Wang Zhao, Zhang Luyue, Fan Ruitao, Shi Jing, Qin Miao, Xu Shijiao, Geng Songmei
Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China.
Dermatol Ther (Heidelb). 2025 Aug 5. doi: 10.1007/s13555-025-01508-w.
Treat-to-target (T2T) strategies have been adopted in atopic dermatitis (AD) management, which defines specific moderate/acceptable and optimal targets for reducing disease severity. However, real-world evidence on the achievement rates of these targets remains limited.
This prospective observational study enrolled patients with moderate-to-severe AD without treatment protocol modifications. Disease severity was longitudinally assessed using 5-point Patient Global Impression of Severity (PGIS-5), Peak Pruritus Numerical Rating Scale (pp-NRS), Dermatology Life Quality Index (DLQI), Patient-Oriented Eczema Measure (POEM), Body Surface Area (BSA), Eczema Area and Severity Index (EASI), and Scoring Atopic Dermatitis (SCORAD) at baseline and weeks 2, 4, 8, and 16. Treatment responses were compared against two established T2T frameworks: the T2T consensus (de Bruin-Weller et al.) and Aiming High in Eczema/Atopic Dermatitis (AHEAD) recommendations (Silverberg et al.). Target feasibility was evaluated through achievement rates, with thresholds calibrated to balance timely clinical response.
Sixty-one patients with moderate-to-severe AD were enrolled. All outcomes measured showed significant improvement over the 16-week observation period. SCORAD50, EASI50, pp-NRS reduction ≥ 3/4, and DLQI reduction ≥ 4 demonstrated appropriate moderate target feasibility. SCORAD75, EASI75/90, pp-NRS ≤ 1, BSA ≤ 2%, and DLQI 0/1 were suitable as optimal targets. Percentage improvements of EASI and SCORAD were more reliable than absolute values. Current targets for PGIS-5 (reduction ≥ 1), POEM (reduction ≥ 4), and BSA (50% improvement) in the moderate category and PGIS-5 ≤ 2 and POEM ≤ 7 in the optimal category may require stricter criteria.
Our finding reflects the real-world achievement rate of the current T2T consensus, suggesting that higher thresholds may be warranted in future refinements of T2T strategies.
在特应性皮炎（AD）管理中已采用达标治疗（T2T）策略，该策略为降低疾病严重程度定义了特定的中度/可接受和最佳目标。然而，关于这些目标达成率的真实世界证据仍然有限。
这项前瞻性观察性研究纳入了未修改治疗方案的中度至重度AD患者。在基线以及第2、4、8和16周，使用5分制患者整体严重程度印象（PGIS-5）、瘙痒峰值数字评定量表（pp-NRS）、皮肤病生活质量指数（DLQI）、患者导向性湿疹评估（POEM）、体表面积（BSA）、湿疹面积和严重程度指数（EASI）以及特应性皮炎评分（SCORAD）对疾病严重程度进行纵向评估。将治疗反应与两个既定的T2T框架进行比较：T2T共识（德布鲁因-韦勒等人）和湿疹/特应性皮炎高目标（AHEAD）建议（西尔弗伯格等人）。通过达成率评估目标可行性，校准阈值以平衡及时的临床反应。
纳入了61例中度至重度AD患者。在16周的观察期内，所有测量结果均显示出显著改善。SCORAD50、EASI50、pp-NRS降低≥3/4以及DLQI降低≥4表明了适当的中度目标可行性。SCORAD75、EASI75/90、pp-NRS≤1、BSA≤2%以及DLQI 0/1适合作为最佳目标。EASI和SCORAD的改善百分比比绝对值更可靠。中度类别中PGIS-5（降低≥1）、POEM（降低≥4）和BSA（改善50%）以及最佳类别中PGIS-5≤2和POEM≤7的当前目标可能需要更严格的标准。
我们的研究结果反映了当前T2T共识的真实世界达成率，表明在未来T2T策略的优化中可能需要更高的阈值。
