Friedreich’s ataxia (FRDA) is a challenging neurodegenerative disorder with limited pharmacologic treatment options. Among the therapies reviewed, omaveloxolone was the only agent to demonstrate a statistically significant improvement in neurological outcomes; however, this finding is based on very low-certainty evidence. Consequently, omaveloxolone may be the most promising current pharmacologic option, but its true efficacy remains uncertain and should be confirmed in larger, longer, and well-designed randomized controlled trials. Other pharmacologic agents showed no consistent evidence of benefit. Safety outcomes were broadly comparable between intervention and control groups; however, available safety evidence remains limited by imprecision, small sample sizes, and relatively short follow-up periods. Although no substantial increase in adverse events was observed, confidence in the safety estimates remains limited.