Minimal Disease Activity Linked to Fewer Flares, Health Care Visits in Atopic Dermatitis

Key Clinical Summary:  

• Adults with moderate-to-severe atopic dermatitis (AD) who achieved minimal disease activity (MDA) experienced fewer and shorter disease flares than patients who did not meet MDA targets.
• Patients meeting neither optimal clinician-reported nor patient-reported targets had 2.2 to 2.7 times as many AD-related health care visits as patients who achieved MDA.
• Only 6.2% to 10.5% of patients achieved MDA, depending on the definition used, highlighting an opportunity to improve disease monitoring and treat-to-target management. 

Achieving MDA was associated with fewer disease flares, lower health care resource utilization, and greater perceived disease control among adults with moderate-to-severe AD, according to a real-world analysis of patients across 28 countries. The findings suggest that combining clinician-reported outcomes (ClinROs) with patient-reported outcomes (PROs) may provide a more comprehensive measure of treatment success and identify patients with lower ongoing health care needs.

Evaluating a Holistic Treatment Target

AD is a chronic inflammatory disease characterized by recurrent flares that can affect patients' physical and psychosocial well-being and generate additional health care utilization.

The Aiming High in Eczema/Atopic Dermatitis initiative established optimal ClinRO and PRO targets, with MDA defined as the simultaneous achievement of at least 1 optimal ClinRO and at least 1 optimal PRO.

Researchers conducted a retrospective post hoc analysis of the real-world, cross-sectional MEASURE-AD study to examine whether meeting these targets was associated with clinically and economically relevant outcomes.

The analysis included 1434 adults with moderate-to-severe AD. Mean age was 39.1 years, 52.2% were male, and mean disease duration was 23.7 years. Nearly all patients (98.4%) were receiving AD treatment, and 56.7% were receiving systemic therapy alone or in combination with other treatments.

Investigators evaluated 3 definitions of MDA combining an Eczema Area and Severity Index (EASI) score of 3 or lower with an optimal score on the Worst Pruritus Numerical Rating Scale (WP-NRS), Dermatology Life Quality Index (DLQI), or Patient-Oriented Eczema Measure (POEM).

10.5% achieved MDA according to the EASI plus WP-NRS definition, 9.2% according to EASI plus DLQI, and 6.2% according to EASI plus POEM.

MDA Associated With Fewer, Shorter Flares

Across the 3 definitions, patients achieving MDA reported a mean of 0.8 to 1.4 AD flares during the preceding 6 months. Patients who did not achieve MDA reported means ranging from 3.8 to 9.8 flares.

Differences were particularly pronounced when neither the optimal ClinRO nor PRO target was achieved. These patients experienced an average of 5.5 to 5.7 more flares during 6 months than patients achieving MDA, representing a 4.9- to 7.9-fold increase. Extrapolated over 1 year, this corresponded to approximately 11.0 to 11.5 additional flares.

MDA was also associated with shorter flares. The proportion of patients reporting flares lasting longer than 7 days ranged from 9.9% to 13.4% among MDA groups compared with 26.4% to 51.1% across groups that did not achieve MDA.

Health Care Utilization Lower Among Patients Achieving MDA

Patients who achieved MDA reported fewer than 2 mean AD-related health care visits over the preceding 6 months, ranging from 1.5 to 1.8 visits depending on the MDA definition.

Among patients who did not achieve MDA, mean utilization ranged from 1.8 to 4.1 visits.

Patients who met neither an optimal ClinRO nor PRO target had 2.2 to 2.6 additional health care visits during 6 months, representing 2.2 to 2.7 times the mean utilization among patients achieving MDA. The investigators estimated that this difference could correspond to approximately 4.3 to 5.1 additional AD-related visits annually.

Patients Report Greater Disease Control

Differences were also observed in patients' perceptions of treatment effectiveness.

Among patients achieving MDA, 86.7% to 94.2% completely agreed that their current treatment effectively controlled their AD. The proportion varied from 19.2% to 74.1% among patients who did not achieve MDA.

The lowest rates of perceived control occurred among patients who met neither the clinician- nor patient-reported optimal target, with only 19.2% to 20.8% completely agreeing that their disease was effectively controlled.

Implications for Managed Care

The association between MDA and lower health care utilization may be particularly relevant for managed care organizations evaluating treatment outcomes in moderate-to-severe AD.

Traditional clinical measures alone may not fully reflect whether treatment is controlling the aspects of disease most important to patients. Combining objective disease severity with measures of symptoms and quality of life could provide a broader framework for evaluating treatment effectiveness.

The relatively small proportion of patients achieving MDA also indicates persistent unmet need. Although most patients in the study were receiving treatment and more than half were receiving systemic therapy, no more than 10.5% met any of the 3 MDA definitions evaluated.

Importantly, the study was a retrospective post hoc analysis of cross-sectional observational data. The findings demonstrate associations and cannot establish that achieving MDA caused reductions in flares or health care utilization. The 6-month patient recall period may also have introduced recall bias.

Conclusion

Adults with moderate-to-severe AD who simultaneously achieved optimal clinician- and patient-reported treatment targets experienced fewer and shorter flares, used fewer AD-related health care services, and reported greater disease control. The findings support further evaluation of MDA as a holistic treatment target that could help clinicians and managed care stakeholders assess both clinical disease activity and outcomes meaningful to patients.

Reference

Silverberg, JI, Prajapati VH, Abraham S, et al. Achieving minimal disease activity in atopic dermatitis Is associated with fewer flares, reduced healthcare resource utilization, and improved disease control: analysis from the real-world MEASURE-AD study. Dermatol Ther. 2026;16:4617–4630. doi:10.1007/s13555-026-01865-0