Selecting the Best Combined Biological Therapy for Refractory Inflammatory Bowel Disease Patients
Round 1
Reviewer 1 Report
Very interesting and short review on dual biologic therapy in aggressive IBD. I like the review and it was easy to read and a nice update!
This is not a new topic, it is not original but it provides a nice summary of the papers published on dual biologic therapy I’m aggressive IBD.
Minor improvements:
introduction: -2nd paragraph: Need to discuss more on why a drug would be withdrawn and replaced by another. Give specific examples for example, mechanistic failure of anti TNF so replace with intern inhibitor.
Discussion: -Please include a line or cite the paper by Molly stone published in Am J gastroenterology “the role of dual biologic therapy in IBD"
Author Response
Thank you for your review and your comments.
- Introduction was modified and the withdrawn and replacement of the treatment was explained better with some examples
- The article of Molly Stone was added in the discussion.
Reviewer 2 Report
Dear Author
This article reviews an important issue of combine therapy for refractory IBD. The followings are my comments.
1. Table 1, please provide more information about the study population, i.e. % of CD and % of UC , patient age, and disease duration information from each study if possible.
2. Line 85, should be UC not CU
3. As mentioned, combination therapy for IBD may be prescribed for active IBD or active EIM without active IBD. The tittle of the article is "refractory IBD" and if so, please exclude patients with combination therapy for active EIM but not active IBD in the analysis. For example, 23 patients have only active EMR received co-therapy among the 98 patients in your reference 10.
Author Response
Thank you for your review and your comments.
- Table 1 was modified including the required information
- Line 85 was changed, UC for CU
- Regarding the mentioned study, patients with EIM were excluded from the analysis of clinical or endoscopic response/remission. However, data of safety were expressed globally and cannot be excluded. We added in the limitations and we modified the table 3 excluding the combinations for EIM
We attach the modified tables:
|
Reference |
Year |
Study type |
Number of subjects |
Disease |
Age (mean) |
Disease duration (mean years) |
Clinical evaluation |
Endoscopic evaluation |
Adverse events |
Follow up (mean) |
|
Goessens et al. (10) |
2021 |
Multicentric Retrospective |
98 |
58 CD 40 UC
|
26 |
|
70% response |
50% response |
42% |
8 month |
|
Glassner et al. (14) |
2020 |
Unicentric Retrospective |
50 |
32 CD 18 UC 1 IBD-U |
36.7 |
14.8 |
50% remission |
34% remission |
16% |
8 month |
|
Kwapisz et al. (12) |
2021 |
Unicentric Retrospective |
15 |
14 CD 1 UC |
36 |
12.5 |
73% response |
44% response |
53% |
24 month |
|
Privitera et al. (13) |
2020 |
Multicentric Retrospective |
16 |
11 CD 5 UC |
38 |
10.5 |
100% response |
|
18.8% |
7 month |
|
Yang et al. (11) |
2020 |
Multicentric Retrospective |
22 |
22 CD |
35 |
|
50% response |
50% response |
13% |
9 month
|
|
Study |
VEDO+ USTE |
TNF+ VEDO |
TNF+ USTE |
Tofa+ VEDO |
Tofa+ USTE |
Tofa+ TNF |
Other** |
|
Goessens et al*. (10) |
16 |
36 |
8 |
12 |
- |
1 |
8 |
|
Glassner et al. (14) |
25 |
7 |
8 |
3 |
9 |
1 |
|
|
Kwapisz et al. (12) |
5 |
8 |
2 |
|
|
|
|
|
Privitera et al**. (13) |
3 |
6 |
4 |
|
|
|
3 |
|
Yang et al. (11) |
8 |
13 |
3 |
|
|
|
|
|
TOTAL |
62 |
75 |
20 |
21 |
3 |
10 |
19 |
Round 2
Reviewer 2 Report
Dear Editor
The authors responded to the questions raised. I have no more questions.
