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Measuring Atopic Eczema Control and Itch Intensity in Clinical PracticeA Consensus Statement From the Harmonising Outcome Measures for Eczema in Clinical Practice (HOME-CP) Initiative

To identify the key insights or developments described in this article
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Key Points

Question  What instruments are recommended to measure eczema control and itch intensity in patients with atopic eczema in clinical practice?

Findings  Based on a consensus process informed by systematic reviews, the Recap of Atopic Eczema (RECAP) and Atopic Dermatitis Control Tool (ADCT) were recommended to measure long-term control in eczema in clinical practice. Recommended itch-intensity instruments were a peak 24-hour numeric rating scale (NRS)-itch and peak and average 1-week NRS-itch instruments from the Patient-Reported Outcomes Measurement Information System (PROMIS) Itch Questionnaire.

Meaning  Clinicians should consider using these simple, validated instruments when treating patients with atopic eczema, to support clinical care, real-world studies, and quality-of-care assessments.


Importance  Measuring outcomes in clinical practice can aid patient care, quality improvement, and real-world evidence generation. The Harmonising Outcome Measures for Eczema (HOME) Clinical Practice initiative is developing a list of validated, feasible instruments to measure atopic eczema in clinical care. Prior work identified symptoms and long-term control as the most important domains to measure in clinical practice. The Patient-Oriented Eczema Measure (POEM) and the Patient-Oriented Scoring Atopic Dermatitis Index (PO-SCORAD) were recommended by consensus to measure symptoms in clinical practice, but a need for instruments to measure itch intensity specifically was recognized. The HOME group also previously decided that long-term control should be captured by repeated measurements of eczema control. Recommended instruments to measure eczema control in clinical practice have not been defined.

Objective  To recommend instruments to measure eczema control and itch intensity in patients with atopic eczema in clinical practice.

Evidence Review  Available instruments to measure eczema control and itch intensity were identified through systematic reviews, informing a consensus process held at the HOME VIII virtual online meeting (October 6 and October 9, 2020). Feasibility aspects were highlighted to optimize instrument selection for the clinical practice. Consensus on an instrument was reached if fewer than 30% of the voters disagreed.

Findings  Of 7 identified instruments, the Recap of Atopic Eczema (RECAP) and Atopic Dermatitis Control Tool (ADCT) were the recommended instruments to measure eczema control (3 of 63 [5%] and 7 of 69 [10%] of voters disagreed, respectively). A single-question patient global assessment garnered support, but the current available instrument did not reach consensus. Six available itch-intensity instruments were identified. Of them, 3 instruments were recommended by consensus: a peak 24-hour numeric rating scale (NRS)-itch, and 1-week NRS-itch instruments from the Patient-Reported Outcomes Measurement Information System (PROMIS) Itch Questionnaire, measuring average and peak itch (11 of 63 [17%], 14 of 63 [22%], and 16 of 59 [27%] voters disagreed, respectively).

Conclusions and Relevance  Clinicians and patients are encouraged to incorporate these well-validated, quick-to-perform, and easy-to-use instruments into their clinic, selecting the instruments that best fit their need. These assessments are meant to enhance, not replace, the patient–clinician encounter, and to support real-world research and health care improvement.

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Article Information

Accepted for Publication: August 9, 2022.

Published Online: October 12, 2022. doi:10.1001/jamadermatol.2022.4211

Corresponding Author: Yael A. Leshem, MD, MCR, Division of Dermatology, Rabin Medical Center, Beilinson Hopsital, 39 Zabotinsky St, Petah Tikva, Israel (yael.leshem@gmail.com).

Author Contributions: Dr Leshem had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Leshem, Chalmers, Apfelbacher, Katoh, Gerbens, Schmitt, Thomas, Williams.

Acquisition, analysis, or interpretation of data: Leshem, Chalmers, Apfelbacher, Katoh, Gerbens, Spuls, Howells, Williams, Simpson.

Drafting of the manuscript: Leshem, Katoh, Thomas.

