{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T10:51:44Z","timestamp":1740135104394,"version":"3.37.3"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T00:00:00Z","timestamp":1639958400000},"content-version":"vor","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100004330","name":"GlaxoSmithKline","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004330","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Tenofovir disoproxil fumarate (TDF) is widely used and recommended as first-line treatment for patients infected with the hepatitis B virus (HBV). However, current data are limited regarding the efficacy and safety of switching to TDF for the treatment of chronic hepatitis B in hepatitis B e-antigen (HBeAg)-positive patients who are virologically suppressed with another nucleos(t)ide analogue. The primary objective of this study was to evaluate the hepatitis B surface antigen (HBsAg) reduction potential of switching from entecavir (ETV) to TDF at week 48 in HBeAg-positive chronic hepatitis B patients with undetectable serum HBV-DNA.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In this multicenter, single-arm, open-label, phase 4 clinical study, 75 participants currently treated with ETV 0.5\u00a0mg once daily were switched to TDF 300\u00a0mg once daily for 96\u00a0weeks.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>At week 48, 3\/74 participants (4%) achieved 0.25 log<jats:sub>10<\/jats:sub> reduction of HBsAg levels from baseline (the primary endpoint). Mean HBsAg reduction was \u22120.14 log<jats:sub>10<\/jats:sub> IU\/mL and 12% (9\/74) achieved 0.25 log<jats:sub>10<\/jats:sub> reduction by 96\u00a0weeks. No participants achieved HBsAg seroclearance. HBsAg reduction at weeks 48 and 96 was numerically greater in participants with higher alanine aminotransferase levels (\u2265\u200960 U\/L). Seventeen participants (25%) achieved HBeAg seroclearance up to week 96. No participants experienced viral breakthrough. All drug-related adverse events (18 participants [24%]) were mild in intensity, including an increase in urine beta-2-microglobulin (15 participants [20%]).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In conclusion, HBsAg reduction was limited after switching from ETV to TDF in this study population. Further investigation is warranted to better understand the clinical impact of switching from ETV to TDF.<\/jats:p>\n                <jats:p><jats:italic>ClinicalTrials.gov<\/jats:italic>: NCT03258710 registered August 21, 2017. <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03258710?term=NCT03258710&amp;draw=2&amp;rank=1\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03258710?term=NCT03258710&amp;draw=2&amp;rank=1<\/jats:ext-link><\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12876-021-02008-9","type":"journal-article","created":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T11:12:19Z","timestamp":1639998739000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Switching from entecavir to tenofovir disoproxil fumarate for HBeAg-positive chronic hepatitis B patients: a phase 4, prospective study"],"prefix":"10.1186","volume":"21","author":[{"given":"Fumitaka","family":"Suzuki","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiyuki","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiyasu","family":"Karino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhito","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayuki","family":"Kurosaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Yatsuhashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomofumi","family":"Atarashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masanori","family":"Atsukawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsunamasa","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaru","family":"Enomoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masatoshi","family":"Kudo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoto","family":"Maeda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Kohno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kouji","family":"Joko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kojiro","family":"Michitaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichiro","family":"Miki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuhiro","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuya","family":"Ide","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigetoshi","family":"Fujiyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoko","family":"Kohno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Itoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sakiyo","family":"Tsukamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuko","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2305-1711","authenticated-orcid":false,"given":"Yoshiaki","family":"Kawano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wataru","family":"Sugiura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiromitsu","family":"Kumada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,12,20]]},"reference":[{"issue":"9401","key":"2008_CR1","doi-asserted-by":"publisher","first-page":"2089","DOI":"10.1016\/S0140-6736(03)15108-2","volume":"362","author":"CL