Treat-to-Target in Atopic Dermatitis: An Italian Survey and Expert Opinion on Clinical Practice and Unmet Needs.

INTRODUCTION Treat-to-target (T2T) strategies are increasingly used in atopic dermatitis (AD), although implementation remains heterogeneous in clinical practice. We aimed to investigate clinical practices, therapeutic priorities, and unmet needs in the long-term management of moderate-to-severe AD within a T2T framework.

Methods

A 19-item survey was completed by 58 Italian dermatologists and 1 allergist, experienced in AD management. Topics included T2T implementation, therapeutic targets, clinician-reported outcomes (CROs), patient-reported outcomes (PROs), and treatment-selection criteria. Findings were discussed by an expert panel. Descriptive analyses were performed.

Results

In total, 59 physicians participated, with 58 completing the T2T-related sections. T2T goals were documented at every visit by 50.0% of respondents, while variability in the use of assessment tools was observed. Therapeutic targets became more ambitious over time, shifting from Eczema Area and Severity Index (EASI) 75, Dermatology Life Quality Index (DLQI) ≤ 5, and Pruritus Numerical Rating Scale (NRS) ≤ 4 at 3 months to EASI 90, DLQI 0-1, and Pruritus NRS 01 at 6 months. Time constraints (69.0%) and limited resources (36.2%) were the main barriers to T2T implementation. Safety/tolerability, clinical efficacy, and efficacy in sensitive areas were the leading treatment drivers, while response maintenance and dosing flexibility supported long-term disease management. Unmet needs included PRO integration, sensitive areas management, and long-term disease control.

Conclusions

These findings reflect real-world clinical practice and highlight opportunities for more structured implementation of T2T strategies in AD. Long-term disease control requires therapies combining efficacy in sensitive areas, safety, and flexibility, while integrating clinician- and patient-reported treatment goals within a personalized approach.