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Article History

Received: 30 October 2025

Accepted: 13 April 2026

First Online: 13 May 2026

Declarations

:

: Central approval for the study protocol was provided by the Ethics Committee of Osaka Metropolitan University Graduate School of Medicine (approval number: 2022–010), with permission for implementation obtained from all of the participating institutions. The study protocol was registered at UMIN-CTR (registration number: UMIN000049223, registration date: October 17, 2022, ) prior to enrollment of the first participants. This study was conducted in accordance with the Declaration of Helsinki, with written informed consent obtained from each participant.

: Not applicable.

: Details of the study protocol are available from the corresponding author upon reasonable request.

: There is no identifying information related to the authors, their institutions, funders, or approval committees that might compromise anonymity.

: AO has received research grants and speaker fees from Pfizer Inc., Bristol-Myers Squibb, Advantest, Asahi Kasei Pharma Corp., Chugai Pharmaceutical Co. Ltd., Eli Lilly Japan K.K, Ono Pharmaceutical Co., UCB Japan Co., Mitsubishi Tanabe Pharma Co., Eisai Co. Ltd., Abbvie Inc., Takeda Pharmaceutical Co. Ltd., and Daiichi Sankyo Co. Ltd. AO belongs to a department that is financially supported by two pharmaceutical companies (AYUMI Pharmaceutical Co., Asahi Kasei Pharma Corp.). TI has received payments for lectures from JCR Pharmaceuticals and Kyowa Kirin. RU has received personal fees from Daiichi Sankyo, Eisai, Sawai Pharmaceutical, SBI Pharmaceuticals, Statcom, and EPS Corporation, and lecture fees from Janssen Pharmaceuticals and SAS Institute Japan, for work outside of the submitted study. HY has received speaker fees from AbbVie, Asahi Kasei Pharma, Astellas, Bristol-Myers Squibb, Chugai, Eisai, Gilead Sciences, Ono, Pfizer, and Taiho Pharmaceutical. KE is affiliated with the Department of Sports Medical Biomechanics of The Osaka University Graduate School of Medicine, which is supported by Asahi-Kasei. KE has received research grants from Asahi-Kasei and Teijin Pharma. KE has received speaker fees from AbbVie, Amgen, Argenx, Asahi-Kasei, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Janssen, Mitsubishi-Tanabe, Ono Pharmaceutical, Pfizer, Sanofi, Taisho, Teijin Pharma, and UCB Japan. Y. Okita has received speaker fees from Eli Lilly, Nippon Boehringer Ingelheim Co., Ltd., Pfizer Inc., Asahi Kasei Pharma Corp., Ono Pharmaceutical Co., Mitsubishi Tanabe Pharma Corporation, Taisho Pharmaceutical Holdings Co., Ltd., and Novartis Pharma. RH has received speaker fees from AbbVie G.K., Asahi Kasei Pharma Co., Eisai Co. Ltd, and Eli Lilly Japan. RW has received a research grant from AbbVie and speaker fees from Asahi-Kasei, Chugai, Eli Lilly, Sanofi, and GSK. TO has received research grants and/or speaker fees from Abbvie, Asahi Kasei, Chugai, Eisai, Eli Lilly, Tanabe Mitsubishi. Janssen, and Novartis Pharma. MH has received research grants and/or speaker fees from Abbvie, Asahi Kasei, Astellas, Ayumi, Bristol Meyers, Chugai, EA Pharma, Eisai, Daiichi Sankyo, Eli Lilly, Nihon Shinyaku, Novartis Pharma, and Tanabe Mitsubishi. The remaining authors have no competing interests to declare. None of above-mentioned pharmaceutical companies were involved in the present study design, data collection, data analysis, manuscript writing, or manuscript submission.

: The authors declare no competing interests.