Comparison of Clinical Efficacy of Tofacitinib Versus Methotrexate in Severe Alopecia Areata, Alopecia Totalis, and Alopecia Universalis: A Randomized Controlled Trial

This randomized controlled trial compared the 12-week efficacy of oral tofacitinib versus methotrexate in 78 adults with severe alopecia areata, alopecia totalis, or alopecia universalis. Participants were divided into two groups, receiving either tofacitinib 10 mg twice daily or methotrexate 0.2-0.4 mg/kg once weekly. The study found that tofacitinib significantly reduced the Severity of Alopecia Tool (SALT) scores more than methotrexate, with a mean percentage improvement of 52.7% compared to 29.7%. Efficacy, defined as a >50% reduction in SALT score, was achieved by 59.0% of participants in the tofacitinib group versus 2.6% in the methotrexate group. The study concluded that tofacitinib has greater short-term efficacy, but long-term safety and other factors remain unestablished.