Use of Upadacitinib to Treat Atopic Dermatitis Refractory to Dupilumab in Elderly Patients

Atopic dermatitis (AD) is a relapsing and remitting inflammatory skin disease that can significantly impair an individual’s quality of life. Elderly-onset AD is increasing in prevalence in developed countries, likely due to aging populations. When AD is refractory to both topical steroids and dupilumab (a systemic IL-4Rα inhibitor), there remains a lack of guidelines for treatment in elderly populations. Herein, we describe the treatment of dupilumab-refractory AD in five elderly patients (≥ 65-years-old) with upadacitinib, a novel JAK inhibitor rarely used in elderly patients due to an elevated risk of systemic side effects. In this report, we found upadacitinib successfully improved these elderly patients’ atopic dermatitis, with minimal adverse events. Presently, all five patients continue with this treatment.