Redefining Treat-to-target in Atopic Dermatitis: Towards Meaningful, Patient-centred Disease Control – An ISAD Position Paper

Abstract

Treat-to-target strategies link predefined goals to regular assessment and treatment adaptation. In atopic dermatitis, recent initiatives have mainly defined thresholds using clinician- and patient-reported outcomes. This review and position paper critically examines current approaches and proposes priorities for a more clinically meaningful, patient-centred and globally applicable framework. It synthesizes recent consensus and outcome-harmonization initiatives with selected lessons from rheumatoid arthritis and asthma and was informed by multidisciplinary, patient-inclusive discussions at an International Society of Atopic Dermatitis-World Health Organization premeeting. The workshop was not a Delphi or formal consensus exercise; it was used to identify conceptual priorities and implementation challenges for future international consensus work. Current proposals converge partly around severity thresholds and symptom control but insufficiently capture disease instability, comorbidities, family burden, treatment burden and real-world constraints. We propose 4 complementary domains: disease activity; symptoms and function; global patient health and disease impact and longitudinal control and treatment adaptation. Some components are supported by validated measures, whereas others remain exploratory. Treat-to-target in atopic dermatitis should evolve beyond isolated thresholds towards an adaptable multidimensional strategy, followed by formal international consensus and prospective validation.