A NEW multicentre real-world study highlights the feasibility of maintaining minimal disease activity (MDA) in adults with moderate-to-severe atopic dermatitis (AD) treated with biologics or JAK inhibitors, while identifying baseline factors linked to long-term sustainability.
MDA is emerging as a multidimensional therapeutic target in AD, combining both objective disease severity and patient-reported symptoms. In this study, MDA was defined as an Eczema Area and Severity Index (EASI) score ≤3 alongside a Pruritus Numerical Rating Scale (NRS) score ≤1, reflecting both skin clearance and itch control.
Researchers conducted a retrospective analysis across multiple centres, including 197 adults with available week 16 data. All patients were receiving advanced systemic therapies, including dupilumab, tralokinumab, or upadacitinib. At week 16, 107 patients (54.3%) achieved MDA.
Among the 59 patients with available week 52 follow-up data, 51 (86.4%) maintained MDA in a per-protocol analysis. These findings suggest that sustained disease control is achievable in a substantial proportion of early responders in routine clinical practice.
Predictors of Sustained Minimal Disease Activity for Atopic Dermatitis
Univariate analyses identified key baseline characteristics associated with maintaining MDA at one year. Patients without hand involvement were more likely to sustain minimal disease activity, as were those who had received fewer prior conventional systemic treatments. In contrast, younger age showed a trend toward association with MDA loss, although this did not reach statistical significance.
Notably, there were no significant differences in MDA sustainability according to gender, body mass index, baseline EASI score, or years of diagnostic delay.
Comparable Outcomes Across Advanced Therapies
Importantly, no statistically significant differences were observed in sustained MDA rates at week 52 between treatment groups, including dupilumab, tralokinumab, and upadacitinib. This suggests that long-term maintenance of minimal disease activity may depend more on patient characteristics than on the specific targeted therapy selected.
Clinical Implications
The findings support MDA as a realistic and clinically meaningful treatment goal in moderate-to-severe AD. Identifying patients most likely to maintain early response may help guide therapeutic decisions and optimise long-term disease control. However, prospective studies are needed to further validate predictive factors and refine treat-to-target strategies in atopic dermatitis.
Reference
Melgosa Ramos FJ et al. Minimal disease activity as a therapeutic goal in atopic dermatitis: predictive factors of sustainability in a multicenter cohort. Dermatol Ther (Heidelb). 2026;doi: 10.1007/s13555-026-01683-4.
Featured image: Evgeniia Primavera on Adobe Stock
