48-Week Real-World Atopic Dermatitis Study on Minimal Disease Activity, Associated Factors, and Agreement Between Clinician- and Patient-Reported Outcomes

Atopic dermatitis (AD) requires multidimensional assessment strategies that integrate clinician and patient perspectives. Minimal disease activity (MDA) has emerged as a treatment target, although its optimal definition and real-world determinants remain unclear. This study aimed to evaluate the proportion of patients achieving MDA under advanced therapies (ATs), identify associated factors, assess agreement between clinician-reported outcomes (CROs) and patient-reported outcomes (PROs), and propose a pragmatic operational definition of MDA. Prospective observational study including patients ≥ 12 years with moderate-to-severe AD initiating AT (biologics or JAK inhibitors) in routine clinical practice. Assessments were performed at baseline and weeks 16, 24, and 48. MDA was defined as the simultaneous achievement of ≥ 1 CRO and ≥ 1 PRO using established cutoffs. Multivariable logistic regression was used to identify factors associated with MDA. Agreement analyses between outcomes were performed, and candidate MDA definitions were validated against external instruments. Ninety-six patients were included. MDA was achieved by 42.7%, 52.6%, and 46.0% of patients at weeks 16, 24, and 48, respectively. Lower baseline disease severity, fewer prior systemic treatments, and fewer AD-related comorbidities were associated with achieving MDA (p < 0.05). Agreement was high among CROs, more variable among PROs, and lower between CROs and PROs. The combination of Eczema Area and Severity Index (EASI) ≤ 3 and Dermatology Life Quality Index (DLQI) 0/1 showed the best performance across validation measures. ATs are effective in achieving MDA in AD. A composite definition integrating EASI ≤ 3 and DLQI 0/1 may represent a practical and clinically useful definition for routine clinical practice. Atopic dermatitis, also known as eczema, is a long-term skin condition that causes itchy, inflamed skin and can affect sleep, daily activities and quality of life. Some patients need advanced treatments, such as biologics or Janus kinase inhibitors (JAKi), to control their disease. We followed 96 patients with moderate-to-severe atopic dermatitis for up to 48 weeks after starting an advanced treatment. Disease control was assessed using measures reported by dermatologists and patients. When patients achieved optimal control from both perspectives, we considered them to have achieved minimal disease activity (MDA). About half of the patients achieved MDA, with similar rates among patients treated with biologics and JAKi. Patients with less severe disease, fewer previous systemic treatments, and fewer associated atopic conditions were more likely to achieve this target. Measures reported by dermatologists generally agreed well with each other, whereas agreement between dermatologist- and patient-reported measures was lower, showing that both perspectives provide complementary information. Among the combinations evaluated, combining the Eczema Area and Severity Index (EASI) with the Dermatology Life Quality Index (DLQI) showed the most consistent performance and may offer a simple way to assess disease control in routine practice. Overall, these findings highlight the importance of considering both the dermatologist’s assessment and the patient’s perspective when evaluating disease control in atopic dermatitis.