{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:32:23Z","timestamp":1780392743119,"version":"3.54.1"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T00:00:00Z","timestamp":1683849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T00:00:00Z","timestamp":1683849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT2013842"],"award-info":[{"award-number":["GNT2013842"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["Investigator Grant GTN1197169"],"award-info":[{"award-number":["Investigator Grant GTN1197169"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["Investigator Grant GNT1176538"],"award-info":[{"award-number":["Investigator Grant GNT1176538"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Australian Government, Australia","award":["Research Training Program Scholarship"],"award-info":[{"award-number":["Research Training Program Scholarship"]}]},{"DOI":"10.13039\/100008158","name":"Arthritis Foundation of Australia","doi-asserted-by":"publisher","award":["ARA Victoria Fellowship"],"award-info":[{"award-number":["ARA Victoria Fellowship"]}],"id":[{"id":"10.13039\/100008158","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arthritis Res Ther"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>To describe the clinical phenotype and prognosis of people in the Australian Scleroderma (SSc) Cohort Study with pulmonary arterial hypertension (PAH) with or without interstitial lung disease (ILD).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Participants meeting ACR\/EULAR criteria for SSc were divided into four mutually exclusive groups: those meeting criteria for PAH (PAH-only), ILD (ILD-only), concurrent PAH and ILD (PAH-ILD) or neither PAH nor ILD (SSc-only). Logistic or linear regression analyses were used for associations between clinical features, health-related quality of life (HRQoL) and physical function. Survival analysis was performed using Kaplan\u2013Meier estimates and Cox-regression modelling.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 1561 participants, 7% fulfilled criteria for PAH-only, 24% ILD-only, 7% PAH-ILD and 62% SSc-only. People with PAH-ILD were more frequently male, with diffuse skin involvement, higher inflammatory markers, older age of SSc onset and higher frequency of extensive ILD than the cohort overall (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). People of Asian race more frequently developed PAH-ILD (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). People with PAH-ILD or PAH-only had worse WHO functional class and 6-min-walk-distance than ILD-only (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). HRQoL scores were worst in those with PAH-ILD (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n                <jats:p>Survival was reduced in the PAH-only and PAH-ILD groups (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Multivariable hazard modelling demonstrated the worst prognosis in extensive ILD and PAH (HR\u2009=\u20095.65 95% CI 3.50\u20139.12 <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), followed by PAH-only (HR\u2009=\u20094.21 95% CI 2.89\u20136.13 <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) and PAH with limited ILD (HR\u2009=\u20092.46 95% CI 1.52\u20133.99 <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The prevalence of concurrent PAH-ILD in the ASCS is 7%, with poorer survival in those patients with PAH-ILD compared to ILD or SSc alone. The presence of PAH confers a poorer overall prognosis than even extensive ILD; however, further data are required to better understand the clinical outcomes of this high-risk patient group.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13075-023-03059-x","type":"journal-article","created":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T07:02:14Z","timestamp":1683874934000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Clinical characteristics and survival of pulmonary arterial hypertension with or without interstitial lung disease in systemic sclerosis"],"prefix":"10.1186","volume":"25","author":[{"given":"Jessica L.","family":"Fairley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Ross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Proudman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Sahhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gene-Siew","family":"Ngian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren V.","family":"Host","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Morrisroe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Apostolopoulous","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nava","family":"Ferdowsi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Tabesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Stevens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandana","family":"Nikpour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Australian Scleroderma Interest Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Cooley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Croyle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Hill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Host","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Lester","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabor","family":"Major","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Nash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Rischmueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Roddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Strickland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tien","family":"Tay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Tymms","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Youssef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,5,12]]},"reference":[{"issue":"11","key":"3059_CR1","first-page":"2100","volume":"22","author":"M Abu-Shakra","year":"1995","unstructured":"Abu-Shakra M, Lee P. Mortality in systemic sclerosis: a comparison with the general population. J Rheumatol. 