A Major Revision decision from a peer-reviewed journal is not a rejection. It is a conditional acceptance with conditions attached. The data makes this clear. Rosenkrantz and Harisinghani's 2015 study of the American Journal of Roentgenology found that 84.7% of manuscripts receiving a Major Revision decision at first submission were ultimately accepted. For Minor Revision decisions, the figure was 98.3%. A similar analysis of the American Journal of Neuroradiology found that essentially all manuscripts receiving a provisional acceptance pending major revision were eventually published.
The revision decision is an invitation to continue, not a verdict. The question is not whether revision is worthwhile. The question is whether the response letter makes the case clearly enough for the editor and reviewers to accept it.
This guide covers revision decision types, the seven-element response letter structure, model responses for the most common systematic review revision requests, and how to handle reviewer comments you disagree with.
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Quick Answer:
A point-by-point response letter addresses every reviewer comment individually, in the order the reviewer presented them, with a three-part reply for each: what the reviewer said (quoted verbatim), what change you made in response, and where in the revised manuscript the change appears (page and line number). For reviewer comments you disagree with, provide a respectful, evidence-based rebuttal explaining why the manuscript has not been changed, and the editor will adjudicate. Submit the response letter alongside a clean version and a tracked-change version of the manuscript. Major revision response letters commonly run 15 to 30 pages and should be as long as needed.
What Type of Revision Decision Did You Receive?
Journals use different terminology for revision decisions. Understanding what each decision means for the response process matters before writing a single line of the letter.
Minor Revision means the editor has found the manuscript acceptable in principle, with small changes needed. Reviewers typically request clarifications, additional references, or minor rewording. The response letter is shorter, and the manuscript changes are limited. Minor revision decisions are accepted at a very high rate (98.3% in the AJR study).
Major Revision means the editor sees potential in the manuscript but requires significant changes before it can be accepted. Reviewers may request additional analyses, expanded methods reporting, additional study inclusion, GRADE rating, or restructuring of the results. The manuscript must be substantially revised. 84.7% of major revisions are ultimately accepted (Rosenkrantz and Harisinghani 2015, AJR). This is the most common decision type for systematic reviews at Tier 1 journals.
Reject and Resubmit is different from a Major Revision. This decision means the manuscript is not acceptable in its current form, but the research topic is of interest. The paper can be resubmitted as a new submission (not a revision) to the same journal. The response process differs: there is no formal revision deadline, and the resubmitted paper will undergo a new editorial assessment. Whether the same reviewers will see it depends on the journal.
Reject without invitation to resubmit is the only decision that closes the door at that journal. It is appropriate to revise the manuscript based on the reviewers' comments and submit it to a different journal.
Table 1: Peer Review Decision Types — What Each Means and What to Do Next
Decision Type | What It Means | Typical Acceptance Rate | Response Letter Length | Manuscript Versions Required |
|---|---|---|---|---|
Minor Revision | The manuscript is acceptable in principle. Small clarifications, additional references, or minor rewording needed. Changes are limited in scope. | 98.3% (Rosenkrantz & Harisinghani, AJR 2015) | 3–8 pages typically. Address all comments with specific locations. It may be shorter if comments are limited. | Clean version + tracked-change version. Response letter. |
Major Revision | Significant changes are required before acceptance. May include additional analyses, expanded methods, restructuring, or additional included studies. The manuscript retains its original submission date. | 84.7% (Rosenkrantz & Harisinghani, AJR 2015) | 15–30 pages are common for systematic reviews. No maximum; as long as needed to address every comment. | Clean version, tracked-change version, and response letter. Some journals also require a highlighted-change version. |
Reject and Resubmit | The current submission is closed, but a new, substantially revised submission is invited. New submission date applies. The resubmitted paper goes through a fresh editorial assessment — not treated as a revision. | No published data; outcome depends on the extent of revision and editorial reassessment | A cover letter explaining the changes made since the previous submission. A point-by-point format is still advisable to show that reviewers' comments were taken seriously. | Fresh submission package as per journal guidelines. Include a cover letter noting that the manuscript is a revision of a previously submitted paper. |
Reject (no invitation to resubmit) | The manuscript has been declined. The door is closed at this journal. Appropriate to revise based on reviewers' feedback and submit to a different journal. | N/A — no revision process at this journal | No response letter required. Prepare a new submission to a different journal, using reviewers' feedback as a guide. | Prepare a fresh submission package for the next target journal. Revise based on reviewer feedback before resubmitting elsewhere. |
Acceptance rate data from: Rosenkrantz AB, Harisinghani M. Am J Roentgenol 2015;204(6):1151–1156. Single-journal, radiology specialty — rates vary by journal and field. Present as illustrative, not universal. Regardless of the field, the direction is consistent: most Major Revision decisions end in acceptance.
