Upadacitinib for the Management of Atopic Dermatitis in Patients Aged ≥60 Years: A Long-Term Multicenter Real-World Study
In brief
Upadacitinib lowered eczema severity scores from 23.9 to 0.9 in adults 60+
In this retrospective study of 72 adults aged 60 and older, average eczema severity scores fell from 23.9 at treatment start to 0.9 after 104 weeks, while itch scores dropped from 8.2 to 1.0. Side effects were mostly manageable, but 15% stopped treatment because of them; the findings support long-term use with monitoring, though larger controlled studies are needed.
- Journal
- Dermatitis : contact, atopic, occupational, drug (Q1)
- Published
- 22 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Elena Ippoliti, Niccolò Gori, Giulia Coscarella, Silvia Mariel Ferrucci, Francesca Barei, Laura Calabrese, et al.
- PMID
- 42914573
- DOI
- 10.1177/17103568261499632
Why clinicians should know about it
- Picked for Dermatology (paper of the day, 27 October 2026): Long-term real-world upadacitinib outcomes in older adults with atopic dermatitis
Abstract
BACKGROUND: Atopic dermatitis (AD) in the elderly is increasing worldwide and presents therapeutic challenges due to age-related comorbidities that often contraindicate systemic therapies. Although oral Janus kinase (JAK) inhibitors show efficacy in moderate-to-severe AD, older adult patients are underrepresented in clinical trials, and regulators recommend caution in this population. MATERIALS AND METHODS: We conducted a multicenter, retrospective, observational study at 15 Italian university hospitals, including patients with moderate-to-severe AD aged ≥60 years treated with upadacitinib 15 or 30 mg once daily, to evaluate the real-world effectiveness and safety of this selective JAK1 inhibitor at weeks 16, 32, 52, and 104. RESULTS: Seventy-two patients were included (mean age 65.9 ± 6.4 years); 48/72 (66.7%) of patients showed a classical flexural phenotype; 34/72 (47.2%) presented with head-and-neck involvement. Upadacitinib led to marked and sustained improvement in both clinician-and-patient-reported outcomes, with mean Eczema Area and Severity Index decreasing from 23.9 ± 9.2 at baseline to 1.5 ± 3.0 at week 52 and 0.9 ± 2.5 at week 104. Mean itch-Numeric Rating Scales (NRS) decreased from 8.2 ± 2.0 at baseline to 1.0 ± 1.9 at week 52 and 1.0 ± 2.4 at week 104, with concomitant amelioration in sleep-NRS (6.5 ± 3.1 to 0.5 ± 1.6 and 0.3 ± 1.3) and Dermatology Life Quality Index (16.8 ± 6.9 to 1.6 ± 4.2 and 1.0 ± 3.2). Adverse events occurred in 37/72 (51,4%) patients and included dyslipidemia in 22/72 (30.6%) patients, creatine phosphokinase elevation in 15/72 (20.8%), and blood count abnormalities in 13/72 (18.1%); they were mostly mild and manageable. Overall, 16/72 patients (22.2%) discontinued treatment, including 11/72 (15.3%) due to AEs. CONCLUSIONS: In our multicenter real-world cohort of patients aged ≥60 years, upadacitinib demonstrated rapid, sustained efficacy and an overall favorable safety profile through 104 weeks, supporting its long-term use in clinical practice with appropriate monitoring.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.