Lai","year":"2003","unstructured":"Lai CL, Ratziu V, Yuen MF, Poynard T. Viral hepatitis B. Lancet. 2003;362(9401):2089\u201394.","journal-title":"Lancet"},{"issue":"6","key":"2008_CR2","doi-asserted-by":"publisher","first-page":"174","DOI":"10.5501\/wjv.v1.i6.174","volume":"1","author":"LP Chen","year":"2012","unstructured":"Chen LP, Zhao J, Du Y, et al. Antiviral treatment to prevent chronic hepatitis B or C-related hepatocellular carcinoma. World J Virol. 2012;1(6):174\u201383.","journal-title":"World J Virol"},{"issue":"20","key":"2008_CR3","doi-asserted-by":"publisher","first-page":"3631","DOI":"10.1002\/cncr.29537","volume":"121","author":"WR Kim","year":"2015","unstructured":"Kim WR, Loomba R, Berg T, et al. Impact of long-term tenofovir disoproxil fumarate on incidence of hepatocellular carcinoma in patients with chronic hepatitis B. Cancer. 2015;121(20):3631\u20138.","journal-title":"Cancer"},{"issue":"37","key":"2008_CR4","doi-asserted-by":"publisher","first-page":"13284","DOI":"10.3748\/wjg.v20.i37.13284","volume":"20","author":"Y Seo","year":"2014","unstructured":"Seo Y, Yano Y. Short- and long-term outcome of interferon therapy for chronic hepatitis B infection. World J Gastroenterol. 2014;20(37):13284\u201392.","journal-title":"World J Gastroenterol"},{"issue":"23","key":"2008_CR5","doi-asserted-by":"publisher","first-page":"2442","DOI":"10.1056\/NEJMoa0802878","volume":"359","author":"P Marcellin","year":"2008","unstructured":"Marcellin P, Heathcote EJ, Buti M, et al. Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B. N Engl J M. 2008;359(23):2442\u201355.","journal-title":"N Engl J M"},{"issue":"3","key":"2008_CR6","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.jhep.2018.10.014","volume":"70","author":"TC Yip","year":"2019","unstructured":"Yip TC, Wong GL, Chan HL, et al. HBsAg seroclearance further reduces hepatocellular carcinoma risk after complete viral suppression with nucleos(t)ide analogues. J Hepatol. 2019;70(3):361\u201370.","journal-title":"J Hepatol"},{"key":"2008_CR7","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.antiviral.2015.06.008","volume":"121","author":"RG Gish","year":"2015","unstructured":"Gish RG, Given BD, Lai CL, et al. Chronic hepatitis B: virology, natural history, current management and a glimpse at future opportunities. Antiviral Res. 2015;121:47\u201358.","journal-title":"Antiviral Res"},{"issue":"3","key":"2008_CR8","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/S2468-1253(16)30024-3","volume":"1","author":"HL Chan","year":"2016","unstructured":"Chan HL, Fung S, Seto WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of HBeAg-positive chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial. Lancet Gastroenterol Hepatol. 2016;1(3):185\u201395.","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"3","key":"2008_CR9","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1002\/jgh3.12273","volume":"4","author":"N Tamaki","year":"2019","unstructured":"Tamaki N, Kurosaki M, Kirino S, et al. Hepatitis B surface antigen reduction as a result of switching from long-term entecavir administration to tenofovir. JGH Open. 2019;4(3):429\u201332.","journal-title":"JGH Open"},{"key":"2008_CR10","doi-asserted-by":"crossref","unstructured":"Yang S, Ma X, Cai C, Wang H, Xiao F, Yu C. Tenofovir disoproxil fumarate is superior to entecavir in reducing hepatitis B surface antigen for chronic hepatitis B in China: 2-year comprehensive comparative result of a matched comparative study.\u00a0Front Med (Lausanne). 2021;8:637126.","DOI":"10.3389\/fmed.2021.637126"},{"issue":"7","key":"2008_CR11","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1002\/jmv.25442","volume":"91","author":"A Iida-Ueno","year":"2019","unstructured":"Iida-Ueno A, Enomoto M, Kozuka R, Tamori A, Kawada N. Switching to tenofovir disoproxil fumarate vs continuing treatment in patients with chronic hepatitis B who maintain long-term virological response to entecavir therapy: a randomized trial. J Med Virol. 