The Seven-Element Structure of a Response Letter
A professional point-by-point response letter has seven elements. The conventions for this structure are consistent across publishers. Taylor and Francis, Wiley, Elsevier, Springer, and the major medical journal groups all describe the same format in their author guidelines.
Element 1: Opening Paragraph to the Editor
The letter opens with a short paragraph addressed to the editor-in-chief (by name if known, or to "the Editor"). Thank the editor and reviewers for their time and for the thoughtful reviews. State that you are pleased to resubmit the manuscript and that the revision addresses every comment raised by both reviewers.
This paragraph should be two to four sentences. It sets a professional tone. Do not express frustration, interpret reviewer motives, or defend the original manuscript before you have addressed the comments.
Element 2: Summary of Major Changes
Before the point-by-point section, include a summary of the most significant changes made to the manuscript. This gives the editor a quick overview before reading the detailed responses, enabling efficient editorial decisions. Four to eight bullet points covering the main substantive changes are appropriate.
Element 3: Organization by Reviewer
Label each reviewer's comments with a clear heading. Use consistent labeling: "Reviewer 1," "Reviewer 2," and so on, matching the labels in the editorial decision letter. If the editor also raised comments, address those under a separate "Editor's Comments" heading before the reviewer sections.
Element 4: Point-by-Point Responses
Each reviewer's comment receives its own numbered response. The structure for each point is:
Reviewer comment (verbatim): Copy the reviewer's exact words. Do not paraphrase. If a reviewer made multiple points in a single comment block, split them into separate items and address each one individually.
Response: State clearly what you did in response. Do not say "we have revised accordingly" without explaining what the revision was if you agree with the comment, state that explicitly and describe the specific change made. If you disagree, state it politely and provide evidence to support your justification.
Location: Give the exact location in the revised manuscript where the change can be found. Use page number and line number if the journal uses line numbering, or page number and paragraph number if not.
Element 5: Quoted Revised Text
For substantive revisions, quote the revised text directly in the response letter after the location reference. This saves the reviewer from having to locate the change in the manuscript and demonstrates that the revision was made precisely. Use a different font, indentation, or formatting to distinguish quoted revised text from your response prose clearly.
Element 6: Handling Disagreements
Not every reviewer comment requires a change to the manuscript. When you disagree with a comment, state that you have considered it carefully and explain why the original approach is correct. Provide supporting evidence: citations, methodological standards, or the study protocol. The editor adjudicates disagreements between authors and reviewers. A polite, well-reasoned rebuttal supported by evidence is appropriate and often successful.
Never ignore a comment. A response that leaves any comment unaddressed signals to the reviewer and editor that the revision was incomplete.
Element 7: Closing Paragraph
Close with a short paragraph stating that the revision addresses all comments and that you remain available for any questions. Two to three sentences are appropriate.
The Most Common Systematic Review Revision Requests
Systematic reviews attract a predictable set of revision requests at peer review. The following are the most frequent, with model response language for each.
Request 1: PROSPERO registration not cited or post-hoc registration.
This is the most common ground for desk rejection and early major revision of systematic reviews. If the review was registered prospectively, confirm this in the response letter and cite the registration number with the submission date. If the registration was post-hoc, disclose this and add a limitation statement to the methods section.
Model response: "The reviewer raises a valid concern regarding protocol registration. Our review was registered prospectively on PROSPERO (registration number CRD[XXXX]) on [date], before the commencement of searching on [date]. The registration number now appears in the abstract (page X) and methods section (page X). The PROSPERO record has been updated to reflect the publication status of this manuscript."
Request 2: The PRISMA 2020 checklist is incomplete or not submitted.
Model response: "We have completed the PRISMA 2020 (Page et al., BMJ, 2021) 27-item checklist with page references for every item. The completed checklist is submitted as Supplementary File 1. Items [X] and [Y], which the reviewer identified as absent, are now addressed: [brief explanation of what was added and where]."
Request 3: Single-reviewer screening (dual independent screening requested).
This is a Cochrane MECIR C39 mandatory requirement and a PRISMA 2020 Item 8 reporting requirement. It is among the most common requests for methodological revisions in systematic reviews.
