Treat-to-Target in Atopic Dermatitis: An International Consensus on a Set of Core Decision Points for Systemic Therapies

Currently no treat-to-target framework to guide sys- temic treatment in adults with moderate-to-severe atopic dermatitis exists. We sought to reach interna- tional consensus through an eDelphi process on a core set of recommendations for such an approach. Recom- mendations were developed by an international Steer- ng Committee, spanning 3 areas (Guiding Principles, Decision Making, and Outcome Thresholds) and 2 speci- fic time-points; an initial acceptable target at 3 months and an optimal target at 6 months, each based on im- provements in patient global assessment plus at least one specific outcome domain. These treat-to-target- orientated recommendations were evaluated by an ex- tended international panel of physicians, nurses and patients. Proposed recommendations were rated using a 9-point Likert scale; for each recommendation, con- sensus agreement was reached if ≥75% of all respon- dents rated agreement as ≥7. Consensus on 16 core recommendations was reached over 2 eDelphi rounds. These provide a framework for shared decision-making on systemic treatment continuation, modification, or discontinuation.