Dupilumab holds up over three years in children; JAK inhibitors in over-65s need a deliberate decision

The edition in brief

In a prospective Dutch registry of 309 children with moderate to severe atopic dermatitis, dupilumab kept disease controlled for up to three years (mean EASI 3.4 at three years), with three-year drug survival of 80.1%. Ocular surface disease was the commonest adverse event (36.6%), and 16.2% stopped the drug, mostly for ineffectiveness or adverse events. A phase 2 intra-patient-controlled trial of 24 patients found 1.5% ruxolitinib cream reduced affected body surface area in cutaneous chronic graft-versus-host disease by 4.2 percentage points more than vehicle at day 28; the trial was small, single-centre and funded by the manufacturer. A retrospective cohort of 420 patients with high-risk cutaneous squamous cell carcinoma linked a preoperative neutrophil-to-lymphocyte ratio of 3 or more with recurrence (sub-hazard ratio 2.43), though discrimination was modest. A survey of 296 long-term survivors of stage IV melanoma found persistent treatment-related adverse events and distress in about 40% each. A clinical review concludes that JAK inhibitors can suit carefully selected adults aged 65 and over, with dose limits and monitoring.