Achieving Both Itch Improvement and Skin Clearance is Crucial, According to AD Patient Expectations

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Real-world registry data from TARGET-DERM AD assessed the relationship between itch relief and skin clearance outcomes and patient-reported quality of life, lesion severity, sleep, and pain in atopic dermatitis (AD).¹ It was found that those with both reduced itch and cleared skin had substantial improvements in disease severity, sleep, and pain, rather than those who had just partial improvements in either category.

The TARGET-DERM AD registry (NCT03661866) is a multicenter, observational registry. For this study, investigators included registrants up to September 2023. Nearly 2000 adult patients with a clinical diagnosis were included. Almost half came from the northeastern United States and 66.8% had private commercial insurance. Half of participants were white, non-Hispanic females with a mean age of 45 years.

One-third of patients were using topical treatment, one-third were on advanced systemic therapy, and the remaining one-third were on conventional systemic therapy. Baseline demographics, medication history, and clinical characteristics were summarized.Participants were then grouped based on their Investigator Global Assessment (IGA) status and Worst Itch Numeric Rating Scale (WI-NRS) score. About half of patients had moderate-to-severe AD with an IGA score of ≥3 and a median WI-NRS score of 8.

The primary outcome of this analysis was the proportion of patients achieving an ideal state according to the Dermatology Life Quality Index(DLQI), Patient-Oriented Eczema Measure (POEM), Sleep-NRS, and Pain-NRS scales. Scores of 0 or 1 were ideal for DLQI, Sleep-NRS, and Pain-NRS, while a score between 0 and 2 was ideal for POEM. At baseline, the mean DLQI score was 6.5 and the mean POEM score was 9.5. Additionally, Sleep-NRS was at an average of 3.4 and Pain-NRS was at a 2.1.

Those with an ideal outcome in DLQI, POEM, Sleep-NRS, and Pain-NRS, also had an IGA of 0/1 (44.7%, 44.3%, 44.7%, and 74.3%, respectively) and WI-NRS of 0/1 (52%, 54%, 57%, and 83%, respectively). As IGA and WI-NRS severity increased, few patents had these same ideal outcomes. 

Interestingly, the adjusted odd ratios of achieving improved patient-reported outcomes were larger for patients with only complete or near-complete itch relief, rather than those with only clear or almost-clear skin. Itch occurs at least once a day in 91% of patients with AD.²

“While skin clearance is essential, ideal outcomes are much more frequently reported when accompanied by significant itch resolution,” the authors said. “Correlation coefficients indicated that itch severity more closely aligns with sleep disturbance and pain, thus it is important for clinicians to assess itch above and beyond the lesion severity.”

The cross-sectional study design does not evaluate changes over time, which could be considered a limitation. Future longitudinal research could better understand these long-term relationships and how they affect patient well-being. Combination treatments can also be assessed in this further work.

These findings align with the recent Aiming High in Eczema/Atopic Dermatitis (AHEAD) recommendations, which emphasize defined and optimal disease management outcomes through a treat-to-target approach.³ Researchers recommend incorporating these patient-outcome measures in clinical practice, as the questions only take a few minutes to ask. This can help physicians have a broader understanding of patients’ experience with the disease and thus can track progress.

“By achieving complete or near-complete resolution of symptoms, clinicians can significantly reduce the disease burden and improve the overall well-being of patients with AD,” the authors wrote.“These real-world findings support the implementation of minimal disease activity criteria as a standard for evaluating therapeutic effectiveness and guiding treatment modifications in routine clinical practice.”

References 

1. Silverberg JI, Calimlim BM, Grada A, et al. Real-world evidence on the benefits of optimal itch relief and skin clearance in atopic dermatitis management: a study from the TARGET-DERM AD registry. J Dermatolog Treat. 2024;35(1):2428729. doi:10.1080/09546634.2024.2428729

2. Dawn A, Papoiu AD, Chan YH, Rapp SR, Rassette N, Yosipovitch G. Itch characteristics in atopic dermatitis: results of a web-based questionnaire. Br J Dermatol. 2009;160(3):642-644. doi:10.1111/j.1365-2133.2008.08941.x

3. Silverberg JI, Gooderham M, Katoh N, et al. 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. J Eur Acad Dermatol Venereol. 2024;38(11):2139-2148. doi:10.1111/jdv.20229