Model response: "The reviewer correctly identifies that the original manuscript did not report dual independent screening. We have conducted a second independent screening of all full-text articles by a second reviewer working independently of the first. The results are concordant with the original screening, with the following discordances resolved by discussion: [list]. Cohen's Kappa inter-rater reliability was [value], indicating [agreement level per Landis and Koch 1977]. The methods section (page X) has been revised to describe the dual screening process and the conflict resolution procedure. The PRISMA flow diagram has been updated to reflect dual independent screening at both the title/abstract and full-text stages."
Request 4: Risk-of-bias tool mismatch or tool applied at study level rather than per outcome.
Model response: "We acknowledge the reviewer's concern regarding the application of the Newcastle-Ottawa Scale to randomized controlled trials. We have replaced the Newcastle-Ottawa Scale assessments for the [n] randomized controlled trials with the Cochrane Risk of Bias 2 (RoB 2) tool (Sterne et al., BMJ, 2019), applied at the outcome level per RoB 2 guidance. The risk-of-bias assessments for observational studies have been retained using the Newcastle-Ottawa Scale, which is appropriate for those study designs. A revised risk-of-bias summary figure is provided (Figure X), and the results section has been updated accordingly (page X to page X)."
Request 5: No GRADE Summary of Findings table.
Model response: "We agree with the reviewer that GRADE certainty ratings are essential for a publication-ready systematic review and regret their absence from the original submission. We have completed GRADE Summary of Findings tables for each of the [n] pre-specified primary outcomes, using GRADEpro software. The certainty of evidence across outcomes ranged from [level] to [level], with the reasons for downgrading documented in the SoF tables. The SoF tables are presented as Table [X] in the revised manuscript, and the methods section has been expanded (page X) to describe the GRADE process and the domains assessed."
Request 6: Heterogeneity not adequately explored.
Model response: "The reviewer raises a valid concern regarding heterogeneity exploration. We have conducted pre-specified subgroup analyses by [factors] and report prediction intervals alongside the pooled effect estimates to characterize the expected range of effects across settings. The I² statistic alone is insufficient for heterogeneity characterization, as it measures the proportion rather than the magnitude of heterogeneity (Higgins et al., BMJ, 2003). We have added tau² and the HKSJ-adjusted 95% confidence intervals to all forest plots. The prediction intervals are discussed in the results and discussion sections, and their clinical implications are addressed explicitly."
Request 7: Search strategy not reproducible or limited to one or two databases.
Model response: "We have expanded the search to include [additional databases]. The full Boolean search strategy for all databases is provided as Supplementary File [X], formatted per PRISMA-S (Rethlefsen et al., Systematic Reviews, 2021). The additional searches retrieved [n] records, of which [n] were screened at full text and [n] were included. The PRISMA flow diagram has been updated to reflect the additional records. The expanded search did not materially alter the review's conclusions, as the additional included studies were consistent with the existing synthesis direction."
Table 2: Systematic Review Peer Review Revision Requests — Diagnosis and Model Response Language
Reviewer Comment Type | Standard / Tool Violated | What the Revision Requires | Opening Language for Response |
|---|---|---|---|
PROSPERO not registered or registered post-hoc | PRISMA 2020 Item 24 (registration); MECIR conduct standards; most Tier 1 journal requirements | If prospective, add the registration number to the abstract and methods. If post-hoc: disclose the deviation explicitly and add a limitation statement. | "Our review was registered prospectively on PROSPERO (CRD[XXXX]) on [date], prior to the commencement of searching on [date]. The registration number has been added to the abstract and methods section..." |
PRISMA checklist not submitted or items missing | PRISMA 2020 (Page et al., BMJ 2021): 27 items with page references required | Complete the PRISMA 2020 checklist, including page references for each item. Submit as a supplementary file. Address any flagged missing items with specific manuscript additions. | "We have completed the PRISMA 2020 (Page et al., BMJ, 2021) 27-item checklist with page references for every item. The completed checklist is submitted as Supplementary File 1..." |
Single-reviewer screening only | MECIR C39 (Mandatory); PRISMA 2020 Item 8; Gartlehner et al. 2020 (single reviewer misses 13% of studies) | Conduct dual independent full-text screening. Report Cohen's Kappa. Add conflict resolution log. Update PRISMA flow diagram. Revise the methods section to describe the dual screening process. | "We have conducted a second independent screening of all full-text articles. Cohen's Kappa inter-rater reliability was [value], indicating [level] agreement. The methods section has been revised (page X)..." |
