{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T12:47:58Z","timestamp":1785934078055,"version":"3.56.0"},"reference-count":67,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017559","name":"Recordati Rare Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017559","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acromegaly is a rare, chronic disease caused by excessive growth hormone (GH) production due to pituitary adenoma. The disease severely impacts patients\u2019 health-related quality of life and mortality while imposing a substantial economic burden. Resistance to first-line medical treatment necessitates effective second-line therapies, including pasireotide long-acting release (PAS LAR) and pegvisomant (PEG).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the cost-effectiveness of PAS LAR versus PEG (monotherapy or combined with FGSRLs) and versus FGSRLs alone, as second-line medical treatments for adults with acromegaly who are not adequately controlled on FGSRLs, from the perspective of the Brazilian Unified Health System (SUS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A hybrid decision-tree and Markov model were developed to evaluate lifetime health and economic outcomes of assessed drugs. To inform the model, health outcomes data were sourced from clinical trials, real-world evidence, systematic reviews, and meta-analyses. Costs were extracted from the official Brazilian tariffs database. Comparators included the FGSRLs, lanreotide (LAN) and octreotide (OCT), and PEG, as monotherapy and in combination with FGSRLs. Deterministic and probabilistic sensitivity analysis were performed to assess the impact of uncertainty on results. The incremental cost-effectiveness ratio (ICER) was the primary analysis outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PAS LAR was dominant versus PEG monotherapy and in combination with LAN, generating similar health benefits (an additional 0.17 and 0.10 QALYs, respectively) and lower therapy costs (savings of -R$538,945 [-US$100,675] and -R$782,542 [-US$146,179]). In the comparison with PEG combined with OCT, PAS LAR was less costly (-R$979,624 [-US$182,994]) and marginally less effective (-0.04 QALYs). Compared to FGSRLs, PAS LAR demonstrated improved health outcomes (QALYs) and increased cost. The ICERs were R$161,411 (US$30,152)\/QALY and R$168,538 (US$31,483)\/QALY versus OCT and LAN, respectively. Scenario analyses confirmed robustness across variations in key model inputs that have the highest impact on cost-effectiveness results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings showed that in the Brazilian SUS context, PAS LAR is cost-effective compared to PEG monotherapy and PEG + LAN, and cost-saving versus PEG + OCT. Compared to FGSRLs, PAS LAR provided better outcomes with higher costs. With limited options for second-line medical treatment in Brazil, the reimbursement of PAS LAR in acromegaly can be considered a cost-effective strategy for acromegaly patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1771580","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T12:12:56Z","timestamp":1785931976000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2212effectiveness of pasireotide as second\u2212line therapy for adult acromegaly patients from the perspective of the Brazilian Unified Health System"],"prefix":"10.3389","volume":"17","author":[{"given":"Vania","family":"dos Santos Nunes Nogueira","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Botucatu, Botucatu","place":["S\u00e3o Paulo, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grzegorz","family":"Binowski","sequence":"additional","affiliation":[{"name":"MAHTA Intl.","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma\u0142gorzata","family":"Bronikowska","sequence":"additional","affiliation":[{"name":"MAHTA Intl.","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Recordati Rare Diseases","place":["Puteaux, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Gueron","sequence":"additional","affiliation":[{"name":"Recordati Rare Diseases","place":["Puteaux, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helder","family":"Paiva","sequence":"additional","affiliation":[{"name":"Recordati Rare Diseases","place":["S\u00e3o Paulo, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sika D\u00e9d\u00e9","family":"Kossi","sequence":"additional","affiliation":[{"name":"Recordati Rare Diseases","place":["Puteaux, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-3-17","article-title":"Acromegaly","volume":"3","author":"Chanson","year":"2008","journal-title":"Orphanet J Rare Dis"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-020-09588-z","article-title":"Multidisciplinary management of acromegaly: a consensus","volume":"21","author":"Giustina","year":"2020","journal-title":"Rev Endocr Metab Disord"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2015.21.12.1106","article-title":"Clinical and economic burden of commercially insured patients with acromegaly in the United States: a retrospective analysis","volume":"21","author":"Placzek","year":"2015","journal-title":"J Manag Care Spec