Title: Risk of Clostridioides difficile infection in inflammatory bowel disease patients
undergoing vedolizumab treatment: a systematic review and meta-analysis
Version: 0 Date: 22 Jun 2024
Reviewer's report:
Authors evaluated the risk of CDI in patients with IBD treated with vedolizumab using
systematic review and meta-analysis. They concluded that the risk of CDI was higher in UC
than in CD. Furthermore, the risk of CDI was not significantly different between vedolizumab
and other medications (anti-TNF# agents, corticosteroids, and 5-ASA).
Evaluating the risk of CDI in patients with IBD is important. However, there are serious concerns
in this study.
Major comment:
The main limitation of this study is the high heterogeneity within included studies. For
example, authors included both clinical trials and real-world observational studies. However, the
characteristics of patients included in clinical trials and real-world settings are quite different.
Furthermore, since the risk of CDI would be different between UC and CD, the results of analysis
comparing the risk of CDI between vedolizumab and other medications would be biased when
studies including both UC and CD patients were  used in the analysis.
Meta-analysis using more severe protocol to include homogenous studies is recommended to
control clinical heterogeneity.
Title: Risk of Clostridioides difficile infection in inflammatory bowel disease patients
undergoing vedolizumab treatment: a systematic review and meta-analysis
Version: 0 Date: 22 Jun 2024
Reviewer's report:
Authors evaluated the risk of CDI in patients with IBD treated with vedolizumab using
systematic review and meta-analysis. They concluded that the risk of CDI was higher in UC
than in CD. Furthermore, the risk of CDI was not significantly different between vedolizumab
and other medications (anti-TNF# agents, corticosteroids, and 5-ASA).
Evaluating the risk of CDI in patients with IBD is important. However, there are serious concerns
in this study.
Major comment:
The main limitation of this study is the high heterogeneity within included studies. For
example, authors included both clinical trials and real-world observational studies. However, the
characteristics of patients included in clinical trials and real-world settings are quite different.
Furthermore, since the risk of CDI would be different between UC and CD, the results of analysis
comparing the risk of CDI between vedolizumab and other medications would be biased when
studies including both UC and CD patients were  used in the analysis.
Meta-analysis using more severe protocol to include homogenous studies is recommended to
control clinical heterogeneity.
Please review this paper.
user
Title: Risk of Clostridioides difficile infection in inflammatory bowel disease patients
undergoing vedolizumab treatment: a systematic review and meta-analysis
Version: 0 Date: 22 Jun 2024
Reviewer's report:
Authors evaluated the risk of CDI in patients with IBD treated with vedolizumab using
systematic review and meta-analysis. They concluded that the risk of CDI was higher in UC
than in CD. Furthermore, the risk of CDI was not significantly different between vedolizumab
and other medications (anti-TNF# agents, corticosteroids, and 5-ASA).
Evaluating the risk of CDI in patients with IBD is important. However, there are serious concerns
in this study.
Major comment:
The main limitation of this study is the high heterogeneity within included studies. For
example, authors included both clinical trials and real-world observational studies. However, the
characteristics of patients included in clinical trials and real-world settings are quite different.
Furthermore, since the risk of CDI would be different between UC and CD, the results of analysis
comparing the risk of CDI between vedolizumab and other medications would be biased when
studies including both UC and CD patients were  used in the analysis.
Meta-analysis using more severe protocol to include homogenous studies is recommended to
control clinical heterogeneity.
assistant