IEC Establishes Global Definitions for AD Disease Control and Remission

Key Takeaways

• The International Eczema Council (IEC) established consensus definitions for low disease activity, very low disease activity, and remission in atopic dermatitis.
• The framework integrates clinician- and patient-reported outcomes, including vIGA-AD, EASI, and pruritus scores.
• Standardized definitions aim to improve clinical trial comparability and support treat-to-target strategies.

A new consensus statement from the International Eczema Council (IEC) proposes standardized definitions for low disease activity (LDA), very low disease activity (vLDA), and remission in atopic dermatitis (AD), addressing what authors noted as a longstanding gap in harmonized outcome measures across clinical trials and practice. 

The IEC conducted a targeted systematic review (2004 to 2024) and a 3-round modified Delphi process involving global AD experts to define clinically meaningful thresholds. Among 151 invited participants, 103 completed the final round, representing diverse geographic regions and professional roles. Consensus definitions incorporated both clinician-reported signs and patient-reported symptoms.

LDA was defined as validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD) score of 2 or Eczema Area and Severity Index (EASI) ≤7, plus Peak Pruritus Numerical Rating Scale (PP-NRS) ≤4. Very low disease activity requires vIGA-AD 0/1 or EASI ≤3 with PP-NRS 0/1. The group also defined “on-drug complete control” (vIGA-AD 0 or EASI 0 with minimal pruritus sustained ≥6 months while on therapy) and “off-drug remission” (similar thresholds maintained ≥12 months after treatment discontinuation).

Most panelists (74%) endorsed a modular framework separating signs and symptoms of remission. Cited limitations included variable participation across Delphi rounds and reliance on expert consensus rather than prospective validation.

"This modified Delphi initiative establishes a globally endorsed, expert-derived framework defining LDA, vLDA, on-drug complete control, and off-drug remission in AD," the authors wrote. "These standardized, clinically meaningful definitions provide a foundation for harmonized trial design, regulatory evaluation, and longitudinal comparative effectiveness research. By promoting consistent assessment of disease control across studies, this framework advances the field toward evidence-based, treat-to-target AD strategies."

Sources:

Merola JF, et al. JAMA Dermatol. Published online April 15, 2026. doi:10.1001/jamadermatol.2026.0662