Pharm"},{"key":"B4","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1507\/endocrj.EJ20-0129","article-title":"Prevalence, incidence, comorbidities, and treatment patterns among Japanese patients with acromegaly: a descriptive study using a nationwide claims database","volume":"67","author":"Matsubayashi","year":"2020","journal-title":"Endocr J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1185\/03007995.2015.1125870","article-title":"Patterns of pharmacologic treatment in US patients with acromegaly","volume":"32","author":"Broder","year":"2016","journal-title":"Curr Med Res Opin"},{"key":"B6","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1530\/EJE-18-0255","article-title":"Mortality in acromegaly decreased in the last decade: a systematic review and meta-analysis","volume":"179","author":"Bolfi","year":"2018","journal-title":"Eur J Endocrinol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s12902-017-0166-6","article-title":"The association between biochemical control and cardiovascular risk factors in acromegaly","volume":"17","author":"Carmichael","year":"2017","journal-title":"BMC Endocr Disord"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.4103\/ijem.IJEM_401_20","article-title":"Health-related quality of life in acromegaly patients: results from generic and disease-specific questionnaires","volume":"24","author":"Oliveira","year":"2020","journal-title":"Indian J Endocrinol Metab"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ghir.2021.101389","article-title":"Economic and clinical burden of comorbidities among patients with acromegaly","volume":"59","author":"Whittington","year":"2021","journal-title":"Growth Horm IGF Res Off J Growth Horm Res Soc Int IGF Res Soc"},{"key":"B10","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/s11102-023-01360-1","article-title":"Consensus on criteria for acromegaly diagnosis and remission","volume":"27","author":"Giustina","year":"2024","journal-title":"Pituitary"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-023-03317-7","article-title":"Modern approach to resistant acromegaly","volume":"80","author":"Giustina","year":"2023","journal-title":"Endocrine"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02240-5","article-title":"Long-term real-life outcomes in a georrefered cohort of acromegalic patients in Brazil","volume":"68","author":"Porto","year":"2020","journal-title":"Endocrine"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2700","article-title":"Acromegaly: an endocrine society clinical practice guideline","volume":"99","author":"Katznelson","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-3757","article-title":"Acromegaly clinical trial methodology impact on reported biochemical efficacy rates of somatostatin receptor ligand treatments: a meta-analysis","volume":"99","author":"Carmichael","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.6061\/clinics\/2017(04)05","article-title":"Treatment of acromegaly patients at the Federal University of Tri\u00e2ngulo Mineiro (UFTM): experience report","volume":"72","author":"de F\u00e1tima Borges","year":"2017","journal-title":"Clin Sao Paulo Braz"},{"key":"B16","unstructured":"SIGNIFOR\u00ae LAR (pasireotide) for injectable suspension, for intramuscular use"},{"key":"B17","unstructured":"Signifor (pasireotide). Summary of product characteristics"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2468","article-title":"A structural and functional acromegaly classification","volume":"100","author":"Cuevas-Ramos","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(14)70169-X","article-title":"Pasireotide versus continued treatment with octreotide or lanreotide in patients with inadequately controlled acromegaly (PAOLA): a randomised, phase 3 trial","volume":"2","author":"Gadelha","year":"2014","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B20","unstructured":"O uso de limiares de custo-efetividade nas decis\u00f5es em sa\u00fade: proposta para as incorpora\u00e7\u00f5es de tecnologias no Sistema \u00danico de Sa\u00fade"},{"key":"B21","year":"2020"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2021-067975","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations","volume":"376","author":"Husereau","year":"2022","journal-title":"BMJ"},{"key":"B23","unstructured":"C\u00e2mara de Regula\u00e7\u00e3o do Mercado de Medicamentos (CMED) \u2013 Pre\u00e7os de medicamentos\n          \n          2025"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200004203421604","article-title":"Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant","volume":"342","author":"Trainer","year":"2000","journal-title":"N Engl J Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03620.x","article-title":"A randomized, controlled, multicentre trial comparing pegvisomant alone with combination therapy of pegvisomant and long-acting octreotide in patients with acromegaly","volume":"71","author":"Trainer","year":"2009","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B26","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1007\/s12020-018-1729-7","article-title":"Effectiveness and safety of pegvisomant: a systematic review and meta-analysis of observational longitudinal