What Are The Best Endpoints For Eczema Area And Severity Index And Scoring Atopic Dermatitis In Clinical Practice? A Prospective Observational Study

Background Multiple strategies have been used to evaluate the minimal important change (MIC) of the Eczema Area and Severity Index (EASI) and Scoring Atopic Dermatitis (SCORAD). The meaningfulness of these MICs is not well established across all severities of atopic dermatitis (AD). Objectives To determine the MIC of percentage and absolute improvement of EASI and SCORAD scores in adults and children with AD. Methods We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 826). An anchor-based approach was used to determine thresholds for the percentage and absolute MICs of EASI, SCORAD and objective SCORAD (O-SCORAD) at follow-up from baseline. Results One-grade improvements of 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. The thresholds for percentage MIC of EASI (Kruskal-Wallis test,P = 0 center dot 61), SCORAD (P = 0 center dot 07) and O-SCORAD (P = 0 center dot 09) were similar across baseline AD severities. One-grade improvements of PGA and vIGA-AD were associated with 14 center dot 0- and 14 center dot 9-point decreases of EASI, 19 center dot 9- and 14 center dot 9-point decreases of SCORAD, and 15 center dot 5- and 17 center dot 4-point decreases of O-SCORAD. The thresholds for the absolute MIC of EASI (P < 0 center dot 001), SCORAD (P < 0 center dot 001) and O-SCORAD (P < 0 center dot 001) significantly differed by baseline AD severity. Percentage and absolute MICs for EASI and SCORAD were associated with improvements of AD symptoms and quality of life. Conclusions EASI 50, SCORAD 35 and O-SCORAD 35 were meaningful percentage MICs regardless of baseline AD severity. The absolute MICs for EASI, SCORAD and O-SCORAD varied by baseline AD severity.