1995;22(11):2100\u20132.","journal-title":"J Rheumatol"},{"issue":"3","key":"3059_CR2","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/j.semarthrit.2015.06.011","volume":"45","author":"M Hinchcliff","year":"2015","unstructured":"Hinchcliff M, Khanna S, Hsu VM, Lee J, Almagor O, Chang RW, et al. Survival in systemic sclerosis-pulmonary arterial hypertension by serum autoantibody status in the Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma (PHAROS) Registry. Semin Arthritis Rheum. 2015;45(3):309\u201314.","journal-title":"Semin Arthritis Rheum"},{"issue":"7","key":"3059_CR3","doi-asserted-by":"publisher","first-page":"1340","DOI":"10.1136\/annrheumdis-2013-203301","volume":"73","author":"JG Coghlan","year":"2014","unstructured":"Coghlan JG, Denton CP, Grunig E, Bonderman D, Distler O, Khanna D, et al. Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study. Ann Rheum Dis. 2014;73(7):1340\u20139.","journal-title":"Ann Rheum Dis"},{"issue":"3","key":"3059_CR4","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1148\/radiology.176.3.2389033","volume":"176","author":"H Schurawitzki","year":"1990","unstructured":"Schurawitzki H, Stiglbauer R, Graninger W, Herold C, Polzleitner D, Burghuber OC, et al. Interstitial lung disease in progressive systemic sclerosis: high-resolution CT versus radiography. Radiology. 1990;176(3):755\u20139.","journal-title":"Radiology"},{"issue":"5","key":"3059_CR5","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.autrev.2010.09.012","volume":"10","author":"G Bussone","year":"2011","unstructured":"Bussone G, Mouthon L. Interstitial lung disease in systemic sclerosis. Autoimmun Rev. 2011;10(5):248\u201355.","journal-title":"Autoimmun Rev"},{"issue":"1","key":"3059_CR6","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1186\/s13075-017-1341-x","volume":"19","author":"K Morrisroe","year":"2017","unstructured":"Morrisroe K, Stevens W, Huq M, Prior D, Sahhar J, Ngian GS, et al. Survival and quality of life in incident systemic sclerosis-related pulmonary arterial hypertension. Arthritis Res Ther. 2017;19(1):122.","journal-title":"Arthritis Res Ther"},{"issue":"11","key":"3059_CR7","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1136\/ard.62.11.1088","volume":"62","author":"D Mukerjee","year":"2003","unstructured":"Mukerjee D, St George D, Coleiro B, Knight C, Denton CP, Davar J, et al. Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach. Ann Rheum Dis. 2003;62(11):1088\u201393.","journal-title":"Ann Rheum Dis"},{"issue":"11","key":"3059_CR8","first-page":"2398","volume":"30","author":"B Chang","year":"2003","unstructured":"Chang B, Wigley FM, White B, Wise RA. Scleroderma patients with combined pulmonary hypertension and interstitial lung disease. J Rheumatol. 2003;30(11):2398\u2013405.","journal-title":"J Rheumatol"},{"issue":"1","key":"3059_CR9","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1002\/art.21538","volume":"54","author":"S Trad","year":"2006","unstructured":"Trad S, Amoura Z, Beigelman C, Haroche J, Costedoat N, le Boutin TH, et al. Pulmonary arterial hypertension is a major mortality factor in diffuse systemic sclerosis, independent of interstitial lung disease. Arthritis Rheum. 2006;54(1):184\u201391.","journal-title":"Arthritis Rheum"},{"issue":"1","key":"3059_CR10","doi-asserted-by":"publisher","first-page":"5289","DOI":"10.1038\/s41598-022-09353-z","volume":"12","author":"A Guillen-Del-Castillo","year":"2022","unstructured":"Guillen-Del-Castillo A, Meseguer ML, Fonollosa-Pla V, Gimenez BS, Colunga-Arguelles D, Revilla-Lopez E, et al. Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension. Sci Rep. 2022;12(1):5289.","journal-title":"Sci Rep"},{"issue":"2","key":"3059_CR11","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1002\/art.24267","volume":"60","author":"SC Mathai","year":"2009","unstructured":"Mathai SC, Hummers LK, Champion HC, Wigley FM, Zaiman A, Hassoun PM, et al. Survival in pulmonary hypertension associated with the scleroderma spectrum of diseases: impact of interstitial lung disease. Arthritis Rheum. 2009;60(2):569\u201377.","journal-title":"Arthritis Rheum"},{"issue":"4","key":"3059_CR12","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1378\/chest.10-2473","volume":"140","author":"D Launay","year":"2011","unstructured":"Launay D, Humbert M, Berezne A, Cottin V, Allanore Y, Couderc LJ, et al. Clinical characteristics and survival in systemic sclerosis-related pulmonary hypertension associated with interstitial lung disease. Chest. 2011;140(4):1016\u201324.","journal-title":"Chest"},{"issue":"9","key":"3059_CR13","doi-asserted-by":"publisher","first-page":"641","DOI":"10.7326\/0003-4819-158-9-201305070-00003","volume":"158","author":"G Raghu","year":"2013","unstructured":"Raghu G, Behr J, Brown KK, Egan JJ, Kawut SM, Flaherty KR, et al. Treatment of idiopathic pulmonary fibrosis with ambrisentan: a parallel, randomized trial. Ann Intern Med. 2013;158(9):641\u20139.","journal-title":"Ann Intern Med"},{"issue":"3","key":"3059_CR14","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1183\/09031936.00011308","volume":"32","author":"D Stolz","year":"2008","unstructured":"Stolz D, Rasch H, Linka A, Di Valentino M, Meyer A, Brutsche M, et al. A randomised, controlled trial of bosentan in severe COPD. Eur Respir J. 2008;32(3):619\u201328.","journal-title":"Eur Respir J"},{"issue":"11","key":"3059_CR15","doi-asserted-by":"publisher","first-page":"1747","DOI":"10.1136\/annrheumdis-2013-204424","volume":"72","author":"F van