Upadacitinib in Adults 60 and Older With Eczema: A Two-Year Real-World Study

Evidence summary only; systemic treatment decisions require a prescriber.

Why older-adult data matter

Older adults are often underrepresented in pivotal eczema trials despite having more cardiovascular, cancer, infection and medication-interaction considerations. A multicenter real-world study followed adults aged 60 years or older receiving upadacitinib for moderate-to-severe atopic dermatitis.

Observed effectiveness

Mean EASI decreased from 23.9 at baseline to 1.5 at week 52 and 0.9 at week 104 among assessed participants. Patient-reported outcomes also improved. These within-person changes suggest substantial disease control in those who remained under treatment and follow-up.

Why this is not a head-to-head answer

There was no randomized comparator. Clinicians may select healthier patients for a JAK inhibitor, and people who tolerate or benefit from therapy are more likely to remain in long-term analysis. Discontinuations, missing visits and concomitant care influence observed averages. The study cannot show that upadacitinib is safer or more effective than a biologic for an individual older adult.

Safety is individualized

JAK inhibitors carry important warnings and require assessment of infection risk, malignancy history, thrombosis, cardiovascular risk, laboratory values, vaccination status and interacting medicines. Older age can change the benefit-risk balance. Never start, interrupt or restart treatment without the prescriber.

Practical monitoring

Follow-up should track skin signs, itch, sleep, function, infections, laboratory results and adverse symptoms. Chest pain, sudden breathlessness, unilateral leg swelling or neurologic symptoms require urgent care.

Bottom line

The cohort adds valuable two-year experience in older adults. Its encouraging effectiveness data must be interpreted alongside selection bias and drug-specific safety monitoring.

Related Dr. Arsy research

• Choosing an eczema moisturizer
• Eczema and sleep research guide
• Childhood eczema and school performance
• Comparing eczema treatments
• Targeted-therapy tapering evidence
• Recognizing eczema across skin tones

References

1. Upadacitinib in adults aged 60 years or older
2. AAD systemic and phototherapy guideline
3. AAD topical therapy guideline
4. AAAAI/ACAAI GRADE guideline
5. Peer-led online self-management randomized trial
6. Emollient plus versus urea 10% trial
7. Lebrikizumab in older adults real-world study
8. Tralokinumab in adults aged 70 years or older
9. Abrocitinib in elderly adults real-world study
10. JAK inhibitors in adults with cardiovascular comorbidity
11. Delgocitinib cream phase 2b trial
12. Ruxolitinib after topical treatment failure trial
13. Mometasone, crisaborole and tofacitinib pilot
14. CAN UpTIMISE after dupilumab study
15. DLLIM international 15,450-patient study
16. REZOLVE-AD phase 2b trial
17. Model-based meta-analysis of 77 studies
18. Targeted-therapy tapering systematic review
19. IL-4 receptor inhibitor meta-analysis
20. Dupilumab SOLO phase 3 trials
21. Tralokinumab ECZTRA 1 and 2 trials
22. Lebrikizumab ADvocate trials
23. Upadacitinib Measure Up trials
24. Abrocitinib JADE MONO-1 trial

Citations do not imply endorsement of #003.