2019;91(7):1295\u2013300.","journal-title":"J Med Virol"},{"issue":"1","key":"2008_CR12","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1001\/jamaoncol.2018.4070","volume":"5","author":"J Choi","year":"2019","unstructured":"Choi J, Kim HJ, Lee J, Cho S, Ko MJ, Lim YS. Risk of hepatocellular carcinoma in patients treated with entecavir vs tenofovir for chronic hepatitis B: a Korean nationwide cohort study. JAMA Oncol. 2019;5(1):30\u20136.","journal-title":"JAMA Oncol"},{"issue":"1","key":"2008_CR13","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1111\/hepr.12902","volume":"48","author":"K Koike","year":"2018","unstructured":"Koike K, Suyama K, Ito H, Itoh H, Sugiura W. Randomized prospective study showing the non-inferiority of tenofovir to entecavir in treatment-naive chronic hepatitis B patients. Hepatol Res. 2018;48(1):59\u201368.","journal-title":"Hepatol Res"},{"issue":"11","key":"2008_CR14","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1111\/jvh.12934","volume":"25","author":"HJ Yim","year":"2018","unstructured":"Yim HJ, Kim IH, Suh SJ, et al. Switching to tenofovir vs continuing entecavir for hepatitis B virus with partial virologic response to entecavir: a randomized controlled trial. J Viral Hepat. 2018;25(11):1321\u201330.","journal-title":"J Viral Hepat"},{"issue":"Suppl 1","key":"2008_CR15","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1111\/liv.12735","volume":"35","author":"M Martinot-Peignoux","year":"2015","unstructured":"Martinot-Peignoux M, Asselah T, Marcellin P. HBsAg quantification to optimize treatment monitoring in chronic hepatitis B patients. Liver Int. 2015;35(Suppl 1):82\u201390.","journal-title":"Liver Int"},{"issue":"4","key":"2008_CR16","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1089\/aid.2008.0202","volume":"25","author":"E Kinai","year":"2009","unstructured":"Kinai E, Hanabusa H. Progressive renal tubular dysfunction associated with long-term use of tenofovir DF. AIDS Res Hum Retroviruses. 2009;25(4):387\u201394.","journal-title":"AIDS Res Hum Retroviruses"},{"issue":"1\u20132","key":"2008_CR17","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1159\/000182234","volume":"29","author":"PH Shea","year":"1981","unstructured":"Shea PH, Maher JF, Horak E. Prediction of glomerular filtration rate by serum creatinine and beta 2-microglobulin. Nephron. 1981;29(1\u20132):30\u20135.","journal-title":"Nephron"},{"issue":"4","key":"2008_CR18","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/j.jhep.2013.06.007","volume":"59","author":"WK Seto","year":"2013","unstructured":"Seto WK, Liu K, Wong DK, et al. Patterns of hepatitis B surface antigen decline and HBV DNA suppression in Asian treatment-experienced chronic hepatitis B patients after three years of tenofovir treatment. J Hepatol. 2013;59(4):709\u201316.","journal-title":"J Hepatol"},{"issue":"2","key":"2008_CR19","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1136\/gutjnl-2016-312653","volume":"67","author":"K Murata","year":"2018","unstructured":"Murata K, Asano M, Matsumoto A, et al. Induction of IFN-lambda3 as an additional effect of nucleotide, not nucleoside, analogues: a new potential target for HBV infection. Gut. 2018;67(2):362\u201371.","journal-title":"Gut"},{"issue":"10","key":"2008_CR20","doi-asserted-by":"publisher","first-page":"1760","DOI":"10.1111\/liv.13716","volume":"38","author":"D Wong","year":"2018","unstructured":"Wong D, Littlejohn M, Edwards R, et al. ALT flares during nucleotide analogue therapy are associated with HBsAg loss in genotype A HBeAg-positive chronic hepatitis B. Liver Int. 2018;38(10):1760\u20139.","journal-title":"Liver Int"},{"issue":"5","key":"2008_CR21","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1111\/jgh.12476","volume":"29","author":"WK Seto","year":"2014","unstructured":"Seto WK, Lam YF, Fung J, et al. Changes of HBsAg and HBV DNA levels in Chinese chronic hepatitis B patients after 5 years of entecavir treatment. J Gastroenterol Hepatol. 2014;29(5):1028\u201334.","journal-title":"J Gastroenterol Hepatol"},{"issue":"2","key":"2008_CR22","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1007\/s00535-018-1502-y","volume":"54","author":"F Suzuki","year":"2019","unstructured":"Suzuki F, Hosaka T, Suzuki Y, et al. Long-term outcome of entecavir treatment of nucleos(t)ide analogue-naive chronic hepatitis B patients in Japan. J Gastroenterol. 