studies","volume":"63","author":"Leonart","year":"2019","journal-title":"Endocrine"},{"key":"B27","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s11154-024-09928-3","article-title":"Real-world evidence of effectiveness and safety of pasireotide in the treatment of acromegaly: a systematic review and meta-analysis","volume":"26","author":"Biagetti","year":"2025","journal-title":"Rev Endocr Metab Disord"},{"key":"B28","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/j.ecl.2025.06.007","article-title":"Medical therapies for acromegaly","volume":"54","author":"Gadelha","year":"2025","journal-title":"Endocrinol Metab Clin"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-2480","article-title":"Pasireotide versus octreotide in acromegaly: a head-to-head superiority study","volume":"99","author":"Colao","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-018-0058-5","article-title":"A consensus statement on acromegaly therapeutic outcomes","volume":"14","author":"Melmed","year":"2018","journal-title":"Nat Rev Endocrinol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/s0895-4356(97)00049-8","article-title":"The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials","volume":"50","author":"Bucher","year":"1997","journal-title":"J Clin Epidemiol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2005-1616","article-title":"Conventional pituitary irradiation is effective in lowering serum growth hormone and insulin-like growth factor-I in patients with acromegaly","volume":"91","author":"Jenkins","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-1097","article-title":"ACTH deficiency, higher doses of hydrocortisone replacement, and radiotherapy are independent predictors of mortality in patients with acromegaly","volume":"94","author":"Sherlock","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1136\/jim-2017-000570","article-title":"Patient-centered assessment on disease burden, quality of life, and treatment satisfaction associated with acromegaly","volume":"66","author":"Liu","year":"2018","journal-title":"J Investig Med Off Publ Am Fed Clin Res"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-1565","article-title":"Quality of life (QOL) in patients with acromegaly is severely impaired: use of a novel measure of QOL: acromegaly quality of life questionnaire","volume":"90","author":"Rowles","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13331","article-title":"Impaired quality of life in patients with treated acromegaly despite long-term biochemically stable disease: results from a 5-years prospective study","volume":"86","author":"Kyriakakis","year":"2017","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B37","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.jcjd.2013.09.001","article-title":"The effect of hypoglycemia on health-related quality of life: Canadian results from a multinational time trade-off survey","volume":"38","author":"Harris","year":"2014","journal-title":"Can J Diabetes"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2021.03.010","article-title":"Japanese population norms of EQ-5D-5L and Health Utilities Index Mark 3: disutility catalog by disease and symptom in community settings","volume":"24","author":"Shiroiwa","year":"2021","journal-title":"Value Health J Int Soc Pharmacoeconomics Outcomes Res"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-11-0408","article-title":"Determinants of cardiac disease in newly diagnosed patients with acromegaly: results of a 10 year survey study","volume":"165","author":"Colao","year":"2011","journal-title":"Eur J Endocrinol"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-08-0442","article-title":"Sleep apnoea syndrome is highly prevalent in acromegaly and only partially reversible after biochemical control of the disease","volume":"159","author":"Davi'","year":"2008","journal-title":"Eur J Endocrinol"},{"key":"B41","unstructured":"Cent Bank Braz"},{"key":"B42","unstructured":"Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e OPM do SUS (SIGTAP)"},{"key":"B43","doi-asserted-by":"publisher","first-page":"100013","DOI":"10.1016\/j.xinn.2020.04.013","article-title":"Trends in hospital admission rates and associated direct healthcare costs in Brazil: a nationwide retrospective study between 2000 and 2015","volume":"1","author":"Zhao","year":"2020","journal-title":"Innov Camb Mass"},{"key":"B44","volume-title":"Contas do SUS na perspectiva da contabilidade internacional: Brasil, 2010-2014","author":"Cruz","year":"2018"},{"key":"B45","unstructured":"National consumer price index (IPCA)"},{"key":"B46","unstructured":"Relat\u00f3rio de Recomenda\u00e7\u00e3o N\u00b0 903: Pegvisomanto para o tratamento de indiv\u00edduos com acromegalia"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-17-0996","article-title":"Increasing frequency of combination medical therapy in the treatment of acromegaly with the GH receptor antagonist pegvisomant","volume":"178","author":"Strasburger","year":"2018","journal-title":"Eur J Endocrinol"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-21-0239","article-title":"More than a decade of real-world experience of pegvisomant for acromegaly: