A Randomized Controlled Trial Comparing the Efficacy and Safety of Oral Tofacitinib vs. Methotrexate in Moderate-to-Severe Alopecia Areata

This study compared the efficacy and safety of oral tofacitinib and methotrexate in treating moderate-to-severe alopecia areata in 36 patients. After 6 months, 50% of patients on tofacitinib achieved a SALT score ≤ 20, compared to 33% on methotrexate. Tofacitinib also showed a greater improvement in scalp hair assessment and a higher percentage of patients with over 90% improvement in SALT score. Both treatments reduced psychological distress with no significant adverse effects, though tofacitinib had a higher incidence of dyslipidaemia and other mild side effects. The study suggests tofacitinib is more effective, but larger studies are needed to confirm these results and investigate the role of alkaline phosphatase activity.