Efficacy and safety of JAK inhibitors in patients aged > 60 years with moderate-to-severe atopic dermatitis: a 52-week multicenter, real-life study—IL AD (Italian Landscape Atopic Dermatitis)

Abstract

Atopic dermatitis (AD) prevalence in elderly patients is increasing. Clinically, elderly AD may present with atypical phenotypes, making the diagnosis difficult. Moreover, treatment challenges arise due to treatment-resistance, comorbidities, polypharmacy, and contraindications to existing therapies. Janus kinase (JAK) inhibitors (abrocitinib, baricitinib, upadacitinib) may offer a valuable alternative. However, their use in elderly populations remains unclear, as older patients are often excluded from clinical trials, and several concerns have been raised about their safety in this category of subjects. This study aimed to evaluate the efficacy and safety of JAK inhibitors in elderly patients with moderate-to-severe AD. A 52-week, multicenter, real-life study was performed enrolling patients aged ≥ 60 years affected by moderate-to-severe AD undergoing treatment with JAK inhibitors for at least 16 weeks across 16 dermatological centers in Italy. Disease severity was assessed at baseline, week (W) 4, 16, 24, and 52 using the Eczema Area and Severity Index (EASI), Dermatology Life Quality Index (DLQI), and Pruritus-Numerical Rating Scale (P-NRS). Adverse events (AEs) were recorded at each follow-up. A total of 72 patients met the inclusion criteria [abrocitinib: 13 (18.06%); baricitinib: 6 (8.33%); upadacitinib: 53 (73.61%)]. Of these, 72 (100.0%) achieved W16 follow-up with 33 (45.83%) and 26 (36.11%) subjects reaching W24 and W52, respectively. At baseline, mean EASI, DLQI and P-NRS were 21.22 ± 10.38, 18.21 ± 7.33, and 7.84 ± 1.94, respectively. A significant improvement in all scores was observed starting from W4 [EASI: 4.77 ± 5.07, DLQI: 4.01 ± 3.98, P-NRS: 1.66 ± 1.83 (p < 0.0001 for all)], continuing to improve up to W52 [EASI: 0.81 ± 1.27, DLQI: 0.31 ± 0.63, P-NRS: 0.42 ± 1.03; (p < 0.0001 for all)]. No treatment interruptions or modifications for ineffectiveness or AEs were registered. No statistically significant differences in terms of efficacy and safety were found among the treatment groups. JAK inhibitors demonstrated significant efficacy and an acceptable safety profile in elderly AD patients.