Title: Only repeatedly elevated IgG4 levels in primary sclerosing cholangitis may distinguish
a particular patient phenotype
Version: 1 Date: 24 Apr 2024
Reviewer's report:
Well-written manuscript that clearly defines a relevant clinical question and aims of work herein.
Minor points:
Authors should specify mean observation period from first IgG4 measurement to final IgG4
measurement of patients that normalized and those who remained consistently high. Is there
a significant sampling difference that could explain the normalization of IgG4 values in some
patients and constant high levels in others?
Is immunosuppressive dosage for IBD  sufficient to ameliorate features of IAC in general? Could
PSC-IgG4const group benefit from stronger immune treatment if they were in fact IAC?
Are the IgG4-constant patients possibly IgG4-IAC patients that are slightly sub-threshold for
HISORt criteria or truly a unique subgroup of PSC? Related, were the IgG4 antibodies tested for
reactivity against known IgG4-IAC antigens (e.g. annexin A11). Did the IgG-constant patients
exhibit  more clinical features associated  with IAC than IgG4-normalize group?
Title: Only repeatedly elevated IgG4 levels in primary sclerosing cholangitis may distinguish
a particular patient phenotype
Version: 1 Date: 24 Apr 2024
Reviewer's report:
Well-written manuscript that clearly defines a relevant clinical question and aims of work herein.
Minor points:
Authors should specify mean observation period from first IgG4 measurement to final IgG4
measurement of patients that normalized and those who remained consistently high. Is there
a significant sampling difference that could explain the normalization of IgG4 values in some
patients and constant high levels in others?
Is immunosuppressive dosage for IBD  sufficient to ameliorate features of IAC in general? Could
PSC-IgG4const group benefit from stronger immune treatment if they were in fact IAC?
Are the IgG4-constant patients possibly IgG4-IAC patients that are slightly sub-threshold for
HISORt criteria or truly a unique subgroup of PSC? Related, were the IgG4 antibodies tested for
reactivity against known IgG4-IAC antigens (e.g. annexin A11). Did the IgG-constant patients
exhibit  more clinical features associated  with IAC than IgG4-normalize group?
Please review this paper.
user
Title: Only repeatedly elevated IgG4 levels in primary sclerosing cholangitis may distinguish
a particular patient phenotype
Version: 1 Date: 24 Apr 2024
Reviewer's report:
Well-written manuscript that clearly defines a relevant clinical question and aims of work herein.
Minor points:
Authors should specify mean observation period from first IgG4 measurement to final IgG4
measurement of patients that normalized and those who remained consistently high. Is there
a significant sampling difference that could explain the normalization of IgG4 values in some
patients and constant high levels in others?
Is immunosuppressive dosage for IBD  sufficient to ameliorate features of IAC in general? Could
PSC-IgG4const group benefit from stronger immune treatment if they were in fact IAC?
Are the IgG4-constant patients possibly IgG4-IAC patients that are slightly sub-threshold for
HISORt criteria or truly a unique subgroup of PSC? Related, were the IgG4 antibodies tested for
reactivity against known IgG4-IAC antigens (e.g. annexin A11). Did the IgG-constant patients
exhibit  more clinical features associated  with IAC than IgG4-normalize group?
assistant