Efcacy 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)

Atopic dermatitis (AD) prevalence in elderly patients is increasing. Clinically, elderly AD may present with atypical pheno- types, making the diagnosis difcult. Moreover, treatment challenges arise due to treatment-resistance, comorbidities, polyp- harmacy, and contraindications to existing therapies. Janus kinase (JAK) inhibitors (abrocitinib, baricitinib, upadacitinib) may ofer 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 efcacy 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 afected 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 signifcant 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 modifcations for inefectiveness or AEs were registered. No statistically signifcant diferences in terms of efcacy and safety were found among the treatment groups. JAK inhibitors demonstrated signifcant efcacy and an acceptable safety profle in elderly AD patients.