ACROSTUDY","volume":"185","author":"Fleseriu","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"B49","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1007\/s11102-012-0420-x","article-title":"A consensus on the diagnosis and treatment of acromegaly complications","volume":"16","author":"Melmed","year":"2013","journal-title":"Pituitary"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1530\/EC-15-0064","article-title":"Need for improved monitoring in patients with acromegaly","volume":"4","author":"Silverstein","year":"2015","journal-title":"Endocr Connect"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2019.00931","article-title":"Evaluation of the efficacy and safety of switching to pasireotide in patients with acromegaly inadequately controlled with first-generation somatostatin analogs","volume":"10","author":"Gadelha","year":"2019","journal-title":"Front Endocrinol"},{"key":"B52","unstructured":"Brasil\n          Banco De Pre\u00e7os Em Sa\u00fade\n          \n          2026"},{"key":"B53","unstructured":"Brasil\n          Consultas P\u00fablicas Encerradas\n          \n          2026"},{"key":"B54","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1007\/s11102-021-01161-4","article-title":"Managing pasireotide-associated hyperglycemia: a randomized, open-label, phase IV study","volume":"24","author":"Samson","year":"2021","journal-title":"Pituitary"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.745843","article-title":"Cost-utility of acromegaly pharmacological treatments in a French context","volume":"12","author":"Brue","year":"2021","journal-title":"Front Endocrinol"},{"key":"B56","doi-asserted-by":"publisher","first-page":"101811","DOI":"10.1016\/j.ando.2025.101811","article-title":"Cost-utility analysis of second line acromegaly treatment in France","volume":"86","author":"Raverot","year":"2025","journal-title":"Ann Endocrinol"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1080\/14737167.2019.1610396","article-title":"Cost-effectiveness analysis of second-line pharmacological treatment of acromegaly in Spain","volume":"20","author":"Peral","year":"2020","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"key":"B58","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1159\/000507890","article-title":"Pharmacological acromegaly treatment: cost-utility and value of information analysis","volume":"111","author":"Leonart","year":"2021","journal-title":"Neuroendocrinology"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1573721","article-title":"Cost-effectiveness analysis of second-line medical therapies in acromegaly: a real-life study","volume":"16","author":"Venegas Moreno","year":"2025","journal-title":"Front Endocrinol"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1530\/EC-23-0247","article-title":"Factors associated with disease control failure in acromegaly patients treated with pegvisomant: an ACROSTUDY analysis","volume":"13","author":"Giampietro","year":"2024","journal-title":"Endocr Connect"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad378","article-title":"Long-term efficacy and safety of pasireotide in patients with acromegaly: 14 years of single-center real-world experience","volume":"108","author":"Gadelha","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.633944","article-title":"The effect of 6 months\u2019 treatment with pasireotide LAR on glucose metabolism in patients with resistant acromegaly in real-world clinical settings","volume":"12","author":"Witek","year":"2021","journal-title":"Front Endocrinol"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-023-02275-1","article-title":"Real-life data of pasireotide LAR in acromegaly: a long-term follow-up","volume":"47","author":"Urbani","year":"2024","journal-title":"J Endocrinol Invest"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1530\/ERC-24-0043","article-title":"Pegvisomant and pasireotide in PRL and GH co-secreting vs GH-secreting Pit-NETs","volume":"31","author":"Araujo-Castro","year":"2024","journal-title":"Endocr Relat Cancer"},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12207","article-title":"Control of growth hormone and IGF1 in patients with acromegaly in the UK: responses to medical treatment with somatostatin analogues and dopamine agonists","volume":"79","author":"Howlett","year":"2013","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B66","article-title":"Chapter 11: Undertaking network meta-analyses","volume-title":"Cochrane Handb. Syst. Rev. Interv","author":"Chaimani","year":"2024"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1530\/EC-20-0361","article-title":"Risk factors and management of pasireotide-associated hyperglycemia in acromegaly","volume":"9","author":"Gadelha","year":"2020","journal-title":"Endocr Connect"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1771580\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T12:13:00Z","timestamp":1785931980000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1771580\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":67,"alternative-id":["10.3389\/fendo.2026.1771580"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1771580","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]},"article-number":"1771580"}}