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. 2024 Nov;38(11):2139-2148.
doi: 10.1111/jdv.20229. Epub 2024 Jul 11.

Combining treat-to-target principles and shared decision-making: International expert consensus-based recommendations with a novel concept for minimal disease activity criteria in atopic dermatitis

Jonathan I Silverberg  1 , Melinda Gooderham  2   3 , Norito Katoh  4 , Valeria Aoki  5 , Andrew E Pink  6 , Yousef Binamer  7   8 , Marius Rademaker  9 , Daria Fomina  10   11   12 , Jan Gutermuth  13   14 , Jiyoung Ahn  15 , Fernando Valenzuela  16 , Mahreen Ameen  17 , Martin Steinhoff  18   19   20   21 , Mark G Kirchhof  22   23 , Peter Lio  24 , Andreas Wollenberg  25   26   27
Affiliations

Combining treat-to-target principles and shared decision-making: International expert consensus-based recommendations with a novel concept for minimal disease activity criteria in atopic dermatitis

Jonathan I Silverberg et al. J Eur Acad Dermatol Venereol. 2024 Nov.

Abstract

Background: Current treat-to-target recommendations for atopic dermatitis (AD) may not include high enough treatment targets and do not fully consider patient needs.

Objective: To develop recommendations for optimized AD management, including disease severity assessments, treatment goals and targets, and guidance for treatment escalation/modification.

Methods: An international group of expert dermatologists drafted a series of recommendations for AD management using insights from a global patient study and 87 expert dermatologists from 44 countries. Experts voted on recommendations using a modified eDelphi voting process.

Results: The Aiming High in Eczema/Atopic Dermatitis (AHEAD) recommendations establish a novel approach to AD management, incorporating shared decision-making and a concept for minimal disease activity (MDA). Consensus (≥70% agreement) was reached for all recommendations in 1 round of voting; strong consensus (≥90% agreement) was reached for 30/34 recommendations. In the AHEAD approach, patients select their most troublesome AD feature(s); the clinician chooses a corresponding patient-reported severity measure and objective severity measure. Treatment targets are chosen from a list of 'moderate' and 'optimal' targets, with achievement of 'optimal' targets defined as MDA.

Conclusions: Patient and expert insights led to the development of AHEAD recommendations, which establish a novel approach to AD management. Patients were not involved in the eDelphi voting process used to generate consensus on each recommendation. However, patient perspectives were captured in a global, qualitative patient research study that was considered by the experts in their initial drafting of the recommendations.

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References

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