This JAAD clinical review, published 24 September, combined phase 3 trials, integrated safety analyses, real-world cohorts and FDA and EMA labelling to guide JAK inhibitor use in adults aged 65 and over with atopic dermatitis, alopecia areata and psoriasis — a group largely left out of the pivotal trials.
For atopic dermatitis, upadacitinib 15 mg and abrocitinib 100 mg are effective in older adults, and higher doses are generally avoided. For alopecia areata, baricitinib has shown efficacy in small older cohorts; ritlecitinib data in this age group are too thin for conclusions. For psoriasis, the TYK2 inhibitor deucravacitinib gives durable responses and does not carry the boxed warnings for major cardiovascular events or venous thromboembolism that apply to the catalytic JAK inhibitors.
The authors do not rule the class out after 65. They ask for a structured decision: disease-specific evidence, baseline cardiovascular and cancer risk, modifiable comorbidities addressed first, label-directed dosing, and close monitoring.
- Assess cardiovascular risk, cancer history, VTE risk and smoking before starting a JAK inhibitor in anyone over 65.
- Use the lower licensed dose in older adults — upadacitinib 15 mg or abrocitinib 100 mg for atopic dermatitis.
- For psoriasis in older adults, deucravacitinib avoids the boxed warnings of the catalytic JAK inhibitors.
- Update zoster vaccination and check lipids and blood counts before and during treatment.
Why it matters
Replaces a blanket reluctance to prescribe in older patients with a checklist that makes the decision defensible.
Don't overread it
This is a narrative clinical review; age-stratified trial data remain sparse and the recommendations are expert synthesis.
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