RESEARCH LETTER

Clinically Meaningful Improvement in Atopic Dermatitis According to Treatment Type in a Real-World Cohort

Emanuel CHEW BONILLA^1*, Yazmín Xurami VEGA-DEL PILAR¹, Eduardo VILCHIS CHAPARRO² and Alicia LEMINI LÓPEZ¹

¹Department of Dermatology, Hospital de Especialidades “Dr. Bernardo Sepúlveda Gutiérrez”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico, and ²Center for Educational Research and Faculty Development, Hospital de Especialidades “Dr. Bernardo Sepúlveda Gutiérrez”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico. ^*Email: aleminil65@gmail.com

 

 

To the Editor,

Interpretation of treatment response in atopic dermatitis (AD) frequently relies on statistically significant changes in severity scores, yet such changes do not necessarily reflect improvement meaningful to patients. Minimal clinically important differences (MCID) have been defined for validated instruments, including reductions of approximately 8 points in SCORAD and 4 points in the Dermatology Life Quality Index (DLQI) (1, 2). AD is a heterogeneous inflammatory disease with substantial quality-of-life burden, underscoring the importance of patient-centred outcome measures (3, 4). Data examining clinically meaningful improvement in real-world practice remain limited.

We performed a retrospective cohort study of adults with AD followed at a tertiary dermatology referral centre in Mexico. Patients ≥18 years with documented baseline and follow-up SCORAD and DLQI assessments were included. Baseline values corresponded to the visit prior to treatment initiation or modification; follow-up values were obtained at the most recent routine visit. Clinically meaningful improvement was defined as a decrease of ≥8.7 points in SCORAD and ≥4 points in DLQI (1, 2). Patients were categorised as receiving targeted systemic therapy (biologics or Janus kinase inhibitors) or nontargeted therapy (topical therapy and/or conventional systemic immunosuppressants). Associations were analysed using Fisher exact test, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Analyses were performed using SPSS version 29. The study was approved by the institutional review board (IMSS approval No. R-2024-3601-240).

Forty-one patients were included (median age 33 years [IQR 24–50]; 53.7% female). Baseline median DLQI was 15 (IQR 6.5–17.5) and SCORAD 41.4 (IQR 25.9–52.3), consistent with moderate-to-severe disease. Application of MCID thresholds demonstrated marked differences according to treatment type. Clinically meaningful improvement in DLQI occurred in 16 of 26 patients (61.5%) receiving targeted systemic therapy compared with 3 of 15 (20.0%) receiving nontargeted therapy (OR 6.40, 95% CI 1.44–28.44; p=0.021). Clinically meaningful improvement in SCORAD was observed in 19 of 26 patients (73.0%) in the targeted group versus 1 of 15 (6.7%) in the nontargeted group (OR 38.00, 95% CI 4.18–345.06; p<0.001) (Table I).

Table I. Clinically meaningful improvement according to treatment type

Outcome	Targeted systemic therapy (n=26)	Nontargeted therapy (n=15)	OR (95% CI)	p-value
DLQI improvement ≥4 points, n (%)	16 (61.5%)	3 (20.0%)	6.40 (1.44–28.44)	0.021
SCORAD improvement ≥8.7 points, n (%)	19 (73.0%)	1 (6.7%)	38.00 (4.18–345.06)	<0.001
Odds ratios (OR) were calculated using Fisher exact test. CI: confidence interval; DLQI: Dermatology Life Quality Index; SCORAD: Scoring Atopic Dermatitis.

These findings align with clinical trials and real-world studies demonstrating the effectiveness of biologics and JAK inhibitors in moderate-to-severe AD (5, 6, 7, 8). Importantly, our data indicate that MCID-based thresholds enhance interpretation of therapeutic response in routine care settings characterized by heterogeneity in disease severity and prior treatment exposure. Analyses based solely on aggregate score changes may underestimate clinically relevant benefit at the individual level.

Limitations include the retrospective single-centre design, limited sample size and absence of multivariable adjustment. Treatment allocation was not randomized, and residual confounding cannot be excluded. Never-theless, the magnitude and consistency of associations across both severity and quality-of-life instruments support the clinical relevance of these findings.

In conclusion, application of clinically meaningful thresholds reveals substantial treatment-associated differences in AD that may remain undetected when relying exclusively on conventional score comparisons. Targeted systemic therapy was strongly associated with clinically meaningful improvement in both disease severity and quality of life in routine clinical practice.

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