{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:01:23Z","timestamp":1792688483950,"version":"4.5.0"},"reference-count":53,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Neurol Disord"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Cladribine (CLAD) stands as an oral disease modifying treatment (DMT) for multiple sclerosis (MS) patients, distinguished by its unique dosing regimen and mechanism of action. However, real-world data on its effectiveness remain limited, particularly regarding the clinical and therapeutical management beyond the 2-year treatment schedule.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>The aim of our study was to explore the effectiveness profile of CLAD in individuals with MS (pwMS). We assessed the proportion of patients achieving no evidence of disease activity (NEDA-3) status and identified variables associated with better outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>In this retrospective study, we collected clinical and magnetic resonance imaging (MRI) data of MS patients across 10 MS Clinics in Central Italy who started CLAD between 2018 and 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We evaluated the annualized relapse rate (ARR) during treatment, and the proportion of patients who experienced relapses, radiological activity, and confirmed disability progression. Additionally, we estimated the proportion of patients achieving NEDA-3 among those with a minimum follow-up of 3\u2009months and explored baseline variables associated with NEDA status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We collected data from 1094 patients with a mean follow-up of 25.1\u2009months, of whom 79% completed the second CLAD cycle. The mean age was 37.7\u2009years (SD 9.7), and the mean disease duration was 6.5\u2009years, with 40.5% being treatment na\u00efve. Despite a significant reduction of the ARR from 0.91 to 0.04 (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.01) following CLAD treatment, 8.9% of patients presented at least one relapse, while 22.0% and 7.9% of patients experienced radiological activity or disability progression, respectively. Across the entire study cohort, 70.2% of patients maintained the NEDA-3 status. Younger age (HR\u2009=\u20090.98,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and higher expanded disability status scale score (HR\u2009=\u20091.11,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.049) were associated with a higher risk of not achieving the NEDA-3 status. Additionally, we included 131 patients who were older than 50\u2009years at the time of CLAD initiation. Among the cohort, 116 patients switched to another DMT after CLAD, primarily anti-CD20 monoclonal antibodies following disease reactivation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This postmarketing experience confirms the effectiveness of CLAD in the treatment of pwMS, with a significant reduction in ARR and a high proportion of patients remaining free from disease activity. By contrast, some patients required an escalation strategy mainly with anti-CD20 monoclonal antibodies because of persisting disease activity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562864251360047","type":"journal-article","created":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T07:10:18Z","timestamp":1766819418000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Real-world experience with cladribine tablets in people with multiple sclerosis: effectiveness data from a multicenter Italian study"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0447-2297","authenticated-orcid":false,"given":"Matteo","family":"Lucchini","sequence":"first","affiliation":[{"name":"Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Centro di Ricerca Sclerosi Multipla \u201cAnna Paola Batocchi,\u201d Largo Agostino Gemelli 8, Rome, Lazio 00168, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Borriello","sequence":"additional","affiliation":[{"name":"San Pietro Fatebenefratelli Hospital, Rome, Italy"},{"name":"Federico II University, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalom","family":"Haggiag","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliera San Camillo Forlanini, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina Gabri","family":"Nicoletti","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Clinical and Research Unit, Fondazione Policlinico Tor Vergata, Department of Systems Medicine, Tor Vergata University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Fantozzi","sequence":"additional","affiliation":[{"name":"IRCCS Neuromed, Pozzilli (IS), Molise, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Chiara","family":"Buscarinu","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University, Neurology Unit, Sant\u2019Andrea University Hospital, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Ferrazzano","sequence":"additional","affiliation":[{"name":"Sapienza University of Rome, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Cortese","sequence":"additional","affiliation":[{"name":"San Filippo Neri Hospital, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4697-2051","authenticated-orcid":false,"given":"Fabiana","family":"Marinelli","sequence":"additional","affiliation":[{"name":"Ospedale Spaziani, Frosinone, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizia","family":"Monteleone","sequence":"additional","affiliation":[{"name":"Ospedale Santa Maria Goretti, Latina, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8390-8545","authenticated-orcid":false,"given":"Diego","family":"Centonze","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Clinical and Research Unit, Fondazione Policlinico Tor Vergata, Department of Systems Medicine, Tor Vergata University, Rome, Italy"},{"name":"IRCCS Neuromed, Pozzilli (IS), Molise, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Conte","sequence":"additional","affiliation":[{"name":"IRCCS Neuromed, Pozzilli (IS), Molise, Italy"},{"name":"Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Ferraro","sequence":"additional","affiliation":[{"name":"San Filippo Neri Hospital, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Gasperini","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliera San Camillo Forlanini, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5863-7758","authenticated-orcid":false,"given":"Girolama Alessandra","family":"Marfia","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Clinical and Research Unit, Fondazione Policlinico Tor Vergata, Department of Systems Medicine, Tor Vergata University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6360-4798","authenticated-orcid":false,"given":"Carlo","family":"Pozzilli","sequence":"additional","affiliation":[{"name":"Sant\u2019Andrea University Hospital, University of Rome Sapienza, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Salvetti","sequence":"additional","affiliation":[{"name":"IRCCS Neuromed, Pozzilli (IS), Molise, Italy"},{"name":"Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University, Neurology Unit, Sant\u2019Andrea University Hospital, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Barbuti","sequence":"additional","affiliation":[{"name":"Sant\u2019Andrea University Hospital, University of Rome Sapienza, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2635-1699","authenticated-orcid":false,"given":"Gianmarco","family":"Bellucci","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University, Neurology Unit, Sant\u2019Andrea University Hospital, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assunta","family":"Bianco","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Centro di Ricerca Sclerosi Multipla \u201cAnna Paola Batocchi\u201d, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Carlomagno","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Centro di Ricerca Sclerosi Multipla \u201cAnna Paola Batocchi\u201d, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Cruciani","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Campus Bio-Medico, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"De