A Pilot Randomized Controlled Trial Comparing the Efficacy and Safety of Oral Tofacitinib Versus Methotrexate in Moderate-To-Severe Alopecia Areata

This pilot randomized controlled trial involving 36 patients with moderate-to-severe alopecia areata compared the efficacy and safety of oral tofacitinib versus methotrexate. Results showed that 50% of patients in the tofacitinib group achieved a SALT score of ≤20 at 6 months, compared to 33.33% in the methotrexate group, suggesting a trend towards greater improvement with tofacitinib. Secondary outcomes also favored tofacitinib, with significant improvements in patient-reported outcomes and SALT scores. Adverse effects included dyslipidemia and scalp folliculitis in the tofacitinib group, and transaminitis and varicella infection in the methotrexate group. The study suggests that tofacitinib may offer a superior response compared to methotrexate, but larger studies are needed to confirm these findings.