A 50% decrease in Eczema Area and Severity Index (EASI 50), 35% decrease in Scoring Atopic Dermatitis (SCORAD 35), and 35% decrease in objective SCORAD (O-SCORAD 35) appear to be the most meaningful clinical end points for these measures in patients with atopic dermatitis (AD), researchers reported in a study published in the British Journal of Dermatology.
The investigators sought to determine the minimal important change (MIC) of percentage and absolute improvement of EASI and SCORAD scores in adults and children with AD. The prospective study used questionnaires and evaluations by a dermatologist and an anchor-based approach to determine thresholds for the percentage and absolute MICs.
A total of 826 patients (aged 8.8 to 96.8 years; 52.5% women; 55.3% White) with AD were assessed at follow-up (mean ± SD time to follow-up: 4.1 ± 5.2 months). The mean ±SD age at enrollment was 42.6 ± 19.3 years.
The researchers found that 1-grade improvements in Physician’s Global Assessment (PGA) and validated Investigator Global Assessment scale for AD (vIGA-AD) were associated with 50%, 35%, and 35% decreases of EASI, SCORAD, and O-SCORAD, respectively. Thresholds for percentage MIC of EASI (Kruskal–Wallis test, P = .61), SCORAD (P = .07), and O-SCORAD (P = .09) were similar in patients with mild, moderate, and severe baseline AD severity.
In addition, 1-grade improvements of PGA and vIGA-AD were associated with 14.0- and 14.9-point decreases of EASI, 19.9- and 14.9-point decreases of SCORAD, and 15.5- and 17.4-point decreases of O-SCORAD, respectively. Thresholds for the absolute MIC of EASI (P < .001), SCORAD (P < .001), and O-SCORAD (P < .001) differed significantly according to baseline AD severity. Improvements of AD symptoms and quality of life were associated with the percentage and absolute MICs for EASI and SCORAD.
Study limitations include that all patients were recruited from a single academic center, which may limit generalizability, and therefore additional studies are needed to confirm these findings in a population-based or multicenter cohort, according to the study authors.
“Improvements of 50%, 35% and 35% appear to be the most meaningful MICs for EASI, SCORAD and OSCORAD, respectively, and performed similarly among patients with mild, moderate and severe AD at baseline,” stated the researchers. “However, thresholds for absolute MIC of EASI, SCORAD and OSCORAD varied by baseline AD severity. As such, baseline AD severity should be considered when selecting an absolute MIC threshold for analysis.”
Silverberg JI, Lei D, Yousaf M, et al. What are the best endpoints for eczema area and severity index and scoring atopic dermatitis in clinical practice? A prospective observational study [published online August 5, 2020]. Br J Dermatol. doi: 10.1111/bjd.19457