Title: Depression symptoms increase the risk for initiation or switching to biologic therapy in
pediatric inflammatory bowel disease patients in remission
Version: 1 Date: 06 Sep 2023
Reviewer:  Partha Pal
Reviewer's report:
The authors have described that depression symptoms in pediatric IBD in remission increases
the risk of biologics use which is novel. However there are few concerns
Major comments
The authors should state references showing  the validity and reliability of these questionnaires
(PHQ 9, GAD 7)  in pediatric population.
The authors have only evaluated age, sex and disesase type as  risk factors of biologic usage
and analyzed  them as confounders. However other factors such as steroid dependence, disease
duration, disease phetotype (stricturing/fistulizing) and BMI etc can influence the risk of
biologic usage and needs to be evaluated in multivariate analysis. If these information are not
available then the authors should ackowledge that in the limitation of the study.
It is not clear whether these patients recieved psychological intervention or not as the authors
have described that  they had 12-24 months follow up. It is important to know whether such
interventions influenced the need for initiation/switch of biologics.
Minor
It is better to present the baseline charateristics in UC and CD separately for better understanding
in a table using separate columns.
Title: Depression symptoms increase the risk for initiation or switching to biologic therapy in
pediatric inflammatory bowel disease patients in remission
Version: 1 Date: 06 Sep 2023
Reviewer:  Partha Pal
Reviewer's report:
The authors have described that depression symptoms in pediatric IBD in remission increases
the risk of biologics use which is novel. However there are few concerns
Major comments
The authors should state references showing  the validity and reliability of these questionnaires
(PHQ 9, GAD 7)  in pediatric population.
The authors have only evaluated age, sex and disesase type as  risk factors of biologic usage
and analyzed  them as confounders. However other factors such as steroid dependence, disease
duration, disease phetotype (stricturing/fistulizing) and BMI etc can influence the risk of
biologic usage and needs to be evaluated in multivariate analysis. If these information are not
available then the authors should ackowledge that in the limitation of the study.
It is not clear whether these patients recieved psychological intervention or not as the authors
have described that  they had 12-24 months follow up. It is important to know whether such
interventions influenced the need for initiation/switch of biologics.
Minor
It is better to present the baseline charateristics in UC and CD separately for better understanding
in a table using separate columns.
Please review this paper.
user
Title: Depression symptoms increase the risk for initiation or switching to biologic therapy in
pediatric inflammatory bowel disease patients in remission
Version: 1 Date: 06 Sep 2023
Reviewer:  Partha Pal
Reviewer's report:
The authors have described that depression symptoms in pediatric IBD in remission increases
the risk of biologics use which is novel. However there are few concerns
Major comments
The authors should state references showing  the validity and reliability of these questionnaires
(PHQ 9, GAD 7)  in pediatric population.
The authors have only evaluated age, sex and disesase type as  risk factors of biologic usage
and analyzed  them as confounders. However other factors such as steroid dependence, disease
duration, disease phetotype (stricturing/fistulizing) and BMI etc can influence the risk of
biologic usage and needs to be evaluated in multivariate analysis. If these information are not
available then the authors should ackowledge that in the limitation of the study.
It is not clear whether these patients recieved psychological intervention or not as the authors
have described that  they had 12-24 months follow up. It is important to know whether such
interventions influenced the need for initiation/switch of biologics.
Minor
It is better to present the baseline charateristics in UC and CD separately for better understanding
in a table using separate columns.
assistant