Janus Kinase Inhibitor Use in Adults Aged 65 Years and Older

BACKGROUNDJAK inhibitors are increasingly used as systemic therapies for inflammatory dermatoses, but adults aged 65 and older are underrepresented in their clinical trials.

OBJECTIVETo synthesize the efficacy, safety, and regulatory evidence on JAK inhibitors in adults aged 65 and older with atopic dermatitis, alopecia areata, and psoriasis.

METHODSClinical review synthesizing phase 3 trials, integrated safety analyses, real-world cohorts, and FDA/EMA labeling with age-stratified outcomes into practice recommendations (Supplementary Appendix 1B).

RESULTSIn atopic dermatitis, upadacitinib 15 mg and abrocitinib 100 mg are effective in older adults, with higher doses generally avoided. In alopecia areata, baricitinib shows efficacy in small older-adult cohorts, while ritlecitinib data in this age group remain too limited for age-specific conclusions. In psoriasis, deucravacitinib provides durable responses and avoids boxed warnings for MACE or VTE, while catalytic JAK inhibitors for psoriatic arthritis need label-directed dosing and close monitoring.

CONCLUSIONJAK inhibitors may be a reasonable option for carefully selected older adults, but the decision should be a deliberate one. It rests on disease-specific efficacy, baseline cardiovascular and oncologic risk, modifiable comorbidities, label-directed dosing, and close monitoring. Age-stratified data remain sparse, and each decision should be individualized.

Abstract from PubMed