{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:19:46Z","timestamp":1787750386302,"version":"build-2784847793"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Treatments for moderate-to-severe alopecia areata (AA) have limited efficacy. Methotrexate, a conventional immunosuppressant, has been used for AA, while Janus kinase\/signal transducer and activator of transcription (JAK\u2013STAT) inhibitors like tofacitinib have shown promising results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To compare the efficacy of tofacitinib and methotrexate in moderate-to-severe AA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>Thirty-six patients aged 18\u201360 years with a severity of alopecia tool (SALT) score &gt;40 were randomized to receive either tofacitinib (5\u201310 mg twice daily) or methotrexate (0.3\u20130.5 mg\/kg weekly) for 6 months, followed by 3-month follow-up. Primary outcomes measured the proportion achieving a SALT score \u226420 at 6 months. Secondary outcomes included patient-reported outcome (PRO) on scalp hair assessment, dermatology life quality index (DLQI), patient health questionnaire (PHQ) scores, relapse rates, and alkaline phosphatase (ALP) activity in scalp biopsies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      At 6 months, 50% of tofacitinib patients achieved a SALT score \u226420 vs. 33.3% with methotrexate (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.31). A \u2265 90% SALT improvement occurred in 33.3% of tofacitinib and 11.1% of methotrexate patients (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.10). The tofacitinib group had greater scalp hair PRO score reductions. Both groups showed significant DLQI and PHQ improvements, with no intergroup differences. Adverse events were reported in 38.8% of tofacitinib and 33.3% of methotrexate patients (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 1). ALP activity was inconclusive.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations:<\/jats:title>\n                    <jats:p>Small sample size, open-label design, lack of stratification, and baseline imbalances that may affect achievable improvement and comparative interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In this pilot trial, both tofacitinib and methotrexate improved SALT score, PRO score, and psychological outcomes, but the tofacitinib group showed greater efficacy. Larger studies are warranted to confirm findings and investigate ALP activity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/idoj.idoj_1146_25","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:00:25Z","timestamp":1782320425000},"page":"548-552","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["A Pilot Randomized Controlled Trial Comparing the Efficacy and Safety of Oral Tofacitinib Versus Methotrexate In Moderate-to-Severe Alopecia Areata"],"prefix":"10.4103","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1156-3613","authenticated-orcid":false,"given":"Mude","family":"Hemalatha","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 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