Treat-to-Target in Atopic Dermatitis: An Italian Survey and Expert Opinion on Clinical Practice and Unmet Needs

Treat-to-target (T2T) strategies are increasingly used in atopic dermatitis (AD), although implementation remains heterogeneous in clinical practice. We aimed to investigate clinical practices, therapeutic priorities, and unmet needs in the long-term management of moderate-to-severe AD within a T2T framework. A 19-item survey was completed by 58 Italian dermatologists and 1 allergist, experienced in AD management. Topics included T2T implementation, therapeutic targets, clinician-reported outcomes (CROs), patient-reported outcomes (PROs), and treatment-selection criteria. Findings were discussed by an expert panel. Descriptive analyses were performed. In total, 59 physicians participated, with 58 completing the T2T-related sections. T2T goals were documented at every visit by 50.0% of respondents, while variability in the use of assessment tools was observed. Therapeutic targets became more ambitious over time, shifting from Eczema Area and Severity Index (EASI) 75, Dermatology Life Quality Index (DLQI) ≤ 5, and Pruritus Numerical Rating Scale (NRS) ≤ 4 at 3 months to EASI 90, DLQI 0–1, and Pruritus NRS 01 at 6 months. Time constraints (69.0%) and limited resources (36.2%) were the main barriers to T2T implementation. Safety/tolerability, clinical efficacy, and efficacy in sensitive areas were the leading treatment drivers, while response maintenance and dosing flexibility supported long-term disease management. Unmet needs included PRO integration, sensitive areas management, and long-term disease control. These findings reflect real-world clinical practice and highlight opportunities for more structured implementation of T2T strategies in AD. Long-term disease control requires therapies combining efficacy in sensitive areas, safety, and flexibility, while integrating clinician- and patient-reported treatment goals within a personalized approach. Atopic dermatitis (AD) is a chronic inflammatory skin disease that can cause severe itching and substantially affect quality of life. A treat-to-target (T2T) approach aims to improve disease management by setting specific treatment goals, regularly assessing progress, and adjusting treatment when needed. However, how T2T is used in everyday clinical practice is not consistent. This study explored how Italian specialists use T2T strategies for adults with moderate-to-severe AD and identified priorities and unmet needs in long-term treatment. A survey was completed by 59 physicians experienced in AD management, and the findings were subsequently discussed by an expert panel. Only half of respondents reported documenting T2T goals at every visit. Treatment goals became more ambitious over time, with clinicians aiming for greater improvements in skin symptoms, itching, and quality of life at 6 months than at 3 months. Lack of time and limited resources were the main barriers to implementing T2T. When choosing treatments, clinicians considered safety, efficacy, and the ability to control disease in sensitive areas particularly important. Maintaining long-term disease control and having flexibility in treatment administration were also key priorities. Important unmet needs included better management of sensitive areas and greater integration of patients’ perspectives into treatment assessment. Overall, the survey identified a need for more regular assessment and shared treatment goals, alongside the clinicians’ priorities for effective and safe treatment and a more personalized T2T approach to long-term AD management.