2019;54(2):182\u201393.","journal-title":"J Gastroenterol"},{"key":"2008_CR23","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1007\/s11901-019-00481-1","volume":"18","author":"MT Wei","year":"2019","unstructured":"Wei MT, Nguyen MH, Cheung R. Epidemiology, diagnosis, and management of bone disease in patients with chronic HBV infection. Curr Hepatol Rep. 2019;18:322\u201330.","journal-title":"Curr Hepatol Rep"},{"key":"2008_CR24","doi-asserted-by":"crossref","unstructured":"Li M-R, Xi H-L, Wang Q-H, et al. Kinetics and prediction of HBsAg loss during long-term therapy with nucleos(t)ide analogues of different potency in patients with chronic hepatitis B. PLoS One. 2014;9(6):e98476.","DOI":"10.1371\/journal.pone.0098476"},{"issue":"11","key":"2008_CR25","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1111\/jvh.12211","volume":"21","author":"T Hara","year":"2014","unstructured":"Hara T, Suzuki F, Kawamura Y, et al. Long-term entecavir therapy results in falls in serum hepatitis B surface antigen levels and seroclearance in nucleos(t)ide-naive chronic hepatitis B patients. J Viral Hepat. 2014;21(11):802\u20138.","journal-title":"J Viral Hepat"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-021-02008-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-021-02008-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-021-02008-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T11:14:16Z","timestamp":1639998856000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-021-02008-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2008"],"URL":"https:\/\/doi.org\/10.1186\/s12876-021-02008-9","relation":{},"ISSN":["1471-230X"],"issn-type":[{"type":"electronic","value":"1471-230X"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"22 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the ethics committee at every participating institution (Ehime Prefectural Central Hospital IRB, Ehime, Japan; Kindai University Hospital IRB, Osaka, Japan; Kitakyushu Municipal Medical Center IRB, Fukuoka, Japan; KKR Clinical Trial Network Central Institutional Review Board, Tokyo, Japan; Kumamotoshinto General Hospital IRB, Kumamoto, Japan; Kurume University Hospital IRB, Fukuoka, Japan; Matsuyama Red Cross Hospital IRB, Ehime, Japan; Musashino Red Cross Hospital IRB, Tokyo, Japan; Nagoya City University Graduate School of Medical Sciences and Nagoya City University Hospital Institutional Review Board, Aichi, Japan; National Hospital Organization Kure Medical Center and Chugoku Cancer Center IRB, Hiroshima, Japan; National Hospital Organization Nagasaki Medical Center IRB, Nagasaki, Japan; Nippon Medical School Chiba Hokusoh hospital IRB, Chiba, Japan; Obihiro-Kosei General Hospital IRB, Hokkaido, Japan; Osaka City University Hospital IRB, Osaka, Japan; Sanin Rosai Hospital IRB, Tottori, Japan; Sapporo-Kosei General Hospital IRB, Hokkaido, Japan; St. Marianna University Group Institutional Review Board, Kanagawa, Japan) and was conducted according to the recommendations of Good Clinical Practice and the Declaration of Helsinki (2013). All participants provided written informed consent to participate in the study. This manuscript was developed following the CONSORT guidelines as much as possible even through this is not a randomized control trial.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"This study (NCT03258710) was conducted with a research fund from GlaxoSmithKline (GSK), in which FS, YS1, YK1, TA, MA, MK1, TW, YT, ME, MK2, NM, HK1, KJ, KM1, KM2, KT, TI, HY, SF, and HK2 participated as investigators and their institutions received funding in relation to this work. FS has served on the advisory board for GSK, and has received personal fees from AbbVie Inc., Bristol Myers Squibb, and GSK; YT has served on several advisory boards for GSK, has received personal fees from Fujirebio Inc., GSK, and Sysmex Corporation, has received personal fees and grants from Gilead Sciences Inc. and grants from FUJIFILM Corporation and Janssen Pharmaceutical KK, and has served on the Board of Trustees of the Leland Stanford Junior University; MK1 and HY have served on the advisory board for GSK, and have received personal fees from GSK; TA has received grants and personal fees from AbbVie Inc.; MA has received grants and personal fees from AbbVie Inc., and Merck Sharp & Dohme (MSD); KJ has received speaking fees from AbbVie Inc., Gilead Sciences, Inc., MSD, and Otsuka Pharmaceutical Co., Ltd.; TK, HI, YS2, and YK2 are employees of and own stock in GSK; ST is employee of GSK; WS is a former employee of GSK; HK2 has served as a speaker and trainer for AbbVie Inc., Eisai Co. Ltd, Gilead Sciences, Inc., MSD KK, and Sumitomo Dainippon Pharma.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"489"}}