{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:13:51Z","timestamp":1792005231402,"version":"4.4.0"},"reference-count":50,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T00:00:00Z","timestamp":1741132800000},"content-version":"unspecified","delay-in-days":63,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["R01 AR080659"],"award-info":[{"award-number":["R01 AR080659"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2025,2,18]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate the risk factors for severe acute COVID-19 outcomes in the Omicron era among individuals with systemic autoimmune rheumatic diseases (SARDs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We identified patients with confirmed SARDs and COVID-19 (positive PCR and\/or antigen test) from 1 September 2022 to 15 March 2024 in the Mass General Brigham healthcare system. We estimated the associations of baseline characteristics with the odds of hospitalisation due to COVID-19 infection, verified by medical record review, using multivariable logistic regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 2061 patients with SARDs and COVID-19 during the Omicron era (75% female, mean age 62.2 years), 134 (6.5%) were hospitalised due to COVID-19, mostly due to respiratory symptoms (84, 63%). Of those hospitalised, 11 (8%) required mechanical ventilation and 20 (15%) died. Older age (adjusted OR (aOR) 1.05 per year), Black race (vs White race, aOR 4.15), ever smoking (vs never, aOR 1.76), CD20 inhibitor use (vs antimalarial monotherapy, aOR 2.22) and glucocorticoid use (vs non-use, aOR 2.07) were significantly associated with higher odds of hospitalisation. Female sex (vs male, aOR 0.63), booster SARS-CoV-2 vaccination (vs initial series, aOR 0.49) and vaccination within either 3 months or 3\u20136 months prior to infection (aOR 0.41 and aOR 0.38, respectively, vs none within 12 months) were significantly associated with lower odds of hospitalisation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Some patients with SARDs remain at higher risk of severe COVID-19 in the Omicron era. Patients who are older, Black, have more comorbidities, use CD20 inhibitors and\/or glucocorticoids, or have not been vaccinated recently may benefit from risk-mitigating strategies, including booster vaccines and pre-exposure prophylaxis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2024-005114","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T19:00:25Z","timestamp":1741201225000},"page":"e005114","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Patients with systemic autoimmune rheumatic diseases remain at risk for hospitalisation for COVID-19 infection in the Omicron era (2022\u20132024): a retrospective cohort study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6038-0346","authenticated-orcid":false,"given":"Naomi J","family":"Patel","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"Rheumatology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruthi","family":"Srivatsan","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily N","family":"Kowalski","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"King","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaosong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen MM","family":"Vanni","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S","family":"Hanberg","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina J","family":"Bade","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alene A","family":"Saavedra","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin T","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Buuthien","family":"Hang","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary K","family":"Williams","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colebrooke","family":"Johnson","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison","family":"Negron","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5556-4618","authenticated-orcid":false,"given":"Jeffrey A","family":"Sparks","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary S","family":"Wallace","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"Rheumatology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"2025090313350591000_11.1.e005114.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-222954"},{"key":"2025090313350591000_11.1.e005114.2","unstructured":"WHO . COVID-19 variant update. 2024. Available: https:\/\/www.idsociety.org\/covid-19-real-time-learning-network\/diagnostics\/covid-19-variant-update\/#\/+\/0\/publishedDate_na_dt\/desc [Accessed 13 Aug 2024]."},{"key":"2025090313350591000_11.1.e005114.3","unstructured":"Centers for Disease Control and Prevention . Trends in united states covid-19 deaths, emergency department (ed) visits, and test positivity by geographic area. 2024. Available: https:\/\/covid.cdc.gov\/covid-data-tracker\/#trends_weeklydeaths_weeklypctdeaths_00 [Accessed 13 Aug 2024]."},{"key":"2025090313350591000_11.1.e005114.4","doi-asserted-by":"crossref","unstructured":"Patel NJ , D\u2019Silva KM , Hsu T-T , et al . COVID-19 outcomes among users of cd20 inhibitors for immune-mediated diseases: a comparative cohort study. medRxiv [Preprint] 2021. doi:10.1101\/2021.08.05.21261643","DOI":"10.1101\/2021.08.05.21261643"},{"key":"2025090313350591000_11.1.e005114.5","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2020-217871"},{"key":"2025090313350591000_11.1.e005114.6","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-eular.2252"},{"key":"2025090313350591000_11.1.e005114.7","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-eular.1632"},{"key":"2025090313350591000_11.1.e005114.8","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2020-219498"},{"key":"2025090313350591000_11.1.e005114.