Reviewer's report
Title:Long-term follow-up with leukocytapheresis re-treatment in patients with
chronically active inflammatory bowel disease
Version: 2Date:5 May 2010
Reviewer: Eugeni EDM Domenech
Reviewer's report:
- The fact that 21 out of 25 CD patients had extensive colonic disease, and only
3/25 had small bowel involvement cannot be explained in the Discussion as this
"may indicate a higher risk for CD patients with colonic inflammation to become
chronic". Maybe, the authors preferred to try apheresis before performing a total
proctocolectomy with ileostomy. As the authors state in their comments, "this
reflection remains speculative", and many other hypothesis should be taken into
account.
- Table 2: explanations about statistical signficance are not clear as far as the
authors indicate the variable but not at which time (before tx, 10 weeks after tx,
20 weeks after tx) was the difference significant between groups (responders,
non-responders,...).
- Conclusion: I agree with the authors that feasibility and tolerance were
excellent. However, can it be stated that GMA did not induce "dependency" when
most patients relapsed soon after treatment discontinuation (wihtin the first 6
months as seen in the survival curves) and responded when treatment was
re-introduced? Isn't it the definition for steroid-dependency? In my opinion, the
main conclusion should be that scheduled maintenance therapy with GMA
should be evaluated in CD patients with chronic disease activity who respond to
an initial GMA course.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Reviewer's report
Title:Long-term follow-up with leukocytapheresis re-treatment in patients with
chronically active inflammatory bowel disease
Version: 2Date:5 May 2010
Reviewer: Eugeni EDM Domenech
Reviewer's report:
- The fact that 21 out of 25 CD patients had extensive colonic disease, and only
3/25 had small bowel involvement cannot be explained in the Discussion as this
"may indicate a higher risk for CD patients with colonic inflammation to become
chronic". Maybe, the authors preferred to try apheresis before performing a total
proctocolectomy with ileostomy. As the authors state in their comments, "this
reflection remains speculative", and many other hypothesis should be taken into
account.
- Table 2: explanations about statistical signficance are not clear as far as the
authors indicate the variable but not at which time (before tx, 10 weeks after tx,
20 weeks after tx) was the difference significant between groups (responders,
non-responders,...).
- Conclusion: I agree with the authors that feasibility and tolerance were
excellent. However, can it be stated that GMA did not induce "dependency" when
most patients relapsed soon after treatment discontinuation (wihtin the first 6
months as seen in the survival curves) and responded when treatment was
re-introduced? Isn't it the definition for steroid-dependency? In my opinion, the
main conclusion should be that scheduled maintenance therapy with GMA
should be evaluated in CD patients with chronic disease activity who respond to
an initial GMA course.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Please review this paper.
user
Reviewer's report
Title:Long-term follow-up with leukocytapheresis re-treatment in patients with
chronically active inflammatory bowel disease
Version: 2Date:5 May 2010
Reviewer: Eugeni EDM Domenech
Reviewer's report:
- The fact that 21 out of 25 CD patients had extensive colonic disease, and only
3/25 had small bowel involvement cannot be explained in the Discussion as this
"may indicate a higher risk for CD patients with colonic inflammation to become
chronic". Maybe, the authors preferred to try apheresis before performing a total
proctocolectomy with ileostomy. As the authors state in their comments, "this
reflection remains speculative", and many other hypothesis should be taken into
account.
- Table 2: explanations about statistical signficance are not clear as far as the
authors indicate the variable but not at which time (before tx, 10 weeks after tx,
20 weeks after tx) was the difference significant between groups (responders,
non-responders,...).
- Conclusion: I agree with the authors that feasibility and tolerance were
excellent. However, can it be stated that GMA did not induce "dependency" when
most patients relapsed soon after treatment discontinuation (wihtin the first 6
months as seen in the survival curves) and responded when treatment was
re-introduced? Isn't it the definition for steroid-dependency? In my opinion, the
main conclusion should be that scheduled maintenance therapy with GMA
should be evaluated in CD patients with chronic disease activity who respond to
an initial GMA course.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
assistant