Wrong risk-of-bias tool or applied per study, not per outcome | RoB 2 (RCTs, per outcome); ROBINS-I V2 (NRS); QUADAS-2 (diagnostic); AMSTAR-2 (included SRs) | Replace the incorrect tool with the validated tool for the study designs included. If RoB 2, apply per outcome. Provide an updated RoB summary figure. Revise the results section. | "We acknowledge the reviewer's concern regarding risk-of-bias tool selection. We have replaced the [original tool] assessments with the [correct tool], applied per [study/outcome level]..." |
GRADE Summary of Findings table absent | GRADE Working Group; required by Cochrane; expected by most Tier 1 clinical journals; PRISMA 2020 Item 22 | Complete GRADE SoF tables for each pre-specified outcome using GRADEpro. Report certainty ratings and reasons for downgrading. Add to the manuscript as a numbered table. Expand the methods section to describe the GRADE process. | "We agree with the reviewer that GRADE certainty ratings are essential. We have completed GRADE Summary of Findings tables for each of the [n] pre-specified primary outcomes (Table X). The certainty of evidence ranged from [level] to [level]..." |
Heterogeneity not adequately explored or reported | Cochrane Handbook v6.5.1: REML estimator; prediction intervals required; I² insufficient alone | Add tau² and prediction intervals to all forest plots. Conduct pre-specified subgroup analyses if available. Discuss prediction intervals in results and discussion. Update conclusions to reflect the range of uncertainty. | "The reviewer correctly identifies that I² alone is insufficient for heterogeneity characterization. We have added tau² and prediction intervals to all forest plots and conducted pre-specified subgroup analyses by [factors]..." |
Search strategy not reproducible or limited to databases | PRISMA 2020 Item 7; PRISMA-S (Rethlefsen et al., Syst Rev 2021); MECIR search standards | Provide full Boolean search strategies for all databases as a supplementary file formatted per PRISMA-S. If additional databases were searched, update the PRISMA flow diagram and report new records and inclusions. | "We have provided the full Boolean search strategy for all databases as a supplementary document (Supplementary File X), formatted per PRISMA-S. The [n] additional records retrieved did not materially alter the conclusions..." |
Standards referenced: PRISMA 2020 (Page et al., BMJ 2021); MECIR (cochrane.org); RoB 2 (Sterne et al., BMJ 2019); GRADE (Schünemann et al., J Clin Epidemiol 2011); PRISMA-S (Rethlefsen et al., Syst Rev 2021); Cochrane Handbook v6.5.1 (March 2025).
How to Handle Reviewer Comments You Disagree With
Disagreement with reviewer comments is normal. Reviewers may misread the methods, apply a different methodological standard, request analyses that are not appropriate for the data, or make suggestions that would change the interpretation without improving it. The response to disagreement requires three things: acknowledgment, evidence, and precision.
Acknowledge the comment fully before rebutting it. A rebuttal that dismisses the concern without engaging with it reads as defensive. Begin by stating what the reviewer's concern is and why it is a reasonable question to raise.
Provide evidence for your position. The best rebuttals cite methodological standards, published guidance, or the study protocol. "We respectfully disagree with the reviewer's suggestion to pool studies using a fixed-effects model. Given the substantial clinical and methodological heterogeneity across the included studies (I² = 78%, tau² = 0.42, prediction interval [X to Y]), a random-effects model is appropriate per current Cochrane Handbook guidance (v6.5.1, Chapter 10). The fixed-effects model assumes a single true effect across all settings, which is not consistent with the populations and interventions studied."
Be precise about what you are and are not changing. If you are partially accepting a comment but declining part of it, say so explicitly and explain each part separately.
Never use phrases such as "the reviewer misunderstood" or "the reviewer is incorrect." The tone should remain professional regardless of the quality of the review. Editors read both documents.
How Long Should the Response Letter Be?
A response letter should be exactly as long as needed to address every comment fully. There is no upper limit. Taylor and Francis guidance explicitly states that response letters can exceed 20 pages for manuscripts with extensive reviewer comments. Wiley, Elsevier, and Springer guidance similarly sets no maximum.
What matters is completeness, not brevity. A two-page response letter for a ten-point major revision tells the editor that the revision was superficial. A 25-page response letter that addresses every point with specific manuscript locations, quoted revised text, and cited evidence tells the editor that the revision was thorough.
For systematic reviews, response letters commonly run 15 to 30 pages because the reviewer comments address multiple methodological components, each requiring specific evidence and manuscript cross-references.
Formatting the Revised Manuscript
Most journals require two versions of the revised manuscript.
Clean version: The final manuscript as it would appear if accepted, with no visible tracked changes. This is the version that will go through production if accepted.