den Hoogen","year":"2013","unstructured":"van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology\/European league against rheumatism collaborative initiative. Ann Rheum Dis. 2013;72(11):1747\u201355.","journal-title":"Ann Rheum Dis"},{"key":"3059_CR16","doi-asserted-by":"crossref","unstructured":"Simonneau G, Montani D, Celermajer DS, Denton CP, Gatzoulis MA, Krowka M, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019;53(1).","DOI":"10.1183\/13993003.01913-2018"},{"issue":"25 Suppl","key":"3059_CR17","doi-asserted-by":"publisher","first-page":"D42","DOI":"10.1016\/j.jacc.2013.10.032","volume":"62","author":"MM Hoeper","year":"2013","unstructured":"Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol. 2013;62(25 Suppl):D42-50.","journal-title":"J Am Coll Cardiol"},{"issue":"11","key":"3059_CR18","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.1164\/rccm.200706-877OC","volume":"177","author":"NS Goh","year":"2008","unstructured":"Goh NS, Desai SR, Veeraraghavan S, Hansell DM, Copley SJ, Maher TM, et al. Interstitial lung disease in systemic sclerosis: a simple staging system. Am J Respir Crit Care Med. 2008;177(11):1248\u201354.","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"3059_CR19","first-page":"202","volume":"15","author":"EC LeRoy","year":"1988","unstructured":"LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA Jr, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol. 1988;15(2):202\u20135.","journal-title":"J Rheumatol"},{"issue":"4","key":"3059_CR20","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1002\/acr2.11126","volume":"2","author":"MP Chung","year":"2020","unstructured":"Chung MP, Dontsi M, Postlethwaite D, Kesh S, Simard JF, Fiorentino D, et al. Increased mortality in Asians with systemic sclerosis in Northern California. ACR Open Rheumatol. 2020;2(4):197\u2013206.","journal-title":"ACR Open Rheumatol"},{"issue":"8","key":"3059_CR21","doi-asserted-by":"publisher","first-page":"2456","DOI":"10.1002\/art.30423","volume":"63","author":"J Le Pavec","year":"2011","unstructured":"Le Pavec J, Girgis RE, Lechtzin N, Mathai SC, Launay D, Hummers LK, et al. Systemic sclerosis-related pulmonary hypertension associated with interstitial lung disease: impact of pulmonary arterial hypertension therapies. Arthritis Rheum. 2011;63(8):2456\u201364.","journal-title":"Arthritis Rheum"},{"key":"3059_CR22","unstructured":"Scheme PB. Post-market review of medicines to treat pulmonary arterial hypertension. In: Scheme PB, editor. November 2018 ed2018."},{"issue":"8","key":"3059_CR23","doi-asserted-by":"publisher","first-page":"3646","DOI":"10.1093\/rheumatology\/keaa827","volume":"60","author":"NM van Leeuwen","year":"2021","unstructured":"van Leeuwen NM, Ciaffi J, Liem SIE, Huizinga TWJ, de Vries-Bouwstra JK. Health-related quality of life in patients with systemic sclerosis: evolution over time and main determinants. Rheumatology (Oxford). 2021;60(8):3646\u201355.","journal-title":"Rheumatology (Oxford)"},{"key":"3059_CR24","doi-asserted-by":"crossref","unstructured":"Durheim MT, Hoffmann-Vold AM, Eagan TM, Hovden AO, Lund MB, Bjerke G, et al. ILD-specific health-related quality of life in systemic sclerosis-associated ILD compared with IPF. BMJ Open Respir Res. 2020;7(1).","DOI":"10.1136\/bmjresp-2020-000598"},{"issue":"11","key":"3059_CR25","doi-asserted-by":"publisher","first-page":"1892","DOI":"10.1002\/art.41415","volume":"72","author":"EJ Bernstein","year":"2020","unstructured":"Bernstein EJ, Jaafar S, Assassi S, Domsic RT, Frech TM, Gordon JK, et al. Performance characteristics of pulmonary function tests for the detection of interstitial lung disease in adults with early diffuse cutaneous systemic sclerosis. Arthritis Rheumatol. 2020;72(11):1892\u20136.","journal-title":"Arthritis Rheumatol"}],"container-title":["Arthritis Research &amp; Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13075-023-03059-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13075-023-03059-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13075-023-03059-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T07:08:59Z","timestamp":1683875339000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthritis-research.biomedcentral.com\/articles\/10.1186\/s13075-023-03059-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,12]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["3059"],"URL":"https:\/\/doi.org\/10.1186\/s13075-023-03059-x","relation":{},"ISSN":["1478-6362"],"issn-type":[{"value":"1478-6362","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,12]]},"assertion":[{"value":"13 February 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 April 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 May 2023","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 Australian Scleroderma Cohort Study has been approved by all Human Research Ethics Committees of participating sites. Written informed consent was obtained from all participants prior to the collection of any study data. This study is conducted in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable; aggregate data only presented.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The Australian Scleroderma Interest Group received research support grants from Actelion. SP has received honoraria from Janssen. JS and JW have received honoraria from Boehringer Ingelheim Pty Ltd. WS has received consultancies from Jansenn and Boehringer-Ingelheim. MN has received honoraria or consultancies from Janssen, AstraZeneca, GlaxoSmithKlein, Boehringer-Ingelheim and Bristol-Myers Squibb. JF has received conference sponsorship from Pfizer and honoraria from Boehringer-Ingelheim. LH has been a paid speaker for the Limbic publication.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"77"}}