Marjolein De Bruin-Weller, Tilo Biedermann, Robert Bissonnette, Mette Deleuran, Peter Foley, Giampiero Girolomoni, Jana Hercogová, Chih-Ho Hong, Norito Katoh, Andrew E. Pink, Marie-Aleth Richard, Stephen Shumack, Juan F. Silvestre, Stephan Weidinger
DOI: 10.2340/00015555-3751

Currently no treat-to-target framework to guide systemic treatment in adults with moderate-to-severe atopic dermatitis exists. We sought to reach international consensus through an eDelphi process on a core set of recommendations for such an approach. Recommendations were developed by an international Steering Committee, spanning 3 areas (Guiding Principles, Decision Making, and Outcome Thresholds) and 2 specific time-points; an initial acceptable target at 3 months and an optimal target at 6 months, each based on improvements in patient global assessment plus at least one specific outcome domain. These treat-to-target- orientated recommendations were evaluated by an extended international panel of physicians, nurses and patients. Proposed recommendations were rated using a 9-point Likert scale; for each recommendation, consensus agreement was reached if ≥ 75% of all respondents rated agreement as ≥ 7. Consensus on 16 core recommendations was reached over 2 eDelphi rounds. These provide a framework for shared decision-making on systemic treatment continuation, modification, or discontinuation.

Moderate-to-severe atopic dermatitis often requires systemic therapies for disease control. Unlike other conditions, such as psoriasis, at present no treat-to-target framework exists to guide optimal use of systemic therapies in atopic dermatitis. We developed recommendations for such a treat-to-target approach and evaluated these through an eDelphi process with proposals rated by an international panel of physicians, nurses and patients to seek international consensus. After 2 eDelphi rounds, consensus agreement was reached on all recommendations. From this, a clinical algorithm is proposed to guide shared decision-making in a treat-to target approach for systemic treatment in adults with moderate-to-severe atopic dermatitis.

Appendix S1