Achievement of Optimal Treatment Targets with Oral Janus Kinase Inhibition in Elderly Patients with Atopic Dermatitis: A Real-world, Multicenter, Retrospective Study.

Objective: Oral Janus kinase inhibitors (JAKi) have demonstrated high levels of efficacy with acceptable safety in patients with atopic dermatitis (AD), yet there remains significant hesitancy among the dermatologic community to use JAKi in elderly populations due to the potential increased risk of serious adverse events in this population. We aimed to perform a retrospective review to describe real-world outcomes for the use of selective JAK-1 inhibitors in patients with AD aged 65 years or older.

Methods: We conducted a multicenter retrospective review. AD cases were identified by ICD-10-CM codes L20.8/L20.89/L20.9. Patients aged 65 years or older years treated with a selective JAK-1 inhibitor were included. Body surface area (BSA), Investigator Global Assessment (IGA), and Peak Pruritus Numerical Rating Scale (NRS) were collected and evaluated independently.

Results: Thirty-eight AD cases in patients aged 65 years or older treated with a selective JAK-1 inhibitor were identified. Patients were aged 65 to 96 years, and treatment duration ranged from 4 to 28 months. Thirty-six out of 38 patients (94.7%) tolerated treatment well; one was switched to another JAKi due to mood lability and another paused therapy during hospitalization for septic pneumonia. Thirty-five out of 37 (94.6%) patients achieved an IGA of 0/1, 28/30 (93.3%) achieved an NRS of 0/1, and 30/30 (100%) had a peak pruritus response with improvement of ≥4 points on NRS. There were no clinically meaningful laboratory abnormalities throughout the treatment course. No laboratory abnormality resulted in treatment discontinuation.

Limitations: Limitations of this retrospective review include selection bias and missing data.

Conclusion: We demonstrate the ability to achieve optimal treatment targets and safety of selective JAKi-1 inhibitors in elderly patients with AD.