Reviewer’s report
Title: 
Inflammatory vaginitis in women on long-term rituximab treatment for
autoimmune disorders
Version: 
1 
Date: 
11 Apr 2021
Reviewer's report:
In my opinion that based on the data presented in this study, it cannot be
concluded that there is a risk of inflammatory vaginitis in patients treated with
rituximab. First of all, I congratulate you in the discussion part for clearly stating
these, being aware of the weaknesses in the study. However, the fact that most of
the patients were using medications other than rituximab, the presence of
autoimmune diseases and patients' vaginitis did not fully recover even in patients
with B cell return make me doubt the result of the study. In addition, due to the
retrospective nature of the study all other causes of vaginitis in 16 patients who
were considered inflammatory vaginitis were not excluded with tests and the
sexual behavior of the patient and other risk factors that could cause vaginitis,
which led to a deficiency in the study. Although the study was conducted in a
tertiary reference center, the small sample size also prevented reaching the
conclusion. Despite all these shortcomings, I care about your study as it
highlights that rituximab may be a medication that causes inflammatory vaginitis
and requires prospective studies with higher patient numbers and will definitely
exclude other vaginitis factors. Since the limitations of the study are clearly
stated in the article, I think the study is acceptable.
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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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Yes
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from apparent manipulation?
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