A clinical review in the Journal of the American Academy of Dermatology (24 September 2026) combined phase 3 trials, integrated safety analyses, real-world cohorts and FDA and EMA labels to give age-specific guidance on JAK inhibitors for atopic dermatitis, alopecia areata and psoriasis in adults aged 65 and over, who were underrepresented in the trials.
For atopic dermatitis, the authors found upadacitinib 15 mg and abrocitinib 100 mg effective in older adults, with higher doses generally avoided. For alopecia areata, baricitinib showed efficacy in small older cohorts, while ritlecitinib data are too limited for age-specific conclusions. For psoriasis, deucravacitinib, an allosteric TYK2 inhibitor, gave durable responses without the boxed warnings for major cardiovascular events and thrombosis carried by the catalytic JAK inhibitors.
The authors' conclusion is that age alone is not a contraindication, but the decision must be deliberate: weigh cardiovascular, thrombotic and cancer risk, address modifiable risk factors, use the labelled lower doses and monitor closely.
- Before prescribing a JAK inhibitor to a patient over 65, record cardiovascular, venous thrombosis and cancer history.
- For atopic dermatitis in this age group, use upadacitinib 15 mg or abrocitinib 100 mg rather than higher doses.
- For psoriasis, consider deucravacitinib, which does not carry the class boxed warnings.
- Address smoking, blood pressure and lipids before starting.
- Review age-appropriate cancer screening and herpes zoster vaccination before starting.
Why it matters
Older adults are increasingly offered these drugs off the back of trials that barely included them, and the dose and drug choice matter more at this age.
Don't overread it
This is a clinical review with expert synthesis; age-stratified trial data remain sparse.
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