Comments on “Efficacy and safety of mirikizumab in maintenance therapy for ulcerative colitis in difficultto- treat inflammatory bowel disease: a single-center retrospective study in Japan”

a response in highly refractory patients, and (2) whether that response can be maintained once treatment is continued. 1,3his distinction is relevant because the article also shows a gap between treatment persistence and point remission rates, and the authors reasonably note that treatment modification may be deferred in patients with mild residual activity. 1 In this context, persistence alone may not be a reliable proxy for target attainment, whereas an week-52 response based on all treatment initiators may understate maintenance-specific benefit among early responders.A complementary landmark analysis (i.e., among patients who remained on mirikizumab, achieved clinical response by week 12, or both) could therefore improve interpretability.Reporting conditional probabilities of sustained response/remission, steroid-free clinical remission, and discontinuation after the induction phase would also help readers align these findings with treat-to-target decision-making in UC. 4 In addition, presenting maintenance outcomes stratified by baseline corticosteroid use and prior treatment burden (e.g., 2-3 vs. 4 or more prior advanced therapies) may further improve clinical applicability, given the observed association between baseline systemic corticosteroid use and earlier withdrawal. 1 This would not lessen the value of the current study; rather, it would clarify which aspect of effectiveness is being captured and improve comparability with trial-based maintenance datasets and other real-world induction reports. 2,5,