Review for 10.1186/s12876-022-02143-x (2022)

Reviewer’s report
Title: 
Objective Disease Activity Assessment and Therapeutic Drug Monitoring
Prior to Biologic Therapy Changes in Routine Inflammatory Bowel Disease
Clinical Practice: TARGET-IBD
Version: 
0 
Date: 
09 Dec 2021
Reviewer: 
Askin Erdogan
Reviewer's report:
Dear Editor,
I have reviewed the manuscript entitled "Objective Disease Activity Assessment
and Therapeutic Drug Monitoring Prior to Biologic Therapy Changes in Routine
Inflammatory Bowel Disease Clinical Practice: TARGET-IBD". 
The authors
aimed to describe objective marker and TDM assessment in routine clinical
practice prior to biologic therapeutic changes in adult IBD patients. They found
that nearly one-third of patients undergoing a biologic dose change or
discontinuation do not undergo objective disease activity assessment or TDM.
Also nearly 2/3 of subjects did not undergo TDM evaluation. No disease or
patıent factors were found as reason for not evaluating and empiric therapeutic
adjustments were probably mostly relıed on for escalatıon or discontinuation
authors stated. Only seemed that academic centers were more likely utilized
testing. 
This study is important showing underutilization of objective marker and TDM
before escalation or discontinuation of treatment. This is particularly important
due to less well optimizing valuable available treatment options. 
My question is whether these patients were evaluated regarding infectious and
other reasons for lack of efficacy? Also any information regarding outcomes of
these patients important if these patients are followed longer after treatment
change/escalation. Also any difference in outcome between properly evaluated
patients and less evaluated ones.
Kind regards,
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
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Are the methods sufficiently described to allow the study to be repeated?
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