Treatment Response Trajectories and Safety Outcomes of Oral Janus Kinase Inhibitors in Older Adults with Moderate-to-Severe Atopic Dermatitis: Findings from a Real-World Prospective Cohort
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Abstract
Managing moderate-to-severe AD in older adults is complicated by age-related physiological decline, coexisting illnesses, and shifts in immune function. Oral JAK inhibitor use has grown in this population, yet controlled trial data on their sustained effectiveness and safety in the elderly remain scarce. This was a prospective cohort study of elderly patients with moderate-to-severe AD treated with abrocitinib or upadacitinib in routine clinical practice. In total, 90 individuals entered the cohort, of whom 80 remained through the full 36-week observation period and were retained for the final analysis. Severity indices, quality-of-life measures, and lab values were tracked across the treatment course, and linear mixed-effects modeling was applied to examine how baseline factors related to changes in EASI. Clinical outcomes improved and remained stable during follow-up in both treatment groups. Most EASI responses were achieved within the first 16 weeks of treatment, followed by a relatively stable response through Week 36. Both treatments demonstrated rapid early improvement; however, the difference between the two drugs decreased at the final visit. Sustained improvements in SCORAD and DLQI scores were observed over the long-term follow-up. A shorter disease history, upadacitinib treatment, and a higher BMI were each linked to greater gains in EASI scores. Safety profiles were generally acceptable, although more cases of herpes zoster were reported in the upadacitinib group. Across the 36-week study period, both agents produced durable clinical benefit with manageable safety in this older AD population. Upadacitinib achieved earlier gains than abrocitinib, though this gap narrowed as follow-up continued. These real-world data support considering oral JAK inhibitors for extended use in elderly patients with moderate-to-severe disease.
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