Achieving Targeted Combined Endpoints in Patients With Atopic Dermatitis: A Real-World Study

Real-world evidence on the treat-to-target strategy in atopic dermatitis (AD) remains limited. To evaluate targeted combined endpoints in AD, we conducted a cross-sectional study that included 100 adults with AD receiving treatment ≥ 6 months. Targeted endpoints included Patient Global Assessment (PGA) ≤ 2, Eczema Area and Severity Index (EASI) ≤ 7, visual analog scale (VAS) of pruritus ≤ 4, Patient Oriented Eczema Measure (POEM) ≤ 7, and Dermatology Life Quality Index (DLQI) ≤ 5. Logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify factors associated with achieving treatment targets. Latent class analysis (LCA) and principal component analysis (PCA) were performed to identify patient subgroups and data components. Only 30% met all five targeted endpoints. An increased age was associated with a higher probability of achieving all treatment targets (aOR: 1.04; 95% CI: 1.00-1.09). DLQI could favorably predict the achievement of all 5 treatment targets (AUROC: 0.93; 95% CI: 0.88, 0.97). Despite no significant differences across treatment groups, the proportion of patients achieving all targets was the highest in the dupilumab group, followed by the Janus kinase inhibitor (JAKi) group. LCA identified one subgroup of patients achieving favorable skin control but poor life quality. PCA showed that life quality-related factors other than the severity of skin lesions explained the majority of variance. In conclusion, achievement of targeted combined endpoints in AD remains suboptimal, partly due to life quality-related factors.