Standardized Treatment Targets for Atopic Dermatitis Defined by International Eczema Council
Overview
The International Eczema Council (IEC) established consensus definitions for low disease activity, very low disease activity, on-drug complete control, and off-drug remission in atopic dermatitis (AD). These standardized targets aim to harmonize clinical trial benchmarks and support treat-to-target strategies in AD management.
Background
Atopic dermatitis has lacked internationally endorsed, standardized thresholds for disease control despite advances in therapies enabling sustained control. The IEC conducted a three-round modified Delphi process with global experts to develop a framework for clinical trials and translational research. The framework integrates clinician-assessed disease activity and patient-reported outcomes to define meaningful disease states. This effort addresses the need for consistent outcome measures to improve trial design and comparative effectiveness research.
Data Highlights
Disease State
vIGA-AD Score
EASI Score
PP-NRS Score
Duration
Treatment Status
Low disease activity
2 (or equivalent IGA 2)
≤7
≤4
Single time point
Any
Very low disease activity
0 or 1
≤3
0 or 1
Single time point
Any
On-drug complete control
0
0
0 or 1
≥6 months
Receiving AD therapy
Off-drug remission
0
0
0 or 1
≥12 months
After discontinuation of AD therapy
Key Findings
Consensus definitions were developed using a 3-round modified Delphi process with 103 experts from over 30 countries.
Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD) and Eczema Area and Severity Index (EASI) were selected as primary clinician-reported measures.
Peak Pruritus Numerical Rating Scale (PP-NRS) was chosen as the preferred patient-reported measure of itch, with 0/1 thresholds used in definitions.
Four disease states defined: low disease activity, very low disease activity, on-drug complete control, and off-drug remission, each with specific vIGA-AD, EASI, and PP-NRS criteria.
On-drug complete control preferred terminology over on-drug remission to reduce ambiguity during active treatment.
High agreement (95%-97%) was achieved for the final definitions, supporting their clinical meaningfulness and feasibility.
Clinical Implications
These standardized definitions provide clinicians and researchers with clear, harmonized targets for assessing disease control in atopic dermatitis. Incorporating both clinician-reported and patient-reported outcomes facilitates comprehensive evaluation of treatment response. Adoption of this framework can improve consistency in clinical trial design, regulatory evaluation, and longitudinal comparative effectiveness studies, ultimately guiding treat-to-target approaches in AD management.
Conclusion
The IEC consensus framework establishes internationally endorsed, clinically meaningful treatment targets for atopic dermatitis, addressing a critical gap in outcome standardization. This foundation supports improved trial comparability and patient-centered care strategies.
References
International Eczema Council/JAMA Dermatology/2025 -- Atopic Dermatitis Treatment Targets Defined
