Title: Medication Use Among Patients with Crohn’s Disease or Ulcerative Colitis Before and
After the Initiation of Advanced Therapy
Version: 3 Date: 27 May 2022
Reviewer's report:
This is a study that retrospectively analyzed the changes in pain treatment before and after the
introduction of biologics using a health care database.
It is very important topics, but there are a lot of limitation in this study.
It is necessary that the authors should perform more precise analysis.
As the author stated, NSAIDs are indistinguishable when used, for example, for headaches. Is
it possible to set a minimum dose to focus on the regular use of NSAIDs as a pain medication
for IBD?
Steroids were included as pain medication, but isn't it used to control the inflammation of IBD?
Steroid free remission is one  of the therapeutic goal which is widely accepted, but why was the
steroid usage rate so high even after the introduction of bio? How much was amount of steroid
after initiation of bio?
There is Insufficient results and discussion regarding the use of the opioids which is th most
important medication in this topic.
Changes of opioid use after bio introduction was not described.
In general consensus, opioid use is a poor prognostic factor in IBD. Therefore, this reviewer
recommends the authors to analyze the surgical rate of opioid users.
In this survey, 36.5% of patients with UC and 41.5% of patients with CD used opioids. This
reviewer believes that this is a fairly high percentage, which this reviewer dose not think that
it is adequate for IBD management. Please analyze more detail and discuss it. For example, is
this database from IBD core-facility? Or does it include a lot of general gastroenterologists? Is
it possible to analyze them separately? The quality of management may affect to the ratio of
opioid use.
In Crohn disease, did the perianal lesion have any effect for use of pain medication?
Title: Medication Use Among Patients with Crohn’s Disease or Ulcerative Colitis Before and
After the Initiation of Advanced Therapy
Version: 3 Date: 27 May 2022
Reviewer's report:
This is a study that retrospectively analyzed the changes in pain treatment before and after the
introduction of biologics using a health care database.
It is very important topics, but there are a lot of limitation in this study.
It is necessary that the authors should perform more precise analysis.
As the author stated, NSAIDs are indistinguishable when used, for example, for headaches. Is
it possible to set a minimum dose to focus on the regular use of NSAIDs as a pain medication
for IBD?
Steroids were included as pain medication, but isn't it used to control the inflammation of IBD?
Steroid free remission is one  of the therapeutic goal which is widely accepted, but why was the
steroid usage rate so high even after the introduction of bio? How much was amount of steroid
after initiation of bio?
There is Insufficient results and discussion regarding the use of the opioids which is th most
important medication in this topic.
Changes of opioid use after bio introduction was not described.
In general consensus, opioid use is a poor prognostic factor in IBD. Therefore, this reviewer
recommends the authors to analyze the surgical rate of opioid users.
In this survey, 36.5% of patients with UC and 41.5% of patients with CD used opioids. This
reviewer believes that this is a fairly high percentage, which this reviewer dose not think that
it is adequate for IBD management. Please analyze more detail and discuss it. For example, is
this database from IBD core-facility? Or does it include a lot of general gastroenterologists? Is
it possible to analyze them separately? The quality of management may affect to the ratio of
opioid use.
In Crohn disease, did the perianal lesion have any effect for use of pain medication?
Please review this paper.
user
Title: Medication Use Among Patients with Crohn’s Disease or Ulcerative Colitis Before and
After the Initiation of Advanced Therapy
Version: 3 Date: 27 May 2022
Reviewer's report:
This is a study that retrospectively analyzed the changes in pain treatment before and after the
introduction of biologics using a health care database.
It is very important topics, but there are a lot of limitation in this study.
It is necessary that the authors should perform more precise analysis.
As the author stated, NSAIDs are indistinguishable when used, for example, for headaches. Is
it possible to set a minimum dose to focus on the regular use of NSAIDs as a pain medication
for IBD?
Steroids were included as pain medication, but isn't it used to control the inflammation of IBD?
Steroid free remission is one  of the therapeutic goal which is widely accepted, but why was the
steroid usage rate so high even after the introduction of bio? How much was amount of steroid
after initiation of bio?
There is Insufficient results and discussion regarding the use of the opioids which is th most
important medication in this topic.
Changes of opioid use after bio introduction was not described.
In general consensus, opioid use is a poor prognostic factor in IBD. Therefore, this reviewer
recommends the authors to analyze the surgical rate of opioid users.
In this survey, 36.5% of patients with UC and 41.5% of patients with CD used opioids. This
reviewer believes that this is a fairly high percentage, which this reviewer dose not think that
it is adequate for IBD management. Please analyze more detail and discuss it. For example, is
this database from IBD core-facility? Or does it include a lot of general gastroenterologists? Is
it possible to analyze them separately? The quality of management may affect to the ratio of
opioid use.
In Crohn disease, did the perianal lesion have any effect for use of pain medication?
assistant