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Article History

Received: 26 May 2025

Accepted: 24 September 2025

First Online: 22 October 2025

Declarations

:

: SS attended scientific advisory committee meetings for Atara, Bristol-Myers-Squibb, Merck, Novartis, Pfizer and Seqirus, and received speaking fees from Boehringer-Ingelheim and Novartis. LA served as a consultant for Roche and Pfizer for work unrelated to this study. LA is an Editorial Board member of Drug Safety. LA was not involved in the selection of peer reviewers for the manuscript nor in any of the subsequent editorial decisions. The other authors have no conflicts of interest to declare.

: This study is based in part on data from the Clinical Practice Research Datalink obtained under license from the UK Medicines and Healthcare products Regulatory Agency. The data are provided by patients and collected by the UK National Health Service as part of their care and support. The interpretation and conclusions contained in this study are those of the authors alone. Because electronic health records are classified as “sensitive data” by the UK Data Protection Act, information governance restrictions (to protect patient confidentiality) prevent data sharing via public deposition. Data are available with approval through the individual constituent entities controlling access to the data. Specifically, the primary-care data can be requested via application to the Clinical Practice Research Datalink ( ).

: The study protocol was approved by the CPRD Research Data Governance (No. 22_001853) and the Research Ethics Board of the Jewish General Hospital, Montreal, Canada.

: Not applicable.

: Not applicable.

: Codes may be made privately available upon reasonable request to the corresponding author.

: YHW, LA, and CR conceived and designed the study and were involved in the analysis and interpretation of the results. All authors contributed to the study design, analysis, and interpretation of the results. Analyses were performed by YHW and SB. The first draft of the manuscript was written by YHW, with editing by KJ and CR. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. CR and LA obtained funding and CR supervised the study.