Reviewer's report
Title:Allopurinol use in pregnancy in three women with inflammatory bowel
disease: safety and outcomes: a case series.
Version: 1Date:13 August 2013
Reviewer: Nanne K de Boer
Reviewer's report:
Major revisions:
NONE
Minor revisions:
1. The largest series of cases describing allopurinol during pregnancy has been
published this year, this important paper must be discussed (Hoeltzenbein, PLOS
one 2013), given its message.
2. The second autoimmune disease, next to IBD, in which allopurinol and
low-dose thiopurines has been used is autoimmune hepatitis. Perhaps the
authors can mention this in their manuscript, just to be complete.
3. Patient 2 displays a normal TPMT activity and has low/normal 6TGN and
6MMP levels (when looking at the ratio it is elevated), but was this patient not
underdosed? Why not increase the dosage first? Perhaps the authors can
explain.
4. May I suggest to outline in the discussion part, how (dedicated) physicians
should monitor their pregnant patients during pregnancy? Should the newborn be
checked for possible toxicity? A practical advice for the clinician!
5. The most important message from the Jharap-paper (Gut 2013) was that the
unborn child was exposed intrauterine to the pharmacologically active 6TGN
metabolite, possibly explaing the high rate of anemia in the newborns (and low
platelets). Perhaps the authors can comment on this, taking in account the
alteration in thiopurine metabolism by adding allopurinol.
6. The landmark paper on the clinical use of allopurinol-thiopurine combination is
written by Chocair (Lancet 1993), this paper should be mentioned.
7. There are quite a lot of review/meta-analysis being used as references, may I
suggest to provide original papers and for example the ECCO statement on this
topic.
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.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Allopurinol use in pregnancy in three women with inflammatory bowel
disease: safety and outcomes: a case series.
Version: 1Date:13 August 2013
Reviewer: Nanne K de Boer
Reviewer's report:
Major revisions:
NONE
Minor revisions:
1. The largest series of cases describing allopurinol during pregnancy has been
published this year, this important paper must be discussed (Hoeltzenbein, PLOS
one 2013), given its message.
2. The second autoimmune disease, next to IBD, in which allopurinol and
low-dose thiopurines has been used is autoimmune hepatitis. Perhaps the
authors can mention this in their manuscript, just to be complete.
3. Patient 2 displays a normal TPMT activity and has low/normal 6TGN and
6MMP levels (when looking at the ratio it is elevated), but was this patient not
underdosed? Why not increase the dosage first? Perhaps the authors can
explain.
4. May I suggest to outline in the discussion part, how (dedicated) physicians
should monitor their pregnant patients during pregnancy? Should the newborn be
checked for possible toxicity? A practical advice for the clinician!
5. The most important message from the Jharap-paper (Gut 2013) was that the
unborn child was exposed intrauterine to the pharmacologically active 6TGN
metabolite, possibly explaing the high rate of anemia in the newborns (and low
platelets). Perhaps the authors can comment on this, taking in account the
alteration in thiopurine metabolism by adding allopurinol.
6. The landmark paper on the clinical use of allopurinol-thiopurine combination is
written by Chocair (Lancet 1993), this paper should be mentioned.
7. There are quite a lot of review/meta-analysis being used as references, may I
suggest to provide original papers and for example the ECCO statement on this
topic.
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.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Allopurinol use in pregnancy in three women with inflammatory bowel
disease: safety and outcomes: a case series.
Version: 1Date:13 August 2013
Reviewer: Nanne K de Boer
Reviewer's report:
Major revisions:
NONE
Minor revisions:
1. The largest series of cases describing allopurinol during pregnancy has been
published this year, this important paper must be discussed (Hoeltzenbein, PLOS
one 2013), given its message.
2. The second autoimmune disease, next to IBD, in which allopurinol and
low-dose thiopurines has been used is autoimmune hepatitis. Perhaps the
authors can mention this in their manuscript, just to be complete.
3. Patient 2 displays a normal TPMT activity and has low/normal 6TGN and
6MMP levels (when looking at the ratio it is elevated), but was this patient not
underdosed? Why not increase the dosage first? Perhaps the authors can
explain.
4. May I suggest to outline in the discussion part, how (dedicated) physicians
should monitor their pregnant patients during pregnancy? Should the newborn be
checked for possible toxicity? A practical advice for the clinician!
5. The most important message from the Jharap-paper (Gut 2013) was that the
unborn child was exposed intrauterine to the pharmacologically active 6TGN
metabolite, possibly explaing the high rate of anemia in the newborns (and low
platelets). Perhaps the authors can comment on this, taking in account the
alteration in thiopurine metabolism by adding allopurinol.
6. The landmark paper on the clinical use of allopurinol-thiopurine combination is
written by Chocair (Lancet 1993), this paper should be mentioned.
7. There are quite a lot of review/meta-analysis being used as references, may I
suggest to provide original papers and for example the ECCO statement on this
topic.
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.
Declaration of competing interests:
I declare that I have no competing interests
assistant