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Article History

Received: 21 August 2025

Accepted: 24 September 2025

First Online: 9 October 2025

Declarations

:

: Yuichi Tamura received remuneration from Janssen, Bayer Yakuhin, and Daiichi Sankyo received research funds from Mochida and Nippon Shinyaku. Yu Taniguchi has received remuneration from Bayer Ltd., Janssen Pharmaceuticals Ltd., and Nippon Shinyaku Ltd., and research funds from Janssen Pharmaceuticals Ltd. Ichizo Tsujino received funding from Janssen Pharmaceutical K.K. for Joint Research, and from Nippon Shinyaku Co Ltd, Mochida Pharmaceuticals Co Ltd, Boehringer Ingelheim Japan Co Ltd, Takeyama Co Ltd, Kaneka Ltd, and Medical System Network Co Ltd as part of an endowed department. Hiromi Matsubara received research grants from Nippon Shinyaku, speaker and consultant fees from Bayer, Janssen, and MSD, speaker fees from Kaneka Medix, Mochida, Nippon Shinyaku, and Nipro. All disclosed fees and support are outside the submitted work. Shiro Adachi has received remuneration from Nippon Shinyaku Co., Ltd., Bayer Yakuhin, Ltd. and Janssen Pharmaceutical K.K.. Shiro Adachi has research funds from Nippon Shinyaku Co., Ltd., Bayer Yakuhin, Ltd., Mochida Pharmaceutical Co., Ltd.and MSD K.K.. Nobuhiro Tahara has received remuneration from Janssen Pharmaceutical K.K., Nippon Shinyaku, Mochida Pharmaceutical, Pfizer, and Bayer Yakuhin. Nobuhiro Tahara has research funds from AJanssen Pharmaceutical K.K. and Ionis Pharmaceuticals Inc. Kohtaro Abe has research funds from grant from Nippon Shinyaku, Mochida Pharmaceutical, Daiichi Sankyo, Janssen Pharmaceutical, Konica Minolta, and Daiichi Sankyo. Yoshihiro Dohi has received remuneration from Janssen Pharmaceutical K.K., Bayer Yakuhin LTd., and Nippon Shinyaku Co Ltd. Kayoko Kubota has received remuneration from Nippon shinyaku and Janssen Pharmaceutical K.K.. Hidekata Yasuoka has received remuneration from Abbvie, Asahi Kasei, Astellas Pharma, Daiichi Sankyo, Eisai. Kissei, Takeda, Tanabe Mitsubishi, Chugai, Novartis, Eli Lilly, Pfizer, Janssen, Sanofi, Teijin, Boehringer Ingelheim, Bayer, Viatris, and research funds from AbbVie, Boehringer Ingelheim, Gilead, Janssen, Nippon shinyaku, Asahi Kasei, Chugai, Eisai, Mitsubishi-Tanabe, Taisho. Satoshi Ikeda has received remuneration from Bayer Healthcare, Bristol Myers Squibb, Janssen Pharmaceutical K.K., Nippon Shinyaku, Pfizer, Viatris, and Daiichi Sankyo. Nobutaka Ikeda has received remuneration from Bayer Yakuhin, Nippon Shinyaku, Janssen Pharmaceutical K.K. Masataka Kuwana has received research grants from Boehringer Ingelheim and MBL, and lecture/consultant fees from Asahi Kasei Pharma, AstraZeneca, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Kissei, Janssen, Mochida, and Tanabe-Mitsubishi. Yudai Tamura, Ryo Takemura, Takumi Inami, Ayako Shigeta, Masaru Hatano, Keiichi Sakurai, Koshin Horimoto, Nobuhiro Yaoita, Kazuhiro Kimura, Kayoko Kubota, Noriko Kikuchi, Yuichi Baba, Toshiro Shinke, Mari Amino, Natsumi Yamaguchi, Teruki Sato, Masaru Ishida, Fusako Sera, Naohiko Nakanishi, Hakuoh Konishi, Koichiro Kinugawa, Takeshi Kashimura, Kaoru Dohi, Kazufumi Nakamura, Soichiro Usui, Sumiaki Tanaka, Shuji Kubota, Masanori Yoshikawa, Keiichi Odagiri, Sadatomo Tasaka, Yasuchika Takeishi, Teruyasu Sugano, Koichiro Sugimura, and Koichiro Tatsumi have nothing to disclose.

: This study conformed to the ethical guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of Kyoto University Graduate School and Faculty of Medicine (approved no. R1919-13) and the International University of Health and Welfare (approval no. 5–21-87). The JAPHR is a prospective national registry. The institutional review boards of all the participating centers approved the study design. All the participants (including those who later died) provided written informed consent at enrolment in accordance with the Japanese Ethical Guidelines for Medical Research Involving Human Subjects. The JAPHR provided anonymized data for this study. Formal approval and permission for data access and use were obtained.