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

Silverberg J.I. Gooderham M. Katoh N. Aoki V. Pink A.E. Binamer Y. Rademaker M. Fomina D. Gutermuth J. Ahn J. Valenzuela F. Ameen M. Steinhoff M. Kirchhof M.G. Lio P. Wollenberg A.
November 2024 John Wiley and Sons Inc

Journal of the European Academy of Dermatology and Venereology
2024 #38 Issue 11 2139 - 2148 pp.

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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The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
Queens University, Kingston, ON, Canada
SKiN Centre for Dermatology, Peterborough, ON, Canada
Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
University of São Paulo School of Medicine, São Paulo, Brazil
St Johns Institute of Dermatology, Guys & St Thomas NHS Foundation Trust, London, United Kingdom
Alfaisal University, Riyadh, Saudi Arabia
King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
Waikato Clinical Campus, Auckland Medical School, Waikato, New Zealand
Moscow City Center of Allergy and Immunology, Clinical City Hospital 52, Moscow, Russian Federation
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
Astana Medical University, Astana, Kazakhstan
Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
Vrije Universiteit Brussel (VUB), SKIN Research Group, Brussels, Belgium
National Medical Center, Seoul, South Korea
University of Chile, Santiago, Chile
Royal Free NHS Foundation Trust, London, United Kingdom
Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
College of Health and Life Sciences, Hamad-Bin Khalifa University-Qatar, Doha, Qatar
Department of Dermatology, Weill Cornell Medicine, New York, NY, United States
Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
The Ottawa Hospital, Ottawa, ON, Canada
Northwestern University Feinberg School of Medicine, Chicago, IL, United States
Department of Dermatology and Allergy, Ludwig-Maximilian University of Munich, Munich, Germany
Department of Dermatology, Augsburg University Hospital, Augsburg, Germany
Comprehensive Center for Inflammatory Medicine CCIM, University Hospital Schleswig-Holstein UKSH, Luebeck, Germany

The George Washington University School of Medicine and Health Sciences
Queens University
SKiN Centre for Dermatology
Department of Dermatology
University of São Paulo School of Medicine
St Johns Institute of Dermatology
Alfaisal University
King Faisal Specialist Hospital & Research Centre
Waikato Clinical Campus
Moscow City Center of Allergy and Immunology
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Astana Medical University
Department of Dermatology
Vrije Universiteit Brussel (VUB)
National Medical Center
University of Chile
Royal Free NHS Foundation Trust
Department of Dermatology and Venereology
College of Health and Life Sciences
Department of Dermatology
Department of Medicine
Faculty of Medicine
The Ottawa Hospital
Northwestern University Feinberg School of Medicine
Department of Dermatology and Allergy
Department of Dermatology
Comprehensive Center for Inflammatory Medicine CCIM

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