Title: Understanding Patient Journey in Ulcerative Colitis Prior to Biologic Initiation: A 5-Year
Exploration
Version: 3 Date: 20 Jan 2021
Reviewer's report:
Wang et al. investigated the pre-biologic treatments of UC patients in association with health
care utilization patterns using a real-world healthcare database. Within 5 years prior to biologics,
the authors found an increasing dose and duration of systemic corticosteroid treatment which was
accompanied by an increased frequency of health care visits. Based on the results, the authors
concluded that a better risk stratification is needed to help identify patients for more timely
biologic treatment.
Major comments;
1. When the authors think is the best to start biologic treatment for potentially high-risk
(increased morbidity and health care utilization) patients based on their data?
In the Introduction, the authors discuss the potential importance of “early” biologic treatment in
a group of high-risk UC patients by comparing with CD. In CD, this usually means top-down
therapy which starts biologic treatment instead of steroids. These description (Line from 60 to
73 of Page 4) imply that some UC patients would require top-down therapy like CD. Otherwise,
do the authors mean to avoid multiple rounds of steroids before biologic treatment?
2. Is there any difference in the patient character between those who experienced treatment
burden (e.g. longer steroid duration and/or frequent health care visit) and those who did not?
Some difference might be helpful to identify patients for more “timely” biologic treatment.
Minor comments;
1. On line 137 of Page 7, “Figure 1” will be “Table 1” because there is no Figure 1 in this
manuscript.
Title: Understanding Patient Journey in Ulcerative Colitis Prior to Biologic Initiation: A 5-Year
Exploration
Version: 3 Date: 20 Jan 2021
Reviewer's report:
Wang et al. investigated the pre-biologic treatments of UC patients in association with health
care utilization patterns using a real-world healthcare database. Within 5 years prior to biologics,
the authors found an increasing dose and duration of systemic corticosteroid treatment which was
accompanied by an increased frequency of health care visits. Based on the results, the authors
concluded that a better risk stratification is needed to help identify patients for more timely
biologic treatment.
Major comments;
1. When the authors think is the best to start biologic treatment for potentially high-risk
(increased morbidity and health care utilization) patients based on their data?
In the Introduction, the authors discuss the potential importance of “early” biologic treatment in
a group of high-risk UC patients by comparing with CD. In CD, this usually means top-down
therapy which starts biologic treatment instead of steroids. These description (Line from 60 to
73 of Page 4) imply that some UC patients would require top-down therapy like CD. Otherwise,
do the authors mean to avoid multiple rounds of steroids before biologic treatment?
2. Is there any difference in the patient character between those who experienced treatment
burden (e.g. longer steroid duration and/or frequent health care visit) and those who did not?
Some difference might be helpful to identify patients for more “timely” biologic treatment.
Minor comments;
1. On line 137 of Page 7, “Figure 1” will be “Table 1” because there is no Figure 1 in this
manuscript.
Please review this paper.
user
Title: Understanding Patient Journey in Ulcerative Colitis Prior to Biologic Initiation: A 5-Year
Exploration
Version: 3 Date: 20 Jan 2021
Reviewer's report:
Wang et al. investigated the pre-biologic treatments of UC patients in association with health
care utilization patterns using a real-world healthcare database. Within 5 years prior to biologics,
the authors found an increasing dose and duration of systemic corticosteroid treatment which was
accompanied by an increased frequency of health care visits. Based on the results, the authors
concluded that a better risk stratification is needed to help identify patients for more timely
biologic treatment.
Major comments;
1. When the authors think is the best to start biologic treatment for potentially high-risk
(increased morbidity and health care utilization) patients based on their data?
In the Introduction, the authors discuss the potential importance of “early” biologic treatment in
a group of high-risk UC patients by comparing with CD. In CD, this usually means top-down
therapy which starts biologic treatment instead of steroids. These description (Line from 60 to
73 of Page 4) imply that some UC patients would require top-down therapy like CD. Otherwise,
do the authors mean to avoid multiple rounds of steroids before biologic treatment?
2. Is there any difference in the patient character between those who experienced treatment
burden (e.g. longer steroid duration and/or frequent health care visit) and those who did not?
Some difference might be helpful to identify patients for more “timely” biologic treatment.
Minor comments;
1. On line 137 of Page 7, “Figure 1” will be “Table 1” because there is no Figure 1 in this
manuscript.
assistant