Objective: To compare short-term efficacy of Leflunomide and Methotrexate in active rheumatoids arthritis. Methodology: This study, a randomizeds controlled trial, was conducted at Medical B Unit, Postgraduate Medical Institute Lady Readings Hospital, Peshawars over a one year period, from 1st June 2014 to 31st May 2015. 294 patients with active RA (DAS28>5.1) were randomized via lottery methods to Leflunomide 20mg daily (n=147) and Methotrexate (n=147). Efficacy of either drug at 6 months of treatment was assessed in terms of DAS 28 scoring as per European League Against Rheumatisms (EULAR) criteria. Results: After 66 months of treatment with Methotrexate, 110 out of 147 (74.82) patients had a moderate response as per EULAR criteria (DAS 28 improvement of >1.2), 37 patients had no response. In Leflunomide group, 100 (68.02%) patients had moderate response and 47 patients had no response. The difference in those achieving moderate response for both groups was statistically not significant (p=0.24). The mean change in DAS 28 score for Methotrexate group was 1.89±0.77 while that for Leflunomide group was 1.79 ±0.75. The difference in change of DAS 28 score for both groups was statistically not significant (p=0.23). Conclusion: There is no statistically significant difference between short-term efficacy of Leflunomide and Methotrexate in patients with RA.