Critical revision of the manuscript for important intellectual content: Chalmers, Apfelbacher, Katoh, Gerbens, Schmitt, Spuls, Howells, Williams, Simpson.

Statistical analysis: Leshem, Simpson.

Administrative, technical, or material support: Leshem, Chalmers, Katoh, Spuls.

Supervision: Apfelbacher, Katoh, Spuls, Thomas.

Conflict of Interest Disclosures: Dr Leshem reported grants from AbbVie; personal fees from AbbVie, Sanofi, Pfizer, Janssen, Genentech, Regeneron Pharmaceuticals, and Dexcel Pharma; and investigator services without personal compensation for Eli Lilly, Pfizer, and AbbVie outside the submitted work. Dr Apfelbacher reported grants and personal fees from Dr Wolff Group and Bionorica and personal fees from Sanofi and LEO Pharma outside the submitted work; and Dr Apfelbacher was involved in the group developing the RECAP instrument. Dr Katoh reported grants from Sun Pharma, Boehringer Ingelheim Japan, Mitsubishi Tanabe Pharma, and Eisai; grants and personal fees from Maruho, Eli Lilly Japan, Taiho Pharmaceutical, Torii Pharmaceutical, Kyowa Kirin, Sanofi, Janssen Pharma, AbbVie, LEO Pharma; and personal fees from Celgene Japan outside the submitted work. Dr Schmitt reported grants from Novartis, Pfizer, Sanofi, ALK, and Lilly (institutional grants for investigator-initiated trials) and personal fees from Sanofi, ALK, Lilly, and Novartis for advisory board participation outside the submitted work. Dr Spuls reported receiving departmental independent research grants for the systemic and phototherapy atopic eczema registry (TREAT NL) registry from pharmaceutical companies since December 2019, being involved in performing clinical trials with many pharmaceutical companies that manufacture drugs used for the treatment of (for example) psoriasis and atopic dermatitis, for which financial compensation was paid to the department/hospital, and is chief investigator of the TREAT NL registry for adults and children and one of the main investigators of the SECURE-AD registry; in addition, Dr Spuls was one of the investigators that developed the RECAP instrument for measuring long-term control in atopic dermatitis, all outside the submitted work. Dr Thomas reported involved in the development and validation of the RECAP questionnaire. Dr Howells reported personal fees from University of Oxford outside the submitted work and involvement in the development of the RECAP questionnaire (authors retain copyright). Dr Williams reported codevelopment of the POEM scale used for assessing AE symptoms. Dr Simpson reported personal fees from AbbVie, Amgen, Arena Pharmaceuticals, Aslan Pharma, Benevolent AI Bio Limited (“BAI”), BiomX Ltd, Bluefin Biomedicine Inc, Boehringer Ingelheim, Boston Consulting Group, Collective Acumen, Coronado, Dermira, Eli Lilly, Evidera, Excerpta Medica, Galderma, GlaxoSmithKline, Forte Bio RX, Incyte Dermatologics, Janssen, Kyowa Kirin, LEO Pharma, Merck, Novartis, Ortho Galderma, Pfizer, Physicians World LLC, Pierre Fabre Dermo-Cosmetique, Regeneron, Roivant, Sanofi Genzyme, SPARC India, Trevi Therapeutics, and Valeant, and grants from AbbVie, Amgen, Arcutis, Aslan, Castle Biosciences, Celgene, CorEvitas, Dermavant, Dermira, Eli Lilly, Galderma, Incyte, Kymab, Kyowa Hakko Kirin, LEO Pharma, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, and TARGET-DERM outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by the Oregon Health & Science University (OHSU) Department of Dermatology.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: HOME VIII meeting attendees are listed in Supplement 2.

Additional Contributions: The authors would like to acknowledge the diligent administrative and technical support from Rebecca Field, BSB, and Joseph Kirkland, BFA, both of OHSU. They did not receive additional compensation beyond their OHSU salaries for their contributions. The OHSU Department of Dermatology funded the technical platform and technical support for conducting the virtual HOME meetings.

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