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Using the strict remission criteria yielded few results.
This remission rate refers to those patients who had experienced no flare-up during the study and fulfilled the other strict remission criteria, including endoscopic remission.
In the present study, the patients who had been in strict remission at 1 year had significantly less radiologic progression throughout the follow-up than did the patients who had not reached remission at 1 year.
In the "per-protocol" population in which, by definition, 100% of patients in both groups met the strict remission criteria at month 0, endoscopic and clinical remission were maintained at month 12 in 67.8% of patients in the once-daily group and 72.3% of patients in the divided-dose group (p = 0.359, OR 0.81 (95% CI 0.52 to 1.27)).
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The placebo remission rates are influenced by the trial length, number of study visits, use of stricter remission definitions, and design features that enroll patients with more active disease.
Study eligibility criteria: Eligibility criteria included patients with acromegaly caused by GH-secreting pituitary macroadenomas, patients pretreated with somatostatin analogs versus direct surgery and a stricter remission criteria defined as the GH nadir < 1 μg/l during an oral glucose tolerance test (OGTT) and the age- and sex- adjusted IGF-1 concentration was normal.
Additionally, several studies confirm that subclinical disease activity, and possibly further radiological progression, may be detectable despite clinical remission, and applying stricter remission criteria should guard against this happening [ 27].
Data from our study confirm that even after reaching remission, strict monitoring is required, as fewer than half of the patients in clinical practice will not sustain remission for more than 1 year.
Treatment benefit was defined separately as response and, with stricter criteria, as remission.
We used a stricter definition of remission as defined by withdrawal of all treatment for diabetes for 4 years, with an HbA1c < 6.5% (48 mmol/mol) during this period.
In order to verify the relevance of a stricter definition of remission on mortality, we tested and compared the effect of two other definitions which were progressively more permissive in terms of residual joint involvement (see online supplementary table S2).
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Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com