Levodopa-Carbidopa Intestinal Gel in Advanced Parkinson’s Disease: Observations and Dilemmas after 10 Years of Real-Life Experience

第1轮

审稿人 1 报告

暂无评论

作者回应

感谢你的反馈。

审稿人 2 报告

这是一篇创新的研究文章。作者正在建议治疗帕金森氏症的新治疗方案。这项研究花了十年时间，令人惊叹，而且会有一些小缺陷。研究的局限是什么？

每种治疗方案都有副作用和缺点。你没有在你的文章中说明这一点。

如果没有限制，请说明。

作者回应

请参阅附件。

作者响应文件：作者响应.doc

审稿人 3 报告

论文“晚期帕金森病中的左旋多巴-卡比多巴肠道凝胶：10 年现实生活经验后的观察和困境”接近作者组用左旋多巴-卡比多巴治疗晚期帕金森病患者的 10 年经验肠凝胶（LCIG）。

这篇论文很有趣，我有一些意见和建议：

1. 数据
   • 是否仅使用主观量表来总结 LCIG 的成功？请讨论您为什么不使用客观量表来评估症状的演变。
   • Please specify is the patients received other therapeutics in addition to LCIG.

2. Interest:
   • Line 38: The abstract would be more attractive if the authors specify the open questions related with the LCIG.
   • Line 47: With the sentence “therefore even patients with advanced PD (APD) now have access to effective treatment options”, the readers cannot understand the interest to develop new therapies and the importance of this study. I recommend you specify what is the problem of advanced Parkinson’s disease therapeutic in the beginning of the introduction.
   • Line 73: I recommend the authors finish the introduction with what they did and what the paper approaches.

3. Discussion
   • The authors put several open questions in the middle of discussion. Does this paper answer some of these questions?
   • Please specify the disadvantages of LCIG.
   • Please explain the reasons for the difference between the calculated doses and the real doses of LCIG.

4. Writing style:
   • Line 28: The use of the adjective “special” is subjective. Please use an objective word.
   • Line 28: What was confirmed?
   • Line 59: I recommend the creation of a new paragraph after “…dyskinesias in most patients [3,4]”.
   • Line 109: Please clarify the sentence “Patients received LD for 10.6±4.4 years until the introduction of LCIG at a frequency of 5.2±1.0 per day”.

5. Abbreviations
   • The authors use several abbreviations, some of them unnecessary because they abbreviate a small word, such as levodopa, or because they do not appear frequently, such as device aided therapies (DAT) or dopamine agonist (DA).
   • Line 79: Specify the meaning of MMSE, and what Hoehn-Yahr and MMSE scores characterize.
   • Line 110: Is PEG or PEG-J?

6. Others
   • Table 3: What are the units of LCIG dose?

Author Response

Please see the attachment.

Author Response File: Author Response.doc

Reviewer 4 Report

Although the long-term course of LCIG is very interesting, the method of evaluation of the effects of LCIG in patients is not a scientific evaluation. Evaluation of on-time, off-time, and dyskinesia time is needed. In addition, the authors should indicate whether there is any overlap with their previous reports and forthcoming papers.

Author Response

Please see the attachment.

Author Response File: Author Response.doc

Reviewer 5 Report

The Authors present a robust, real world retrospective analysis of LCIG in 150 advanced PD patients. Their findings add value to the established scientific literature on how to contextualize this advanced therapy in the care of Parkinson's patients with motor complications. 

The data presented focuses primarily on the state of the cohort and their regimen prior to initiating LCIG. The authors present changes in HY and PGI-I clinical data but do not indicate explicitly at what time point this data was captured after patients were started on LCIG.

How many patients remained on LCIG? What were the reasons for those who discontinued treatment?

What was the breakdown of LCIG treatment duration for the cohort?

Was the "5-2-1" used in selecting this 150 patients for LCIG? The methods do not explain the multidisciplinary approach taken to determine candidates for LCIG? Was DBS an option for this cohort?

讨论范围很广，但不连贯，并且曲折地提出了一系列实践挑战，但没有花足够的时间解释这项研究如何在其中任何一个问题上发挥作用，特别是因为作者提供的队列临床结果数据很少。讨论更像是一本书章节的序言，最好通过解释当前研究的优势和局限性，因为它与概述的实践挑战有关。 

作者回应

请参阅附件。

作者响应文件：作者响应.doc

第二轮

审稿人 4 报告

我们指出的区域通常已得到纠正。