The letter by Dr. Zelnik (1) about our article (2) expresses concerns around the selection of the “individual best-performing drug,” subsequent reexposure to the same drug, and, most importantly, the lack of reexposure to the three ineffective drugs. We agree that including a second exposure for all drugs would reduce potential bias in selecting the right drug for each patient. In fact, the original protocol was designed to reexpose participants to one of the nonpreferred agents. However, ethics committees did not allow us to reexpose participants to one of the nonpreferred agents.
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