EFFICACY AND SAFETY OF ORAL TOFACITINIB VERSUS METHOTREXATE IN MODERATE-TO-SEVERE CHRONIC PLAQUE PSORIASIS: A COMPARATIVE STUDY

Background: Psoriasis is a common, chronic and recurrent inflammatory skin disease characterized by the development of scaly, red, and well-demarcated plaques. Treatment of psoriasis varies depending on the severity and extent of the skin involvement. Methotrexate is an effective treatment option for psoriasis but limitations for the use include slow onset of therapeutic effect, teratogenicity and toxicities. JAK inhibitors such as tofacitinib has been studied for psoriasis patients and the data are promising as potential treatment option. Aims and Objectives: To compare the efficacy and safety of tofacitinib with methotrexate in moderate-to-severe chronic plaque psoriasis. Methods: The non-randomized clinical trial was conducted at the psoriasis clinic, Department of Dermatology and Venereology, Dhaka Medical College Hospital, Dhaka from 1st January 2022 to 30th June,2022. After fulfilling inclusion and exclusion criteria 32 psoriasis patients were treated with tofacitinib (Group-A) and another 32 psoriasis patients were treated with methotrexate (Group-B). Psoriasis area and severity score (PASI) was used to assess the severity at the end of 1st month and 3rd month from baseline. Data was collected by semi-structured questionnaire. Statistical analysis was done by SPSS 25. Results: The mean age was (36.1 ± 8.3) years vs (36.3 ± 7.5) in Group A and Group B respectively with no statistical significance (p=0.4). Mean baseline PASI score of Group A vs Group B were (20.9 ± 5.3) vs (18.7 ± 5.0), And Mean PASI score at the end of 3rd month were (4.8 ± 3.2) vs (4.6 ± 3.8) respectively which were statistically not significant. Whereas Mean PASI at the end of 1st month were (8.7 ± 3.8) vs (12.0 ± 5.7) in Group A vs Group B which is statistically significant (p= 0.01). Conclusion: In this study PASI 75 was achieved significantly in patients treated with oral tofacitinib in 1st month than in patients treated with methotrexate. After 3rd month achievement of PASI 75 was similar in both groups. Mild adverse effects were observed in both groups.