Older adults are underrepresented in the trials of JAK inhibitors for inflammatory skin disease, yet they are increasingly prescribed them. A clinical review pulls together the age-stratified evidence across atopic dermatitis, alopecia areata and psoriasis into practical guidance.
In atopic dermatitis, upadacitinib 15 mg and abrocitinib 100 mg were effective in older adults, with the higher doses generally avoided. In alopecia areata, baricitinib showed efficacy in small older cohorts while other agents had too little age-specific data. In psoriasis, deucravacitinib gave durable responses and, unlike the catalytic JAK inhibitors, carries no boxed warning for major cardiovascular events or venous thromboembolism.
The decision should be deliberate rather than reflexive. Weigh disease-specific efficacy against baseline cardiovascular and cancer risk, use label-directed dosing, address modifiable comorbidities, and monitor closely. With age-stratified data still thin, each choice should be individualised.
- In atopic dermatitis, prefer upadacitinib 15 mg or abrocitinib 100 mg in older adults and avoid higher doses.
- In psoriasis, deucravacitinib gives durable responses without a boxed warning for cardiovascular events or venous thromboembolism.
- Weigh baseline cardiovascular and cancer risk before starting a catalytic JAK inhibitor in an older adult.
- Use label-directed dosing, treat modifiable comorbidities, and monitor closely.
- Age-stratified evidence is sparse, so individualise each decision.
Why it matters
Older adults are the group most exposed to the cardiovascular and malignancy warnings on JAK inhibitors yet least represented in the trials.
Don't overread it
This is a narrative clinical review, not new trial data; its recommendations synthesise sparse age-stratified evidence.
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