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Article History

Received: 22 September 2025

Accepted: 9 January 2026

First Online: 5 February 2026

Declarations

:

: This study used anonymised patient data from the Clinical Practice Research Datalink (CPRD), which is provided by the Medicines and Healthcare products Regulatory Agency (MHRA), with support from the National Institute for Health and Care Research (NIHR), under the Department of Health and Social Care. CPRD has ethical approval from the Health Research Authority (HRA) to facilitate research using anonymised patient data. Informed consent from individual patients was not required, as the data used in this study were anonymised and collected in accordance with CPRD’s governance framework. Access to CPRD data is subject to protocol approval through CPRD’s Research Data Governance (RDG) Process. The protocol for use of CPRD Aurum data was approved by the CPRD Independent Scientific Advisory Committee (ISAC) (Study reference ID: 23_003538). This research complied with the UK Policy Framework for Health and Social Care Research, the UK General Data Protection Regulation (UK GDPR), the Data Protection Act 2018, and relevant HRA guidance on the use of anonymised data. The study was conducted in accordance with the approved guidelines and the principles of the Declaration of Helsinki.

: Not applicable.

: Dr Shamil Haroon receives research funding from NIHR and UKRI and has received consultancy fees from the Phoenix Group; all other authors report no conflicts of interest.