidence connecting media coverage with both patient behaviors and the practices of clinicians, citing the example of a promotional campaign for colon cancer screening.³

The new research into minoxidil prescribing was led by Anupam B. Jena, MD, PhD, from the Department of Health Care Policy at Harvard Medical School. Jena and colleagues conducted a cross-sectional study to examine this connection between the spike in prescribing and the newspaper article.

“We used prescription drug data to investigate changes in prescribing of oral minoxidil after the article, which was covered broadly by news and social media,” the research team wrote.

Background and Findings

The investigators conducted a cross-sectional study, in which adults who were prescribed oral minoxidil between January of 2021 and December of 2022, were identified from electronic health records in the Truveta database.

Those who had been given first-time oral minoxidil were included if they were treated in 8 health systems, mainly from 13 states, and had taken the drug before or after the publication of the newspaper article.

The research team calculated the weekly rate of first-time oral minoxidil prescriptions for 2.5-mg and 5-mg tablets (excluding 10-mg tablets, used for hypertension), and interrupted time-series analyses of weekly prescription rates were conducted. Autocorrelation was accounted for through an autoregressive, integrated moving-average model.

Two-sample t-tests were used by the team to compare means for 8 weeks prior to and after the article’s publication, and the P values were set at α = .025 in each tail. Comparisons were made by the investigators with first-time low-dose finasteride hair loss medication (excluding 5-mg doses, which treat benign prostatic hyperplasia) and antihypertensive medications, as minoxidil is an antihypertensive.

The investigators included a total of 6541 patients who were prescribed oral minoxidil for the first time. Of these patients, 2846 had received prescriptions in the 7 months before the publication of an article related to minoxidil, while 3695 patients reported receiving prescriptions in the 5 months following the publication.

Overall, they noted that 41.0% were male and 36.8% were between the ages of 45-64 years, and the racial distribution of these patients was 12.5% Black, 7.5% Asian, 10.2% Hispanic, and 65.2% White.

The investigators also reported that after the article was published, there was a higher proportion of males (43.6% vs 37.7%) and White patients (68.6% vs 60.8%), and a lower proportion of those with comorbidities such as hypertension (38.3% vs 46.7%), diabetes (16.0% vs 22.1%), and chronic kidney disease (14.4% vs 22.3%).

The weekly rate of first-time minoxidil prescriptions per 10,000 outpatient encounters was significantly higher 8 weeks after the publication, both for males and females, and then decreased overall. No similar increases were observed in first-time finasteride or hypertension prescriptions.

According to the study results, the weekly rate of first-time minoxidil prescriptions per 10,000 outpatient encounters was significantly higher after 8 weeks of publication than before, overall (0.9 prescriptions [95% CI, 0.8 - 1.0 prescriptions] vs 0.5 prescriptions [95% CI, 0.4 - 0.6 prescriptions]; P < .001).

The increase was observed in males (1.1 prescriptions [95% CI, 0.9 - 1.3 prescriptions] vs 0.5 prescriptions [95% CI, 0.4 - 0.6 prescriptions], a 2.4-fold increase; P < .001). It was also observed in females (0.8 prescriptions [95% CI, 0.7 - 0.9 prescriptions] vs 0.5 prescriptions [95% CI, 0.4 - 0.6 prescriptions], a 1.7-fold increase; P < .001).

The investigators added that prescriptions did decrease for both sexes after the initial increase associated with the article's publication, and there were no similar increases in first-time finasteride or hypertension prescriptions.

“Underlying factors associated with this change in prescription behavior from patients, doctors, or both and differences between males and females are important to understand,” they wrote. “Socioeconomic factors, such as access to health care and education and income levels, may be associated with individuals seeking low-dose oral minoxidil after article publication.”

References

1. ^{Goodwin Cartwright BM, Wang M, Rodriguez P, et al. Changes in Minoxidil Prescribing After Media Attention About Oral Use for Hair Loss. JAMA Netw Open. 2023;6(5):e2312477. doi:10.1001/jamanetworkopen.2023.12477.}
2. ^{Kolata G. An old medicine grows new hair for pennies a day, doctors say. The New York Times. Accessed March 31, 2023. https://www.nytimes.com/2022/08/18/health/minoxidil-hair-loss-pills.html}
3. ^{Cram P, Fendrick AM, Inadomi J, Cowen ME, Carpenter D, Vijan S. The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect. Arch Intern Med. 2003;163(13):1601-1605. doi:10.1001/archinte.163.13.1601.}