Upadacitinib Dose Reduction Regimen in Elderly Patients with Atopic Dermatitis, Guided by Treat-to-Target Consensus Recommendations

Background

The effectiveness of Janus kinase (JAK) inhibitors in treating atopic dermatitis (AD) is well established. However, little is known about whether disease control can be maintained with longer dosing intervals, especially in older patients who are at higher risk of adverse events from JAK inhibitors. The treat-to-target (T2T) consensus was established to guide systemic treatment in adults with AD, aiming to achieve disease control promptly and sustain it in the long term.

Objective

The aim of this study was to evaluate the efficacy and safety of extended JAK inhibitor dosing intervals based on the T2T consensus in older adults.

Methods

A prospective observational cohort study was conducted from July 2022 to February 2024. Fifty-eight elderly patients (aged ≥ 65 years) were included in the study and received upadacitinib with gradually longer dosing intervals. The primary outcome was the proportion of patients maintaining different treatment dosing intervals at the end of the follow-up, as well as the assessment of six scales at every visit.

Results

Among the 58 patients (median [IQR] age, 70 [68–77] years) included in the study, 86.2% completed the 1-year follow-up. By the last visit, among those who completed the follow-up, 26.0% maintained a dosing interval of every 3 days, and 72.0% maintained a dosing interval of every 2 days. The overall incidence of adverse events (AEs) was 29.3% among all patients, with the most common AE reported being herpes virus infection (13.8%).

Conclusions

The dose reduction regimen guided by the T2T consensus was well tolerated in elderly patients with moderate-to-severe AD. Prolonging dosing intervals offers potential benefits for both patients and socioeconomic outcomes.