Treat-to-Target in Clinical Practice: Evaluating Real-World Achievement Rates Against Consensus Guidelines for Atopic Dermatitis

Introduction: Treat-to-target (T2T) strategies have been adopted in atopic dermatitis (AD) management, which defines specific moderate/acceptable and optimal targets for reducing disease severity. However, real-world evidence on the achievement rates of these targets remains limited. Methods: This prospective observational study enrolled patients with moderate-to-severe AD without treatment protocol modifications. Disease severity was longitudinally assessed using 5-point Patient Global Impression of Severity (PGIS-5), Peak Pruritus Numerical Rating Scale (pp-NRS), Dermatology Life Quality Index (DLQI), Patient-Oriented Eczema Measure (POEM), Body Surface Area (BSA), Eczema Area and Severity Index (EASI), and Scoring Atopic Dermatitis (SCORAD) at baseline and weeks 2, 4, 8, and 16. Treatment responses were compared against two established T2T frameworks: the T2T consensus (de Bruin-Weller et al.) and Aiming High in Eczema/Atopic Dermatitis (AHEAD) recommendations (Silverberg et al.). Target feasibility was evaluated through achievement rates, with thresholds calibrated to balance timely clinical response. Results: Sixty-one patients with moderate-to-severe AD were enrolled. All outcomes measured showed significant improvement over the 16-week observation period. SCORAD50, EASI50, pp-NRS reduction ≥ 3/4, and DLQI reduction ≥ 4 demonstrated appropriate moderate target feasibility. SCORAD75, EASI75/90, pp-NRS ≤ 1, BSA ≤ 2%, and DLQI 0/1 were suitable as optimal targets. Percentage improvements of EASI and SCORAD were more reliable than absolute values. Current targets for PGIS-5 (reduction ≥ 1), POEM (reduction ≥ 4), and BSA (50% improvement) in the moderate category and PGIS-5 ≤ 2 and POEM ≤ 7 in the optimal category may require stricter criteria. Conclusion: Our finding reflects the real-world achievement rate of the current T2T consensus, suggesting that higher thresholds may be warranted in future refinements of T2T strategies.