Title: Relapse rate and predictors of relapse after cessation of glucocorticoid maintenance
therapy in type 1 autoimmune pancreatitis: a multicenter retrospective study
Version: 2 Date: 21 Jul 2023
Reviewer's report:
I have read with interest the article from Kiyoshita et al on relapse rate of AIP patients after
glucocorticoids withdrawal. The article is of interest as it covers a gap in the literature as the
need for maintenance therapy is still debated and its role in preventing relapse after withdrawal
is unknown. The authors report a relapse rate of  almost50% after treatment withdrawal that
is unrelated to the lenght of manteinance treatment.  Most of relapses occured within 1 year
from GC withrawal. Interestingly, elevated serum IgG4 level at the time of treatment withdrawal
represented the only independent risk factor for AIP relapse.
I have few comments:
- introduction could be shortened and english language slightly improved;
- ref 12 basically provide evidence for the relapse rate after GC withdrawal (page 7 line 8-9),
so this should be rephrased.
- can the authors provide data on the prevalence of endocrine and exocrine insufficiency at
baseline and at follow up? Is there any differences among the three groups?
- were all patients in complete remission at the time of GC withdrawal?
- is there a linear trend between the lenght of maintenance treatment and relapse rate (time to
event analysis with lenght of GC therapy as covariate without clustering in the three groups).
- is the median cumulative GC dose-per patient available in the three groups?
- the first paragraph of the result session could be shortened as many of the lines refer to Table
1 and it is quite redundant to report each feature.
- can the authors compare and report the  time to relapse with KM analysis within the three
stratus?
- i would cancelled the serum IgG4 level at the diagnosis from the multivariate analysis as it
could be colinear with the igg4 level at GC cessation. On the contrary, i would add 'previous
relapses' to this analysis.
- typo in table 2 (should be > 36 months and not '<').
Title: Relapse rate and predictors of relapse after cessation of glucocorticoid maintenance
therapy in type 1 autoimmune pancreatitis: a multicenter retrospective study
Version: 2 Date: 21 Jul 2023
Reviewer's report:
I have read with interest the article from Kiyoshita et al on relapse rate of AIP patients after
glucocorticoids withdrawal. The article is of interest as it covers a gap in the literature as the
need for maintenance therapy is still debated and its role in preventing relapse after withdrawal
is unknown. The authors report a relapse rate of  almost50% after treatment withdrawal that
is unrelated to the lenght of manteinance treatment.  Most of relapses occured within 1 year
from GC withrawal. Interestingly, elevated serum IgG4 level at the time of treatment withdrawal
represented the only independent risk factor for AIP relapse.
I have few comments:
- introduction could be shortened and english language slightly improved;
- ref 12 basically provide evidence for the relapse rate after GC withdrawal (page 7 line 8-9),
so this should be rephrased.
- can the authors provide data on the prevalence of endocrine and exocrine insufficiency at
baseline and at follow up? Is there any differences among the three groups?
- were all patients in complete remission at the time of GC withdrawal?
- is there a linear trend between the lenght of maintenance treatment and relapse rate (time to
event analysis with lenght of GC therapy as covariate without clustering in the three groups).
- is the median cumulative GC dose-per patient available in the three groups?
- the first paragraph of the result session could be shortened as many of the lines refer to Table
1 and it is quite redundant to report each feature.
- can the authors compare and report the  time to relapse with KM analysis within the three
stratus?
- i would cancelled the serum IgG4 level at the diagnosis from the multivariate analysis as it
could be colinear with the igg4 level at GC cessation. On the contrary, i would add 'previous
relapses' to this analysis.
- typo in table 2 (should be > 36 months and not '<').
Please review this paper.
user
Title: Relapse rate and predictors of relapse after cessation of glucocorticoid maintenance
therapy in type 1 autoimmune pancreatitis: a multicenter retrospective study
Version: 2 Date: 21 Jul 2023
Reviewer's report:
I have read with interest the article from Kiyoshita et al on relapse rate of AIP patients after
glucocorticoids withdrawal. The article is of interest as it covers a gap in the literature as the
need for maintenance therapy is still debated and its role in preventing relapse after withdrawal
is unknown. The authors report a relapse rate of  almost50% after treatment withdrawal that
is unrelated to the lenght of manteinance treatment.  Most of relapses occured within 1 year
from GC withrawal. Interestingly, elevated serum IgG4 level at the time of treatment withdrawal
represented the only independent risk factor for AIP relapse.
I have few comments:
- introduction could be shortened and english language slightly improved;
- ref 12 basically provide evidence for the relapse rate after GC withdrawal (page 7 line 8-9),
so this should be rephrased.
- can the authors provide data on the prevalence of endocrine and exocrine insufficiency at
baseline and at follow up? Is there any differences among the three groups?
- were all patients in complete remission at the time of GC withdrawal?
- is there a linear trend between the lenght of maintenance treatment and relapse rate (time to
event analysis with lenght of GC therapy as covariate without clustering in the three groups).
- is the median cumulative GC dose-per patient available in the three groups?
- the first paragraph of the result session could be shortened as many of the lines refer to Table
1 and it is quite redundant to report each feature.
- can the authors compare and report the  time to relapse with KM analysis within the three
stratus?
- i would cancelled the serum IgG4 level at the diagnosis from the multivariate analysis as it
could be colinear with the igg4 level at GC cessation. On the contrary, i would add 'previous
relapses' to this analysis.
- typo in table 2 (should be > 36 months and not '<').
assistant