JMIRx Medxmed34JMIRx MedJMIRx Med2563-6316JMIR PublicationsToronto, Canadav6i1e8347910.2196/83479Peer-Review ReportPeer Review of “Real-World Performance of COVID-19 Antigen Tests: Predictive Modeling and Laboratory-Based Validation”KostGeraldUC DavisDavisCAUnited StatesWuFuqing202561020256e834790309202503092025© Gerald Kost. Originally published in JMIRx Med (https://med.jmirx.org), 6.10.2025. 2025

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIRx Med, is properly cited. The complete bibliographic information, a link to the original publication on https://med.jmirx.org/, as well as this copyright and license information must be included.

https://www.medrxiv.org/content/10.1101/2024.10.21.24315762v1https://med.jmirx.org/2025/1/e83474https://med.jmirx.org/2025/1/e68376COVID-19real-world datalimit of detection lateral flow testprobability of positive agreementlogistic regressionCOVID-19 antigen test clinical performance

This is a peer-review report for “Real-World Performance of COVID-19 Antigen Tests: Predictive Modeling and Laboratory-Based Validation.”

Round 1 ReviewGeneral Comments

This paper [1] introduces a novel approach to speeding COVID-19 antigen test deployment, possibly during the next pandemic, whether it be a COVID-19 variant or a new pathogen that arises.

Specific CommentsMajor Comments

1. The authors’ clinical conclusions based on their prediction theory are overly optimistic.

2. The authors can explore actual clinical evaluations to determine the robustness of their prediction modeling.

3. Thus, the paper merits publication, providing the limitations are more clearly described and the conclusions are limited to the mathematical results for which the authors have proven their claims theoretically. Extension to clinical applicability is a different story yet to be told.

4. The authors should be encouraged to move forward in view of the need and the poor performance of COVID-19 rapid antigen tests during the pandemic because of low sensitivity, a lack of deep understanding, and the “prevalence boundary,” a measure of when the rate of false omissions becomes too high and false negatives spread disease.

Minor Comments

5. Needs English grammar review. This could be achieved by using an artificial intelligence editor.

None declared.

ReferencesBoschM GarciaD RudtnerL Real-world performance of COVID-19 antigen tests: predictive modeling and laboratory-based validationJMIRx Med20256e6837610.2196/68376