Efficacy Trajectory and Hematologic Safety of Oral JAK Inhibitors in Elderly Patients with Moderate-to-Severe Atopic Dermatitis: A Prospective Real-World Study

Abstract

Lin Zhang, Sirong Xie, Hongze Han, Yidi Zhu, Zhiping Wei and Guan Jiang

Background: Elderly patients with moderate-to-severe atopic dermatitis (AD) often have multiple comorbidities and immunosenescence, raising concerns regarding the efficacy and safety of systemic therapies. Real-world evidence on oral Janus kinase (JAK) inhibitors in this population remains limited.

Methods: In this prospective real-world cohort, 90 elderly patients with moderate-to-severe AD received abrocitinib or upadacitinib and were followed for up to 36 weeks. After early discontinuations, 80 patients were included in the final analysis. Disease severity (EASI, SCORAD, and DLQI) and laboratory parameters were assessed longitudinally, and linear mixed-effects models were applied to identify factors associated with treatment response.

Results: Both JAK inhibitors induced rapid and sustained clinical improvement. EASI50, EASI75, and EASI90 response rates increased as early as Week 4 and reached a stable plateau after Week 16. Upadacitinib was associated with faster and greater early improvement, whereas long-term efficacy was comparable between groups by Week 36. SCORAD and DLQI scores decreased significantly throughout follow-up (both P < 0.001). Shorter disease duration, treatment with upadacitinib, and higher body mass index were independently associated with greater EASI improvement. Both treatments were generally well tolerated. Herpes zoster occurred more frequently in the upadacitinib group but was mild to moderate and manageable, and no serious adverse events were observed.

Conclusions: In elderly patients with moderate-to-severe AD, both abrocitinib and upadacitinib demonstrated rapid, durable efficacy and an acceptable safety profile in a real-world setting, with upadacitinib showing a modest advantage in early disease control.

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