The Use of JAK Inhibitors in Elderly Patients with Moderate-to-Severe Atopic Dermatitis: A Narrative Review of Clinical and Real-World Evidence.

Atopic dermatitis (AD) in elderly patients presents unique clinical challenges due to comorbidities, polypharmacy, and an increased risk of adverse events. Janus kinase inhibitors (JAKis) have emerged as effective oral treatments, but limited data are available for their use in older adults. A narrative review was conducted through a comprehensive search of PubMed/MEDLINE, Ovid, Scopus, Embase, Cochrane Library, Web of Science, and Google Scholar up to July 2025. Only English-language studies evaluating abrocitinib, baricitinib, or upadacitinib in elderly patients (≥65 years) with moderate-to-severe AD were included. RCTs enrolled few elderly patients and lacked dedicated subgroup analyses. Abrocitinib showed similar efficacy in older and younger adults, but higher rates of adverse events, especially at the 200 mg dose. Real-world studies, mainly on upadacitinib, demonstrated rapid and sustained clinical improvements, including in difficult-to-treat areas. Safety outcomes were generally favorable; most adverse events were mild and manageable. Herpes zoster and hematological changes were more frequent in elderly patients, while serious cardiovascular events were rare. JAK inhibitors are effective therapeutic options for elderly patients with moderate-to-severe AD. Careful patient selection, dose tailoring, and close monitoring are essential. Further age-specific RCTs and long-term real-world data are needed to guide clinical practice.