Definition of the Concept of Super-responders in Atopic Dermatitis: A Spanish Delphi Consensus

Abstract

A consensus study of experts was conducted to establish a definition of the concept of super-responders (SR) in atopic dermatitis (AD). The study employed a Delphi methodology based on 2 rounds to define the concept of SR in AD, exploring the opinions of expert dermatologists in AD from across Spain regarding a series of statements developed after a systematic review. Consensus was predefined as an agreement of ≥ 80% among all respondents. In the first round, 4 statements reached consensus. In the second round, 2 additional statements reached consensus. To illustrate these definitions, a set of practical cases was provided, and the level of agreement among experts was evaluated. According to the agreed statements, time is important when defining the achievable response as SR. The concept of SR should associate a rapid response (before week 16), include both symptom variables, such as the Eczema Area and Severity Index and Investigators Global Assessment (IGA) and patient-reported outcomes, including pruritus or the Patient-Oriented Eczema Measure. This concept should be associated with complete or nearly complete clearance of lesions (IGA 0–1), and with sustained responses over time (at week 52). Mild flares (IGA ≤2) may occur without varying according to the patient’s age.