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2021.06.036"},{"key":"2025090313350591000_11.1.e005114.10","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-221326"},{"key":"2025090313350591000_11.1.e005114.11","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2020-eular.1181"},{"key":"2025090313350591000_11.1.e005114.12","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2020-219279"},{"key":"2025090313350591000_11.1.e005114.13","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2021.2002063"},{"key":"2025090313350591000_11.1.e005114.14","doi-asserted-by":"crossref","first-page":"e855","DOI":"10.1016\/S2665-9913(21)00316-7","article-title":"Outcomes of COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica from the COVID-19 Global Rheumatology Alliance physician registry: a retrospective cohort study","volume":"3","author":"Sattui","year":"2021","journal-title":"Lancet Rheumatol"},{"key":"2025090313350591000_11.1.e005114.15","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1136\/annrheumdis-2021-221636","article-title":"Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance","volume":"81","author":"Ugarte-Gil","year":"2022","journal-title":"Ann Rheum Dis"},{"key":"2025090313350591000_11.1.e005114.16","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1002\/acr.25220","article-title":"Impact of Risk Factors on COVID \u201019 Outcomes in Unvaccinated People With Rheumatic Diseases: A Comparative Analysis of Pandemic Epochs Using the COVID \u201019 Global Rheumatology Alliance Registry","volume":"76","author":"Yazdany","year":"2024","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090313350591000_11.1.e005114.17","doi-asserted-by":"crossref","first-page":"e765","DOI":"10.1016\/S2665-9913(22)00227-2","article-title":"Risk of severe COVID-19 outcomes associated with rheumatoid arthritis and phenotypic subgroups: a retrospective, comparative, multicentre cohort study","volume":"4","author":"Figueroa-Parra","year":"2022","journal-title":"Lancet Rheumatol"},{"key":"2025090313350591000_11.1.e005114.18","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.ipha.2024.05.003","article-title":"Association of immunomodulatory therapies with COVID-19 mortality in rheumatoid arthritis: An analysis of the FDA adverse event reporting system","volume":"2","author":"Bing","year":"2024","journal-title":"Intelligent Pharmacy"},{"key":"2025090313350591000_11.1.e005114.19","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2020-218054"},{"key":"2025090313350591000_11.1.e005114.20","doi-asserted-by":"publisher","DOI":"10.20411\/pai.v6i1.435"},{"key":"2025090313350591000_11.1.e005114.21","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2023-003250","article-title":"Risk factors for severe COVID-19 among patients with systemic lupus erythematosus: a real-world analysis of a large representative US administrative claims database, 2020-2021","volume":"9","author":"Calabrese","year":"2023","journal-title":"RMD Open"},{"key":"2025090313350591000_11.1.e005114.22","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"2025090313350591000_11.1.e005114.23","first-page":"1044","article-title":"Calculating the benefits of a Research Patient Data Repository","volume":"2006","author":"Nalichowski","year":"2006","journal-title":"AMIA Annu Symp Proc"},{"key":"2025090313350591000_11.1.e005114.24","unstructured":"Department of Public Health, Executive Office of Health and Human Services . COVID-19 reporting. Available: https:\/\/www.mass.gov\/info-details\/covid-19-reporting [Accessed 13 Aug 2024]."},{"key":"2025090313350591000_11.1.e005114.25","unstructured":"Centers for Disease Control and Prevention . Concerns about bivalent covid-19 vaccine and reasons for non-vaccination among adults who completed a primary series \u2013 omnibus survey, march 10\u2013april 30, 2023 & household pulse survey, march 1\u2013april 10, 2023. 2023. Available: https:\/\/www.cdc.gov\/vaccines\/imz-managers\/coverage\/covidvaxview\/pubs-resources\/covid-vaccine-reasons-non-vaccination.html#:~:text=In%20September%202022%2C%20the%20CDC,%2D19%20strain%20(2) [Accessed 16 Aug 2024]."},{"key":"2025090313350591000_11.1.e005114.26","unstructured":"Broad Institute . Tracking the omicron variant in massachusetts. Available: https:\/\/www.broadinstitute.org\/news\/tracking-omicron-variant-massachusetts [Accessed 5 Jul 2022]."},{"key":"2025090313350591000_11.1.e005114.27","unstructured":"Sinha A , Deshwal H , Vashisht R . Safe and effective use of baricitinib and remdesivir in hospitalized patients with coronavirus (covid-19). In: StatPearls. FL Treasure Island: StatPearls Publishing, 2024."},{"key":"2025090313350591000_11.1.e005114.28","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1002\/art.41567","article-title":"Association of Race and Ethnicity With COVID-19 Outcomes in Rheumatic Disease: Data From the COVID-19 Global Rheumatology Alliance Physician Registry","volume":"73","author":"Gianfrancesco","year":"2021","journal-title":"Arthritis Rheumatol"},{"key":"2025090313350591000_11.1.e005114.29","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-02156-9"},{"key":"2025090313350591000_11.1.e005114.30","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-006434","article-title":"The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis","volume":"6","author":"Romero Starke","year":"2021","journal-title":"BMJ Glob Health"},{"key":"2025090313350591000_11.1.e005114.31","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa924"},{"key":"2025090313350591000_11.1.e005114.32","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00272-2"},{"key":"2025090313350591000_11.1.e005114.33","unstructured":"CDC . COVID-19 vaccines are effective. Available: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/vaccines\/effectiveness\/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fcovid-19%2Fhealth-departments%2Fbreakthrough-cases.html [Accessed 3 Jul 2022]."