Clinical Scorecard: Atopic Dermatitis Treatment Targets Defined

At a Glance

Key Highlights

• International Eczema Council developed consensus definitions for low disease activity, very low disease activity, on-drug complete control, and off-drug remission in AD.
• Framework uses validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD), Eczema Area and Severity Index (EASI), and Peak Pruritus Numerical Rating Scale (PP-NRS) for assessment.
• On-drug complete control defined as vIGA-AD 0 or EASI 0 plus PP-NRS 0 or 1 maintained for 6 months on therapy; off-drug remission requires same criteria maintained for at least 12 months off therapy.

Guideline-Based Recommendations

Diagnosis

• Use validated clinician-reported measures: vIGA-AD and EASI to assess disease activity.
• Incorporate patient-reported itch severity using PP-NRS.

Management

• Aim for treatment targets defined by disease activity states: low disease activity, very low disease activity, on-drug complete control, and off-drug remission.
• Recognize on-drug complete control as sustained disease control during active therapy.
• Exclude nonmedicated moisturizers and emollients from 'drug' definition.

Monitoring & Follow-up

• Assess disease activity at single time points using vIGA-AD, EASI, and PP-NRS.
• Confirm on-drug complete control by maintaining target scores for 6 months during treatment.
• Confirm off-drug remission by maintaining target scores for at least 12 months after treatment discontinuation.

Risks

• No specific risks detailed; framework emphasizes standardized outcome measures to improve trial comparability and treatment evaluation.

Patient & Prescribing Data

Patients with atopic dermatitis undergoing clinical trials or treatment evaluation

Treatment success defined by achieving and maintaining specific thresholds in clinician and patient-reported measures; sustained control is feasible with current therapies.

Clinical Best Practices

• Combine vIGA-AD and EASI assessments to balance clinical judgment with detailed disease evaluation.
• Use PP-NRS to quantify itch, with thresholds of 0 or 1 considered aspirational but clinically meaningful.
• Adopt standardized definitions to harmonize clinical trial design and regulatory evaluation.
• Recognize limitations of numeric cutoffs and incorporate clinical context in disease assessment.
• Engage patient-reported outcomes alongside clinician measures for comprehensive evaluation.

Related Resources & Content

• JAMA Dermatology Consensus Statement on Atopic Dermatitis Treatment Targets