Comparison Between Oral Methotrexate and Tofacitinib in the Treatment Of Chronic Plaque Psoriasis
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Background: Chronic plaque psoriasis is a systemic immune-mediated inflammatory disease requiring effective systemic therapy in patients with moderate-to-severe disease or inadequate response to topical treatment. Methotrexate remains widely used because of affordability and availability, while tofacitinib offers targeted oral Janus kinase inhibition with potential efficacy in plaque psoriasis. Objective: To compare the efficacy and short-term safety of oral tofacitinib and oral methotrexate in patients with chronic plaque psoriasis. Methods: This randomized controlled trial was conducted at the Department of Dermatology, Lahore General Hospital, Lahore, from February 2025 to June 2025. Seventy-five patients aged 18–70 years with chronic plaque psoriasis of at least 6 months’ duration, PASI score ≥10 or body surface area involvement ≥10%, and inadequate response to topical therapy were included. Group A received oral tofacitinib 5 mg twice daily, while Group B received oral methotrexate once weekly, starting at 10 mg and titrated according to response and tolerance. Patients were followed for 12 weeks. The primary outcome was PASI-75 achievement at week 12. Results: Tofacitinib was given to 38 patients and methotrexate to 37 patients. Mean PASI decreased from 18.6 ± 4.4 to 4.9 ± 3.1 with tofacitinib and from 18.2 ± 4.6 to 6.7 ± 3.7 with methotrexate. Mean percentage PASI reduction was higher with tofacitinib than methotrexate. PASI-75 was achieved by 23 patients (60.5%) receiving tofacitinib and 16 patients (43.2%) receiving methotrexate. Any adverse event occurred in 10 patients (26.3%) in the tofacitinib group and 12 patients (32.4%) in the methotrexate group. Conclusion: Both oral tofacitinib and methotrexate improved PASI score over 12 weeks. Tofacitinib produced greater mean PASI reduction and numerically higher PASI-75 response, although categorical response superiority was not statistically confirmed. Both drugs were generally tolerated during short-term follow-up.
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