Reviewer ’s report  
 
Title: Safety and Effectiveness of Granulocyte and Monocyte A dsorptive Apheresis in Patients 
with Inflammatory Bowel Disease in Special Situations: A Mul ticentre Cohort Study  
 
Version: 0 Date: 21 Sep 2019  
 
Reviewer: Antonio Ferronato  
 
Reviewer's report:  
 
1) You c hose IOIBD score for patients with Crohn's disease. The first problem is that the 
reference [41] seems to be wrong, and does not indicate how to calculate the score, the second 
problem is that this score is poorly known from physicians, and not validated. A solution could 
be a different reference article or a table illustrating the score itself, but the best solution (that I 
strongly suggest), is to change the scoring system for Crohn's disease patients, i.e. CDAI or 
Harvey Bradshaw Index. The number of Cro hn's disease patients is relatively small, so it coud be 
considered to exclude these patients from the analysis (and there is no mention of Crohn's 
disease patients in the abstract).  
 
2) The observation period could be prolonged to 3 months after the last GMA session. One 
month (on line 158 it is written "within 1 month") is generally considered a short period.  
 
3) As to methods  for assessment of GMA effectiveness, you excluded patients  using anti -TNF 
agents, calcineurin inhibitors or methotrexate (line 198 -199), so you excluded 96 patients 
receiving anti -TNF agents. However, in this "biologic era" of IBD therapy, it could be very 
interesting to study this sub -group of patients, in this paper or in a future work. Can be GMA a 
"rescue therapy" in patients with a partial response or a secondary loss of response to anti -TNF 
agents?  
 
Are the methods approp riate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions  drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain  or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future? 
 
3. Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of  the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is acce pted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons .org/licenses/by/4.0/ ). I understand tha t any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Safety and Effectiveness of Granulocyte and Monocyte A dsorptive Apheresis in Patients 
with Inflammatory Bowel Disease in Special Situations: A Mul ticentre Cohort Study  
 
Version: 0 Date: 21 Sep 2019  
 
Reviewer: Antonio Ferronato  
 
Reviewer's report:  
 
1) You c hose IOIBD score for patients with Crohn's disease. The first problem is that the 
reference [41] seems to be wrong, and does not indicate how to calculate the score, the second 
problem is that this score is poorly known from physicians, and not validated. A solution could 
be a different reference article or a table illustrating the score itself, but the best solution (that I 
strongly suggest), is to change the scoring system for Crohn's disease patients, i.e. CDAI or 
Harvey Bradshaw Index. The number of Cro hn's disease patients is relatively small, so it coud be 
considered to exclude these patients from the analysis (and there is no mention of Crohn's 
disease patients in the abstract).  
 
2) The observation period could be prolonged to 3 months after the last GMA session. One 
month (on line 158 it is written "within 1 month") is generally considered a short period.  
 
3) As to methods  for assessment of GMA effectiveness, you excluded patients  using anti -TNF 
agents, calcineurin inhibitors or methotrexate (line 198 -199), so you excluded 96 patients 
receiving anti -TNF agents. However, in this "biologic era" of IBD therapy, it could be very 
interesting to study this sub -group of patients, in this paper or in a future work. Can be GMA a 
"rescue therapy" in patients with a partial response or a secondary loss of response to anti -TNF 
agents?  
 
Are the methods approp riate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions  drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain  or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future? 
 
3. Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of  the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is acce pted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons .org/licenses/by/4.0/ ). I understand tha t any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Safety and Effectiveness of Granulocyte and Monocyte A dsorptive Apheresis in Patients 
with Inflammatory Bowel Disease in Special Situations: A Mul ticentre Cohort Study  
 
Version: 0 Date: 21 Sep 2019  
 
Reviewer: Antonio Ferronato  
 
Reviewer's report:  
 
1) You c hose IOIBD score for patients with Crohn's disease. The first problem is that the 
reference [41] seems to be wrong, and does not indicate how to calculate the score, the second 
problem is that this score is poorly known from physicians, and not validated. A solution could 
be a different reference article or a table illustrating the score itself, but the best solution (that I 
strongly suggest), is to change the scoring system for Crohn's disease patients, i.e. CDAI or 
Harvey Bradshaw Index. The number of Cro hn's disease patients is relatively small, so it coud be 
considered to exclude these patients from the analysis (and there is no mention of Crohn's 
disease patients in the abstract).  
 
2) The observation period could be prolonged to 3 months after the last GMA session. One 
month (on line 158 it is written "within 1 month") is generally considered a short period.  
 
3) As to methods  for assessment of GMA effectiveness, you excluded patients  using anti -TNF 
agents, calcineurin inhibitors or methotrexate (line 198 -199), so you excluded 96 patients 
receiving anti -TNF agents. However, in this "biologic era" of IBD therapy, it could be very 
interesting to study this sub -group of patients, in this paper or in a future work. Can be GMA a 
"rescue therapy" in patients with a partial response or a secondary loss of response to anti -TNF 
agents?  
 
Are the methods approp riate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions  drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain  or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future? 
 
3. Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of  the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is acce pted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons .org/licenses/by/4.0/ ). I understand tha t any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant