Redefining Treat-to-target in Atopic Dermatitis: Towards Meaningful, Patient-centred Disease Control - An ISAD...

Area of Science:

• Dermatology
• Clinical Strategy
• Patient-Centered Care

Background:

• Current treat-to-target strategies for atopic dermatitis primarily rely on clinician- and patient-reported outcomes.
• Existing initiatives often lack a comprehensive approach, failing to fully address disease instability, comorbidities, and patient/family burden.

Purpose of the Study:

• To critically examine current treat-to-target approaches in atopic dermatitis.
• To propose priorities for a more clinically meaningful, patient-centered, and globally applicable framework.
• To synthesize recent consensus and outcome-harmonization initiatives with insights from other chronic diseases.

Main Methods:

• Review and position paper synthesizing recent consensus and outcome-harmonization efforts.
• Informed by multidisciplinary, patient-inclusive discussions at an International Society of Atopic Dermatitis-World Health Organization premeeting.
• Analysis of current proposals and identification of conceptual priorities and implementation challenges.

Main Results:

• Current proposals for atopic dermatitis treat-to-target insufficiently capture disease instability, comorbidities, family burden, treatment burden, and real-world constraints.
• A proposed framework includes four complementary domains: disease activity; symptoms and function; global patient health and disease impact; and longitudinal control and treatment adaptation.
• Some components of the proposed framework utilize validated measures, while others require further exploration.

Conclusions:

• Treat-to-target strategies in atopic dermatitis require evolution beyond isolated thresholds to an adaptable, multidimensional approach.
• The proposed framework aims for a more comprehensive and patient-centered strategy for managing atopic dermatitis.
• Formal international consensus and prospective validation are necessary next steps for implementing an improved treat-to-target strategy.