{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:17:56Z","timestamp":1787746676496,"version":"build-2784847793"},"reference-count":21,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81502725"],"award-info":[{"award-number":["81502725"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"award":["81502725"],"award-info":[{"award-number":["81502725"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004731","name":"Zhejiang Provincial Natural Science Foundation","doi-asserted-by":"publisher","award":["Y15H110007"],"award-info":[{"award-number":["Y15H110007"]}],"id":[{"id":"10.13039\/501100004731","id-type":"DOI","asserted-by":"publisher"}]},{"award":["Y15H110007"],"award-info":[{"award-number":["Y15H110007"]}],"id":[{"id":"https:\/\/ror.org\/04aqat463","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Elderly patients (\u226565 years) with atopic dermatitis (AD) often carry multimorbidity and face elevated risks with Janus kinase (JAK) inhibitors. Phase III trials included few older adults, and real-world data beyond 12 months remain scarce. We evaluated 36-month efficacy, safety, and drug persistence of upadacitinib 15 mg once daily in 62 Chinese elderly patients. Methods: This retrospective cohort study was conducted at Sir Run Run Shaw Hospital (March 2022-July 2026). All patients received upadacitinib 15 mg once daily. Assessments included Week 4 pruritus Numerical Rating Scale (NRS) response, Eczema Area and Severity Index (EASI) 75\/90, and Investigator\u2019s Global Assessment (IGA) 0\/1 at Weeks 12 and 24. Drug persistence was estimated with the Kaplan\u2013Meier method (36-month cutoff), and predictors were identified by Cox regression. Results: Median age was 70.0 years, 75.8% were male, and baseline EASI was 34.5, with substantial comorbidity (Charlson Comorbidity Index [CCI] 5.0; psychotropic use 46.8%). Week 4 itch response was 70.8%. EASI 75 reached 75.0% (IGA 0\/1 44.4%) at Week 12, rising to 88.0% (64.0%) at Week 24. Persistence declined from 88.7% at Month 3 to 66.1% at Month 6, the steepest drop, reaching 38.7% at Month 36. Treatment-emergent adverse events (TEAEs) occurred in 54.8% and serious adverse events (SAEs) in 8.1%, with herpesvirus infection (21.0%) being the most common event, and there were no adverse event (AE)-related discontinuations, major adverse cardiovascular events (MACE), or venous thromboembolism (VTE). In multivariate analysis, Week 4 itch response predicted longer persistence (hazard ratio [HR] = 0.203, 95% confidence interval [CI]: 0.091-0.452, p &lt; 0.001), while psychotropic medication use predicted shorter persistence (HR = 2.814, 95% CI: 1.237-6.403, p = 0.014). Conclusions: Upadacitinib showed robust efficacy and acceptable safety over 36 months in elderly AD patients. Persistence dropped most sharply between Months 3 and 6. Week 4 itch response and psychotropic medication use independently predicted persistence. A structured Month 3 visit integrating itch reassessment, mental health screening, and dose optimization may improve long-term outcomes.<\/jats:p>","DOI":"10.3390\/jcm15176593","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:59:23Z","timestamp":1787741963000},"page":"6593","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-World Effectiveness, Safety, and 36-Month Persistence of Upadacitinib in Elderly Patients with Moderate-to-Severe Atopic Dermatitis: The 3\u20136 Month Critical Window and the Role of Early Itch Response and Psychotropic Medication Use"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3502-0549","authenticated-orcid":false,"given":"Yaoyao","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianzhen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongdong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boya","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Defeng","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yudan","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianze","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyan","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kejian","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou 310016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/S0140-6736(24)02519-4","article-title":"Atopic dermatitis","volume":"405","author":"Brunner","year":"2025","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.1016\/S0140-6736(21)00588-2","article-title":"Once-daily upadacitinib versus placebo in adolescents and adults with moderate-to-severe atopic dermatitis (Measure Up 1 and Measure Up 2): Results from two replicate double-blind, randomised controlled phase 3 trials","volume":"397","author":"Teixeira","year":"2021","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1016\/S0140-6736(21)00589-4","article-title":"Safety and efficacy of upadacitinib in combination with topical corticosteroids in adolescents and adults with moderate-to-severe atopic dermatitis (AD Up): Results from a randomised, double-blind, placebo-controlled, phase 3 trial","volume":"397","author":"Reich","year":"2021","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1007\/s00403-025-04278-9","article-title":"Efficacy and safety of JAK inhibitors in patients aged >60 years with moderate-to-severe atopic dermatitis: A 52-week multicenter, real-life study\u2014IL AD (Italian Landscape Atopic Dermatitis)","volume":"317","author":"Barei","year":"2025","journal-title":"Arch. 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