Giglio","sequence":"additional","affiliation":[{"name":"San Filippo Neri Hospital, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Dionisi","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Clinical and Research Unit, Fondazione Policlinico Tor Vergata, Department of Systems Medicine, Tor Vergata University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Ianniello","sequence":"additional","affiliation":[{"name":"San Pietro Fatebenefratelli Hospital, Rome, Italy"},{"name":"Sapienza University of Rome, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Malimpensa","sequence":"additional","affiliation":[{"name":"IRCCS Neuromed, Pozzilli (IS), Molise, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Nasello","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University, Neurology Unit, Sant\u2019Andrea University Hospital, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviana","family":"Nociti","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Centro di Ricerca Sclerosi Multipla \u201cAnna Paola Batocchi\u201d, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Prosperini","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliera San Camillo Forlanini, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Tortorella","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliera San Camillo Forlanini, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7783-114X","authenticated-orcid":false,"given":"Massimiliano","family":"Mirabella","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Centro di Ricerca Sclerosi Multipla \u201cAnna Paola Batocchi\u201d, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,26]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30481-1"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2024.100977"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2022.06.023"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-023-00801-6"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00289-7"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000009636"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26913"},{"issue":"4","key":"e_1_3_4_9_2","article-title":"Treatment effect modifiers of immunotherapies for relapsing-remitting multiple sclerosis-a systematic review and meta-analysis","volume":"10","author":"Heesen C","year":"2024","unstructured":"Heesen C, R\u00f6ver C, Salem S, et al. Treatment effect modifiers of immunotherapies for relapsing-remitting multiple sclerosis-a systematic review and meta-analysis. Mult Scler J Exp Transl Clin 2024; 10(4): 20552173241274616.","journal-title":"Mult Scler J Exp Transl Clin"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/ph17111474"},{"key":"e_1_3_4_11_2","first-page":"1","article-title":"An overview on disease modifying and symptomatic drug treatments for multiple sclerosis","author":"Dalla Costa G","year":"2024","unstructured":"Dalla Costa G, Leocani L, Rodegher M, et al. An overview on disease modifying and symptomatic drug treatments for multiple sclerosis. Expert Rev Clin Pharmacol 2024; 1\u201321.","journal-title":"Expert Rev Clin Pharmacol"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2019.02.018"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0902533"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458517727603"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/17562864231183221"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2022.104459"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16250"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/13524585241302170"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30470-2"},{"key":"e_1_3_4_20_2","unstructured":"Pagina non trovata http:\/\/www.regione.lazio.it\/binary\/rl_sanita\/tbl_normativa\/SAN_DCA_U00386_13_11_2014.pdf (accessed 13 March 2025)."},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.33.11.1444"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-013-1485-7"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20740"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2023.3331"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458517703193"},{"key":"e_1_3_4_26_2","unstructured":"Summary of product characteristics https:\/\/ec.europa.eu\/health\/documents\/community-register\/2018\/20180709141793\/anx_141793_en.pdf (accessed 13 March 2025)."},{"key":"e_1_3_4_27_2","unstructured":"Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 https:\/\/ctep.cancer.gov\/protocoldevelopment\/electronic_applications\/docs\/CTCAE_v5_Quick_Reference_85x11.pdf (accessed 13 March 2025)."},{"key":"e_1_3_4_28_2","first-page":"763433","article-title":"Integrated lymphopenia analysis in younger and older patients with multiple sclerosis treated with cladribine tablets","volume":"12","author":"Giovannoni G","year":"2021","unstructured":"Giovannoni G, Coyle PK, Vermersch P, et al. Integrated lymphopenia analysis in younger and older patients with multiple sclerosis treated with cladribine tablets. Mult Scler J Exp Transl Clin 2021; 12: 763433.","journal-title":"Mult Scler J Exp Transl Clin"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/1756286419836913"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2022.103170"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2022.104491"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/WNF.0000000000000598"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-024-12448-4"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.2174\/1570159X21666230322140711"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000209752"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2023-331920"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2022-329049"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2017.00577"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.829331"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458520964778"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-024-00603-y"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1177\/17562864231200627"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2024.105704"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-11700-7"},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-022-00364-6"},{"key":"e_1_3_4_46_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458520921087"},{"key":"e_1_3_4_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2022.103755"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2023.578164"},{"key":"e_1_3_4_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2023.104951"},{"key":"e_1_3_4_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2025.106272"},{"issue":"1","key":"e_1_3_4_51_2","article-title":"European experience of cladribine tablets in elderly patients with multiple sclerosis: could it be the last treatment?","volume":"11","author":"de Seze J","year":"2025","unstructured":"de Seze J, Zecca C, Castelnovo G, et al. European experience of cladribine tablets in elderly patients with multiple sclerosis: could it be the last treatment? Mult Scler J Exp Transl Clin 2025; 11(1): 20552173251321810.","journal-title":"Mult Scler J Exp Transl Clin"},{"key":"e_1_3_4_52_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2023-332883"},{"key":"e_1_3_4_53_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-025-00767-1"},{"key":"e_1_3_4_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2023.111192"}],"container-title":["Therapeutic Advances in Neurological Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17562864251360047","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17562864251360047","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17562864251360047","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T17:39:57Z","timestamp":1769362797000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17562864251360047"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":53,"alternative-id":["10.1177\/17562864251360047"],"URL":"https:\/\/doi.org\/10.1177\/17562864251360047","relation":{},"ISSN":["1756-2864","1756-2864"],"issn-type":[{"value":"1756-2864","type":"print"},{"value":"1756-2864","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"article-number":"17562864251360047"}}