Introduction <p>Treat-to-target (T2T) is a clinical paradigm intended to improve disease outcomes using measurement-based goals. Various groups of dermatologists have made T2T recommendations for managing moderate-to-severe atopic dermatitis (AD). These are based primarily on expert opinion, and their relevance for real-world outcomes has received limited attention. The objective of the present analysis was to assess the relevance of Canadian T2T criteria for moderate-to-severe AD in real-world practice by describing the agreement between achieving criteria and treatment decisions.</p> Methods <p>Canadian dermatologists conducted retrospective chart reviews of adult patients with moderate-to-severe AD treated with an advanced systemic therapy (AST) in clinical practice. T2T criteria were applied to patient outcomes and treatment decisions were reported.</p> Results <p>Charts were reviewed for 297 patients who were assessed a combined 503 times over up to 1 year of treatment. Treatment modifications were made in less than 10% (38/425, 9%) of cases where patients met target and more than half (41/78, 53%) where they missed target. For patients missing target, switching AST was the most common modification.</p> Conclusions <p>Treatment decisions were generally aligned with the retrospectively applied Canadian T2T criteria. While these results require further validation, they suggest that the T2T criteria represent valid thresholds for clinical decision-making.</p>