Disease burden, clinical management and unmet treatment need of patients with moderate to severe atopic dermatitis; consensus statements, insights and practices from CERTADE (Central/Eastern EU, Russia, Turkiye AD Experts) Delphi panel
Multinational CEE + Turkish dermatologis… · 2024 · Türkiye
Source and licence
- Authors
- Magdalena Trzeciak, Lidia Rudnicka, Petr Arenberger et al.
- Title
- Disease burden, clinical management and unmet treatment need of patients with moderate to severe atopic dermatitis; consensus statements, insights and practices from CERTADE (Central/Eastern EU, Russia, Turkiye AD Experts) Delphi panel
- Journal
- Frontiers in Medicine, 2024
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC11220254
Licence statement of the original publication
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Disease severity
- AD patients with a minimum involvement of 10% BSA may be considered as moderate-to-severe AD.Consensus %: 92.6
- AD patients who have individual lesions with moderate-to-severe features may be considered as moderate-to-severe AD regardless of BSAConsensus %: 74.2
- Involvement of highly visible areas or those important for function (e.g., neck, face, genitals, palms and/or soles) in AD patients may be considered as moderate-to-severe AD regardless of BSAConsensus %: 85.1
- AD patients who have significantly impaired quality of life can be considered to have moderate-to-severe AD regardless of BSAConsensus %: 96.3
- Using systems that allow patients' self-assessment of disease severity, provides an ideal treatment approach by combining the patient's and physician's perspective in AD managementConsensus %: 91.5
- Common observations, perspectives and practices *Consensus %: %
Clinical practice
- Disease severity scale/scoring systems are not used as much as they should to evaluate AD patients in daily practice in my countryConsensus %: 88.8
- I use disease severity scoring systems to assess treatment response in ADConsensus %: 74
- The scoring system/s I prefer when estimating the severity of disease: SCORAD**(Experts from Czechia chose EASI as the most common, IGA-BSA and SCORAD the least common), EASI the second most common among all countries (66.6%)Consensus %: 74
- I need a more practical scoring system (ex: less time consuming, more inclusive of other factors rather than just BSA percentage) to assess severity of disease. ***Consensus %: 74.2
Treatment response
- Inadequate clinical improvement despite appropriate dose and duration of and adherence to a therapeutic agent can be defined as treatment failure.Consensus %: 100
- Failure to achieve stable long-term disease control despite appropriate dose and duration of and adherence to a therapeutic agent can be defined as treatment failureConsensus %: 92.6
- Presence of ongoing impairment (eg, pruritus, pain, loss of sleep, and poor quality of life) while on treatment despite appropriate dose and duration of and adherence to a therapeutic agent can be defined as treatment failure.Consensus %: 88.8
- Unacceptable adverse events or poor tolerability experienced with the treatment despite appropriate dose and duration of and adherence to a therapeutic agent can be defined as treatment failure.Consensus %: 81.4
- Response to treatment in AD patients should be assessed by disease severity scores (such as SCORAD, EASI, IGA etc.)Consensus %: 96.3
- There are no generally accepted criteria for defining treatment failure in AD patients.Consensus %: 92.6
Unmet need
- Topical therapies do not sufficiently cover the therapeutic needs of patients with moderate-to-severe AD.Consensus %: 92.6
- The current immune response modifiers do not sufficiently cover the therapeutic needs of patients with moderate-to-severe AD.Consensus %: 92.6
- There is a significant burden of adverse events with off-label use of currently available immunosuppressantsConsensus %: 85.2
- There is a significant unmet need for novel topical agents that offer prolonged remission and a safe side-effect profile in long-term moderate to severe AD treatment.Consensus %: 100
- There is a significant unmet need for novel systemic agents that offer prolonged remission and a safe side-effect profile in long-term moderate to severe AD treatment.Consensus %: 100
Clinical practice
- I use disease severity scoring systems to assess flares in AD.Consensus %: 70.3
Observations
- More than half of the children AD patients' families have topical steroid phobia.Consensus %: 74
- Families of child AD patients have more fears over systemic steroids' side effects than topical steroidsConsensus %: 85
Abstract
Background: There is limited insight into the current disease burden and everyday clinical management of moderate-to- severe AD in Poland, Czechia, Russia, and Turkiye. Therefore, this study aimed to get information-driven insights regarding the current disease burden and clinical management of patients with moderate-to-severe AD with common and differentiating aspects of the patient journey and establish a consensus.
Methods: In this modified 2-round Delphi panel, 133 questions were asked in total to 27 dermatologists. A consensus was achieved when 70% of the panel members strongly agreed or agreed (or strongly disagreed or disagreed) with an item. Statements with <40% agreement dropped from the Delphi rounds and were not repeated.
Results: The results state that AD has a significant impact on the quality of life for both patients and their families with social and economic consequences in these countries. While there were significant dissimilarities regarding the current treatment approach by preference order and treatment duration among participants, there was also a high percentage of consensus on literature and guideline-based statements. Current topical therapies and the immune response modifiers were not found to be sufficient by panelists to cover the therapeutic needs of patients with moderate-to-severe AD. Moreover, panelists highlighted the significant burden of adverse events with the off-label use of currently available immunosuppressants.
Conclusions: These results underlined that there is a significant disease burden with an unmet treatment need for patients with moderate-to-severe AD in Poland, Czechia, Russia, and Turkiye.
Contents of the original publication
The section headings of the original.
- Introduction
- Methods
- Study design
- Participants and process
- Results
- Questionnaire structure
- General results
- Disease burden
- Diagnosis and patient journey
- Disease severity
- Treatment
- Treatment response and unmet need
- Discussion
- Study limitations
A question about this guideline?
Medelix answers clinical questions from guidelines and studies – every statement with its source.
Are you the rights holder and object to this reproduction? Write to contact@medelix.ai and we will take the page down promptly. Imprint