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)

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.

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Publication Details

Journal
Archives of Dermatological Research
Published
2025-05-23
DOI
https://doi.org/10.1007/s00403-025-04278-9
Citations
4
Primary Topic
Dermatology and Skin Diseases
Type
article
Field-Weighted Citation Impact
8.02

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article

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)

Luca Mastorino, Martina Maurelli, Simone Ribero, Giovanni Paolino et al.
4 citations
Archives of Dermatological Research
Dermatology and Skin Diseases
8.02
article

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)

Luca Mastorino, Martina Maurelli, Simone Ribero, Giovanni Paolino, Maddalena Napolitano, Maria Esposito, Luigi Gargiulo, Giampiero Girolomoni, Piergiorgio Malagoli, Paola Savoia, Luca Stingeni, Francesco Leo, Santo Raffaele Mercuri, Antonio Costanzo, Anna Balato, Luca Potestio, Luciano Ibba, Michela Ortoncelli, Elena Pezzolo, Cataldo Patruno, Luisa Angileri, Claudio Sciarrone, Caterina Foti, Silvia Mariel Ferrucci, Alessandra Narcisi, Francesca Barei, Katharina Hansel, Benedetta Tirone, Claudio Brescia
article en
4 citations

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.

Archives of Dermatological ResearchVol. 317(1)
University of Verona (IT), Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), University of Molise (IT), Humanitas University (IT), University of Campania "Luigi Vanvitelli" (IT), University of L'Aquila (IT), University of Perugia (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), IRCCS Policlinico San Donato (IT), Department of Medical Sciences (BY), IRCCS Ospedale San Raffaele (IT), Ospedale San Bortolo (IT), IRCCS Humanitas Research Hospital (IT), Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte (IT), University of Turin (IT), University of Bari Aldo Moro (IT), University of Naples Federico II (IT)
Università degli Studi di Napoli Federico II
Responsible consumption and production
Openalex Percentile: Top 3%
Dermatology and Skin Diseases
8.02
DOIOpen Access PDFOpenAlex
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