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Article History

Received: 16 September 2025

Accepted: 26 March 2026

First Online: 23 June 2026

Declarations

:

: The study was considered exempt research under 45 CFR § 46.104(d)(4) as it involved only the secondary use of data that were de-identified in compliance with the Health Insurance Portability and Accountability Act (HIPAA), specifically, 45 CFR § 164.514. The study was conducted according to the standards of Good Pharmacoepidemiology Practice (GPP) and all applicable federal, state, and local laws, rules, and regulations.

: Not applicable.

: XY and MO are employees of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA and own stock/stock options in Merck & Co., Inc., Rahway, NJ, USA. TD and AA are employees of Alexion, AstraZeneca Rare Disease and own stock/stock options. JTJ is an independent consultant of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA., Akeila Bio, Alexion Pharmaceuticals, AstraZeneca, Navio Theragnostics, Recursion Pharmaceuticals, Shepherd Therapeutics, Springworks Therapeutics, is an employee of University of Texas Southwestern Medical Center, and owns stock/stock options from Akeila Bio, Khora TX, Navio Theragnostics, and Shepherd Therapeutics. MC, QL, DL, GC, and MSD are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, which funded the development and conduct of this study and manuscript.