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48-Week Real-World Atopic Dermatitis Study on Minimal Disease Activity, Associated Factors, and Agreement Between
Andrea I Rodriguez-Sanna1, Carmen García-Moronta1, Julia Castro-Martin1
1Dermatology Department, Hospital Universitario Virgen de Las Nieves, Avenida de Madrid 15, 18012, Granada, Spain.
Introduction:
Atopic dermatitis (AD) requires multidimensional assessment strategies that integrate clinician and patient perspectives. Minimal disease activity (MDA) has emerged as a treatment target, although its optimal definition and real-world determinants remain unclear. This study aimed to evaluate the proportion of patients achieving MDA under advanced therapies (ATs), identify associated factors, assess agreement between clinician-reported outcomes (CROs) and patient-reported outcomes (PROs), and propose a pragmatic operational definition of MDA.
Methods:
Prospective observational study including patients ≥ 12 years with moderate-to-severe AD initiating AT (biologics or JAK inhibitors) in routine clinical practice. Assessments were performed at baseline and weeks 16, 24, and 48. MDA was defined as the simultaneous achievement of ≥ 1 CRO and ≥ 1 PRO using established cutoffs. Multivariable logistic regression was used to identify factors associated with MDA. Agreement analyses between outcomes were performed, and candidate MDA definitions were validated against external instruments.
Results:
Ninety-six patients were included. MDA was achieved by 42.7%, 52.6%, and 46.0% of patients at weeks 16, 24, and 48, respectively. Lower baseline disease severity, fewer prior systemic treatments, and fewer AD-related comorbidities were associated with achieving MDA (p < 0.05). Agreement was high among CROs, more variable among PROs, and lower between CROs and PROs. The combination of Eczema Area and Severity Index (EASI) ≤ 3 and Dermatology Life Quality Index (DLQI) 0/1 showed the best performance across validation measures.
Conclusions:
ATs are effective in achieving MDA in AD. A composite definition integrating EASI ≤ 3 and DLQI 0/1 may represent a practical and clinically useful definition for routine clinical practice.
