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

This randomized controlled trial compared the efficacy and safety of oral tofacitinib and methotrexate in 36 patients with moderate-to-severe alopecia areata. 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 more than 90% improvement in SALT score. Both treatments significantly reduced psychological distress, with no serious adverse effects reported. Common adverse events included dyslipidaemia and scalp folliculitis for tofacitinib, and transaminitis and varicella infection for methotrexate. Tofacitinib demonstrated greater efficacy, but larger studies are needed to confirm these results and investigate the role of alkaline phosphatase activity.