},{"key":"2025090313350591000_11.1.e005114.34","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003992","article-title":"Vaccine effectiveness against SARS-CoV-2 infection or COVID-19 hospitalization with the Alpha, Delta, or Omicron SARS-CoV-2 variant: A nationwide Danish cohort study","volume":"19","author":"Gram","year":"2022","journal-title":"PLoS Med"},{"key":"2025090313350591000_11.1.e005114.35","unstructured":"GOV.UK . A guide to the spring 2024 covid-19 vaccination campaign. 2024. Available: https:\/\/www.gov.uk\/government\/publications\/covid-19-vaccination-spring-booster-resources\/a-guide-to-the-covid-19-spring-booster-2023#:~:text=You%20will%20be%20invited%20to,as%20soon%20as%203%20months [Accessed 13 Aug 2024]."},{"key":"2025090313350591000_11.1.e005114.36","unstructured":"GOV.AU . COVID-19 vaccination. 2024. Available: https:\/\/www.healthdirect.gov.au\/covid-19\/vaccinations#:~:text=Further%20doses-,If%20you%20have%20had%20your%20primary%20vaccination%20course%20and%20you,19%20vaccine%20every%2012%20months [Accessed 13 Aug 2024]."},{"key":"2025090313350591000_11.1.e005114.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2021.12.013"},{"key":"2025090313350591000_11.1.e005114.38","doi-asserted-by":"crossref","first-page":"e237","DOI":"10.1016\/S2665-9913(22)00001-7","article-title":"COVID-19 vaccine perceptions and uptake: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey","volume":"4","author":"Putman","year":"2022","journal-title":"Lancet Rheumatol"},{"key":"2025090313350591000_11.1.e005114.39","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-021-01283-z"},{"key":"2025090313350591000_11.1.e005114.40","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2022-002587","article-title":"Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey","volume":"8","author":"DiIorio","year":"2022","journal-title":"RMD Open"},{"key":"2025090313350591000_11.1.e005114.41","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1002\/acr2.11386","article-title":"Coronavirus Disease 2019 Outcomes Among Recipients of Anti-CD20 Monoclonal Antibodies for Immune-Mediated Diseases: A Comparative Cohort Study","volume":"4","author":"Patel","year":"2022","journal-title":"ACR Open Rheumatol"},{"key":"2025090313350591000_11.1.e005114.42","doi-asserted-by":"crossref","first-page":"152108","DOI":"10.1016\/j.semarthrit.2022.152108","article-title":"Factors associated with COVID-19 breakthrough infection among vaccinated patients with rheumatic diseases: A cohort study","volume":"58","author":"Patel","year":"2023","journal-title":"Semin Arthritis Rheum"},{"key":"2025090313350591000_11.1.e005114.43","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1002\/acr2.11681","article-title":"COVID-19 Vaccination Before Initiating Rituximab Treatment Induces Strong Serological Response in Autoimmune Rheumatic Disease, Reducing Post-Pandemic Concerns About the Impact of Rituximab","volume":"6","author":"Ammitzb\u00f8ll","year":"2024","journal-title":"ACR Open Rheumatol"},{"key":"2025090313350591000_11.1.e005114.44","unstructured":"COVID-19 vaccine guidance summary for patients with rheumatic and musculoskeletal diseases. 2022. Available: https:\/\/www.rheumatology.org\/Portals\/0\/Files\/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf [Accessed 10 Feb 2024]."},{"key":"2025090313350591000_11.1.e005114.45","first-page":"109","article-title":"Real-World Experience of Tixagevimab and Cilgavimab (Evusheld) in Rheumatologic Patients on Rituximab","volume":"29","author":"Ocon","year":"2023","journal-title":"J Clin Rheumatol"},{"key":"2025090313350591000_11.1.e005114.46","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1093\/ckj\/sfad111","article-title":"Safety and efficacy of pre-exposure prophylaxis with tixagevimab\/cilgavimab (Evusheld) in patients with glomerular diseases who received rituximab","volume":"16","author":"Sciascia","year":"2023","journal-title":"Clin Kidney J"},{"key":"2025090313350591000_11.1.e005114.47","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.2023-0742"},{"key":"2025090313350591000_11.1.e005114.48","doi-asserted-by":"publisher","DOI":"10.7326\/m20-6306"},{"key":"2025090313350591000_11.1.e005114.49","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1164\/rccm.202007-2794OC","article-title":"Outcome of Hospitalization for COVID-19 in Patients with Interstitial Lung Disease. An International Multicenter Study","volume":"202","author":"Drake","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"2025090313350591000_11.1.e005114.50","unstructured":"Centers for Disease Control and Prevention . COVID-net interactive dashboard. Available: https:\/\/www.cdc.gov\/covid\/php\/covid-net\/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcovidnetdashboard%2Fde%2Fpowerbi%2Fdashboard.html [Accessed 13 Aug 2024]."}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2024-005114","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T20:35:18Z","timestamp":1756931718000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2024-005114"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,3,5]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/rmdopen-2024-005114"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2024-005114","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}