PONE-D-23-28841The Influence of Prior Use of Inhaled Corticosteroids on COVID-19 Outcomes: A Systematic Review and Meta-AnalysisPLOS ONE

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Academic Editor

PLOS ONE

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Additional Editor Comments:

Thank you for submitting your manuscript. The reviewers and I believe it is of potential value for our readers. However, the reviewers have raised a number of very important issues, and their excellent comments will need to be adequately addressed in a revision before the acceptability of your manuscript for publication in the Journal can be determined. We cannot guarantee that your revised paper will be chosen for publication; this would be solely based on how satisfactorily you have addressed the reviewer comments.

#1. COVID-19 patients. -> patients with COVID-19

Please use the patient-first language.

#2.A significance level of p<0.05 -> A significance level of two-sided p<0.05

#3. was assessed using odds ratios (ORs) with 95% confidence intervals (95% CI). -> Please cite the statistical guideline (DOI: https://doi.org/10.54724/lc.2022.e9).

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear authors I congratulate to you for your outstanding work and research.

1. The introduction provides clear context and rationale for the study, referencing relevant research, and citing sources appropriately. The safety of ICD in COVID pandemic has been severly debated with more or less weak evidence.

2. The inclusion of PROSPERO registration number adds transparency to the research process in Methods.

3. The process of data extraction and outcome assessment is described adequately, including details on how discrepancies were resolved among investigators.

4. The use of the ROBINS-I tool for assessing the risk of bias in the included studies is appropriate, and the results are presented clearly.

5. The assessment of publication bias is appropriately conducted using funnel plots and statistical tests.

6. The use of sensitivity analyses to test the robustness of the results is a good practice.

7. Figures and tables are used effectively to present the findings, making them easily comprehensible.

8. The discussion section provides a comprehensive interpretation of the results.

9. While the paper acknowledges limitations, it would be beneficial to discuss them in more detail, particularly regarding study heterogeneity and potential confounders such as dosage of inhaled corticosteroids which are not disclosed in the analysis. It may be that we would see some signal of lower hospital admission in high dose ICS group. You mention that "results remained consistent even after stratifying the analysis by ICS monotherapy or ICS in combination with LABD therapy" which should not have any effect on the hypothesis or does it explain the confounding factors.

Overall, this scientific paper is well-structured and provides a thorough investigation into the impact of pre-existing ICS use on COVID-19 outcomes. It adheres to established guidelines and offers valuable insights into a relevant clinical question.

Reviewer #2: Dear Authors,

The research topic, which examines the effects of previous use of inhaled corticosteroids on the outcomes of COVID-19, is not a new subject. However, the systematic review and meta-analysis has been conducted with acceptable precision and well documented. The only recommendation is to include the number of studies used in each subgroup analysis within the text.

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Reviewer #1: No

Reviewer #2: No

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The Influence of Prior Use of Inhaled Corticosteroids on COVID-19 Outcomes: A Systematic Review and Meta-Analysis

PONE-D-23-28841R1

Dear Dr. Fu,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Dong Keon Yon, MD, FACAAI, FAAAAI

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

This is an excellent paper!

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: You have made appropriate changes to the manuscript. The manuscript is technically sound, and the data support the conclusions. I cannot give analysis to the statistical process .

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

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