Tracked-change version: The manuscript with all changes marked using Microsoft Word's Track Changes function. This allows reviewers to see exactly what was changed without having to reread the entire manuscript. Changes should be clearly visible. If extensive revisions were made to a section, it may be helpful to note in the response letter that the entire section was rewritten, so reviewers know to read it fresh rather than searching for individual tracked changes.
Some journals also request a version where changes are highlighted in a color rather than tracked. Check the journal's revision instructions for the specific format required.
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Common Mistakes in Revision Response Letters
Responding without changes. Writing "we have revised the manuscript accordingly" without describing what changed is the most frequent problem editors see in inadequate revisions. Every response must describe the specific change and give the location.
Ignoring a comment. If a reviewer raised twelve points and the response letter addresses eleven, the editor will notice. Every comment requires a response, even if it's a polite disagreement.
Inconsistent manuscript locations. Citing page 8, paragraph 2, for a change that is actually on page 11 suggests the manuscript was not proofread after revision. The response letter and the revised manuscript must match exactly.
Defensive tone. A response letter that reads as an argument against the review, rather than a response to it, prejudices the editor before they have read the manuscript changes. Professional disagreement is appropriate; argumentative defensiveness is not.
Paraphrasing reviewer comments. Always quote reviewer comments verbatim. Paraphrasing risks misrepresenting what the reviewer said and gives editors the impression that the author is reframing comments to avoid addressing them directly.
Submitting too quickly. Major revision decisions at Tier 1 journals typically come with a revision deadline of four to twelve weeks. Use the full time available. A rushed major revision that misses components performs worse at re-review than a thorough revision that takes the full available time.
Our target journal selection guide covers what to do if a revision decision leads you to reconsider the journal choice, including how to assess whether a reject-and-resubmit is better handled at a different venue.
Frequently Asked Questions
Should I respond to all reviewer comments even if I disagree with them?
Yes. Every comment requires a response. For comments you disagree with, write a polite, evidence-based rebuttal explaining your position and the reason the manuscript has not been changed. Never leave a comment unaddressed. An incomplete response letter signals to the editor that the revision was not thorough.
How do I know if a revision decision is worth pursuing?
A Major Revision decision at the journal you targeted is almost always worth pursuing. Rosenkrantz and Harisinghani (2015) found that 84.7% of Major Revision decisions at a Tier 1 radiology journal were ultimately accepted. The threshold for abandoning a revision is high. It applies when there is a systematic methodological flaw that cannot be corrected, or a fundamental scope mismatch identified in the editor's letter rather than the reviewers' comments.
How long do I have to respond to a revision decision?
Most journals set a revision deadline of 4 to 12 weeks from the date of the decision letter. Check the editorial decision letter for the specific deadline. Extensions are often available if requested in advance and with a reasonable explanation. Contact the editorial office before the deadline, not after it has passed.
What is the difference between a Major Revision and a Reject and Resubmit?
A Major Revision invites revision of the specific manuscript on file. The revised version retains the original submission date. A Reject and Resubmit closes the current submission and invites a new submission, which goes through a fresh editorial assessment. A Reject and Resubmit decision gives you more flexibility to restructure the work substantially, but does not carry the implicit commitment of a Major Revision decision.
Can I appeal a rejection rather than revise?
Most journals have an appeals process for outright rejections where the author believes the decision was based on factual error or serious reviewer misconduct. Appeals are not appropriate for editorial decisions based on scope, priority, or general quality. If your manuscript was rejected without an invitation to resubmit, the most efficient path is to revise based on the reviewers' feedback and submit to a different journal.
How should I handle reviewer comments that contradict each other?
When Reviewer 1 requests a change that conflicts directly with what Reviewer 2 requests, address the contradiction explicitly in the response letter. Explain the conflict, state your judgment about which position is methodologically stronger, and explain your decision. This is a situation where the editor actively appreciates a clear account of your reasoning, since they are the arbitrator.
The Response Letter Is Where the Publication Is Won or Lost
A Major Revision decision means the editor sees enough value in your systematic review to invest further review time. 84.7% of those decisions end in publication. The response letter determines whether your manuscript falls into the 84.7% or the 15.3%.
A response letter that addresses every comment, provides specific manuscript locations, quotes revised text, and handles disagreements respectfully gives the editor exactly what they need to move the manuscript forward.
If the revision decision involved GRADE, dual screening, RoB, PRISMA, or PROSPERO issues (the most common grounds for systematic review revisions), ScribeLab Writer's peer-review response service handles the full response and manuscript revision for $350. Submit the decision letter and manuscript, and a methodologist will respond within 24 hours.
