Introduction: In the aging population, inflammatory skin disorders are prevalent, attributed to physiological changes like compromised skin barrier function, immune system alterations, and neurodegenerative issues. Conventional treatments, including immunosuppressive therapies and biologic agents, pose challenges in the elderly due to age-related factors. This retrospective study focuses on evaluating the safety of Janus kinase (JAK) inhibitors in elderly patients with inflammatory skin disorders.
Methods: Conducted in the Department of Dermatology at the Veterans Health Service Medical Center, this study obtained Institutional Review Board approval. The medical records of elderly patients treated between January 2021 and June 2023 with JAK inhibitors and other modalities (corticosteroids, cyclosporine, methotrexate, dupilumab) were retrospectively reviewed. Inclusion criteria involved a diagnosis of inflammatory skin disorders and the ability to assess adverse events through electronic medical records. Demographic and clinical data, treatment duration, and adverse events were collected and compared among treatment groups.
Results: Among eligible patients, 15% received JAK inhibitors (65% upadacitinib, 35% baricitinib). Comorbidities were prevalent, with hypertension and diabetes mellitus being the most common. JAK inhibitors showed a higher incidence of adverse events compared to some medications, with abnormality of laboratory finding being the most common. However, the severity was predominantly mild, and the discontinuation rate due to adverse events was the lowest in the JAK inhibitor group.
Discussion: Comparisons among treatment groups revealed that JAK inhibitors exhibited a higher incidence of adverse events, but the severity was milder than in some other treatment groups. Cardiovascular complications were absent in JAK inhibitor-treated elderly patients, and the incidence of severe adverse events was lower compared to other treatments. JAK inhibitors demonstrated favorable safety outcomes in elderly patients, suggesting their potential as a safe alternative in this population.
Conclusion: This retrospective study sheds light on the safety profile of JAK inhibitors in elderly patients with inflammatory skin disorders, emphasizing their favorable outcomes compared to conventional immunosuppressive and biologic agents. Despite study limitations, these findings underscore the need for further research, particularly with long-term real-world data, to comprehensively assess the safety of JAK inhibitors in this demographic.