Janus Kinase Inhibitor Use in Adults Aged 65 Years and Older: A Clinical Review Across Atopic Dermatitis, Alopecia Areata, and Psoriasis.

BACKGROUND: JAK inhibitors are increasingly used as systemic therapies for inflammatory dermatoses, but adults aged 65 and older are underrepresented in their clinical trials. OBJECTIVE: To synthesize the efficacy, safety, and regulatory evidence on JAK inhibitors in adults aged 65 and older with atopic dermatitis, alopecia areata, and psoriasis. METHODS: Clinical review synthesizing phase 3 trials, integrated safety analyses, real-world cohorts, and FDA/EMA labeling with age-stratified outcomes into practice recommendations (Supplementary Appendix 1B). RESULTS: In atopic dermatitis, upadacitinib 15 mg and abrocitinib 100 mg are effective in older adults, with higher doses generally avoided. In alopecia areata, baricitinib shows efficacy in small older-adult cohorts, while ritlecitinib data in this age group remain too limited for age-specific conclusions. In psoriasis, deucravacitinib provides durable responses and avoids boxed warnings for MACE or VTE, while catalytic JAK inhibitors for psoriatic arthritis need label-directed dosing and close monitoring. CONCLUSION: JAK inhibitors may be a reasonable option for carefully selected older adults, but the decision should be a deliberate one. It rests on disease-specific efficacy, baseline cardiovascular and oncologic risk, modifiable comorbidities, label-directed dosing, and close monitoring. Age-stratified data remain sparse, and each decision should be individualized.