Title: VALIDATION OF DIAGNOSES OF LIVER DISORDERS IN USERS OF SYSTEMIC
ANTIFUNGAL MEDICATION IN SWEDEN
Version: 1 Date: 17 Oct 2023
Reviewer's report:
I read with interest the report from Giunta DH et al.
With this study, authors tried to characterize the possible link between azoles and liver
dysfunction within 6 months of onset. Following medical records review, PPV of 3 different
liver dysfunction diagnoses were diverse: low for toxic liver disease or hepatic failure; high for
jaundice.
Although interesting, results give rise to some questions:
- How did you select 150 from 335 patients?
- Definitions used of liver dysfunction were agreed based on which consensus?
- Why look only for azoles and not other antifungals?
- Were liver diagnoses defined to better reflect potential toxicity patterns of azoles?
- How can you account for liver disease arising after azole initiation but not related to that?
- What sort of malignancy do you report - liver related, other?
- There seems to be a potential association between discordance in liver diagnoses between
reviewers at the start and PPV at the end of the study - is this bias?
Overall, it would be nice to have more granular data to support a potential link between azoles
use and liver toxicity.
Title: VALIDATION OF DIAGNOSES OF LIVER DISORDERS IN USERS OF SYSTEMIC
ANTIFUNGAL MEDICATION IN SWEDEN
Version: 1 Date: 17 Oct 2023
Reviewer's report:
I read with interest the report from Giunta DH et al.
With this study, authors tried to characterize the possible link between azoles and liver
dysfunction within 6 months of onset. Following medical records review, PPV of 3 different
liver dysfunction diagnoses were diverse: low for toxic liver disease or hepatic failure; high for
jaundice.
Although interesting, results give rise to some questions:
- How did you select 150 from 335 patients?
- Definitions used of liver dysfunction were agreed based on which consensus?
- Why look only for azoles and not other antifungals?
- Were liver diagnoses defined to better reflect potential toxicity patterns of azoles?
- How can you account for liver disease arising after azole initiation but not related to that?
- What sort of malignancy do you report - liver related, other?
- There seems to be a potential association between discordance in liver diagnoses between
reviewers at the start and PPV at the end of the study - is this bias?
Overall, it would be nice to have more granular data to support a potential link between azoles
use and liver toxicity.
Please review this paper.
user
Title: VALIDATION OF DIAGNOSES OF LIVER DISORDERS IN USERS OF SYSTEMIC
ANTIFUNGAL MEDICATION IN SWEDEN
Version: 1 Date: 17 Oct 2023
Reviewer's report:
I read with interest the report from Giunta DH et al.
With this study, authors tried to characterize the possible link between azoles and liver
dysfunction within 6 months of onset. Following medical records review, PPV of 3 different
liver dysfunction diagnoses were diverse: low for toxic liver disease or hepatic failure; high for
jaundice.
Although interesting, results give rise to some questions:
- How did you select 150 from 335 patients?
- Definitions used of liver dysfunction were agreed based on which consensus?
- Why look only for azoles and not other antifungals?
- Were liver diagnoses defined to better reflect potential toxicity patterns of azoles?
- How can you account for liver disease arising after azole initiation but not related to that?
- What sort of malignancy do you report - liver related, other?
- There seems to be a potential association between discordance in liver diagnoses between
reviewers at the start and PPV at the end of the study - is this bias?
Overall, it would be nice to have more granular data to support a potential link between azoles
use and liver toxicity.
assistant