A clinical review in the Journal of the American Academy of Dermatology brings together phase 3 trials, integrated safety analyses, real-world cohorts and FDA and EMA labelling for people aged 65 and over, a group under-represented in trials.
For atopic dermatitis it reports that upadacitinib 15 mg and abrocitinib 100 mg are effective in older adults, with higher doses generally avoided. For alopecia areata, baricitinib shows efficacy in small older cohorts, while ritlecitinib data are too limited for age-specific conclusions. For psoriasis, deucravacitinib gave durable responses and avoids boxed warnings for major cardiovascular events and venous thromboembolism, while JAK inhibitors used in psoriatic arthritis need label-directed dosing and close monitoring.
The authors conclude that these drugs may be reasonable for carefully selected older adults, based on baseline cardiovascular and cancer risk, modifiable comorbidities, dosing and monitoring. Age-stratified data remain sparse. This is a narrative synthesis, so check the current label and local guidance for any decision.
- Older adults are under-represented in JAK inhibitor trials.
- In atopic dermatitis, the review favours the lower licensed doses in this age group.
- Assess baseline cardiovascular, thromboembolic and cancer risk before choosing.
- Review modifiable comorbidities and plan monitoring.
- Ritlecitinib data in older adults are too limited for age-specific conclusions.
Why it matters
Older adults are a growing share of dermatology patients and the group in which the safety warnings bite hardest.
Don't overread it
A clinical review of limited age-stratified data guides judgement, and does not replace the product label or a patient-specific risk assessment.
The statistics, in plain English
No pooled effect size is given because this is a narrative review. Small older-adult subgroups in trials give imprecise estimates, so absence of a signal in them is weaker reassurance than it sounds.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for dermatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free