Unmet Needs of Effective Advanced Systemic Therapies in Moderate-to-Severe Atopic Dermatitis Patients in the TARGET-DERM AD Registry

In the United States, 40-50% of patients with atopic dermatitis (AD) have moderate-to-severe disease, often necessitating advanced systemic therapies (ASTs; biologics or Janus kinase inhibitors). TARGET-DERM AD is an observational, longitudinal registry that tracks the natural history and treatment of AD, including patients with moderate-to-severe disease. Among enrollees, we defined 4 patient subgroups: AST-Naïve, AST-Retrospective (AST initiated prior to enrollment), AST-Prospective (AST initiated at or after enrollment), and AST-Failed (failed at any point). This analysis describes AST-patient demographics, treatment patterns, and longitudinal outcomes. Of 598 qualifying participants (22% adolescent, 78% adult), 34% were AST-Naive, 27% AST-Retrospective, 31% AST-Prospective, and 8% AST-Failed. Comparing the adult subgroups showed significant differences in enrollment age, and race/ethnicity, but not among adolescents. There was no significant difference in AST prescription rates. Literature-based validated thresholds were used to define unchanged or worsening for each outcome, which was combined into a single category, "lacked improvement." At 52 weeks of AST, AST-Prospective adolescents lacked improvement on Validated Investigator's Global Assessment of Atopic Dermatitis (vIGA-AD) (26%), body surface area (BSA) (34%), Numeric Rating Scale (NRS)-Pain (63%), and NRS-Sleep (52%); AST-Prospective adults lacked improvement on vIGA-AD (21%), BSA (51%), NRS-Pain (66%), and NRS-Sleep (60%). As one-third of participants did not progress to AST, and noteworthy proportions of patients lacked improvement, this study highlights unmet needs and treatment inadequacies in patients with moderate-to-severe AD.