{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T10:33:13Z","timestamp":1776853993764,"version":"3.51.2"},"reference-count":56,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T00:00:00Z","timestamp":1722211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background: Age-related macular degeneration (AMD) is the leading cause of vision loss in elderly people. Current pharmacological treatment in vascular AMD includes anti-VEGF agents, such as ranibizumab and aflibercept. Additionally, the off-label use of bevacizumab has been shown to be effective and has a lower cost, making it an interesting pharmacological approach; however, there is no consensus about its use. Therefore, this systematic review and meta-analysis aims to evaluate the efficacy, safety, and efficiency of bevacizumab in AMD patients. Methods: This review only focused on randomized controlled clinical trials published in 2010 in the MEDLINE database that compared the effect of bevacizumab with ranibizumab. The risk of bias in each included study was assessed using the CASP Randomised Clinical Trials checklist. Results: Twelve studies were included for qualitative synthesis, and nine of them were considered for meta-analysis. Bevacizumab-treated patients showed a significantly reduced neovascularization in a longer spectrum of time; however, they had a higher incidence of endophthalmitis than those treated with ranibizumab. Regarding efficiency, the mean number of administrations was reduced in the treatment with bevacizumab in comparison to ranibizumab. Conclusions: Clinical evidence demonstrates that bevacizumab has efficacy and safety profiles comparable with ranibizumab; however, it is relatively more efficient.<\/jats:p>","DOI":"10.3390\/ph17081000","type":"journal-article","created":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T12:27:43Z","timestamp":1722256063000},"page":"1000","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Off-Label Use of Bevacizumab in Patients Diagnosed with Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"17","author":[{"given":"Jo\u00e3o","family":"Estarreja","sequence":"first","affiliation":[{"name":"H&TRC\u2014Health and Technology Research Center, ESTeSL\u2014Escola Superior de Tecnologia da Sa\u00fade, Instituto Polit\u00e9cnico de Lisboa, 1990-096 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0013-3140","authenticated-orcid":false,"given":"Priscila","family":"Mendes","sequence":"additional","affiliation":[{"name":"H&TRC\u2014Health and Technology Research Center, ESTeSL\u2014Escola Superior de Tecnologia da Sa\u00fade, Instituto Polit\u00e9cnico de Lisboa, 1990-096 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1021-7935","authenticated-orcid":false,"given":"Carina","family":"Silva","sequence":"additional","affiliation":[{"name":"H&TRC\u2014Health and Technology Research Center, ESTeSL\u2014Escola Superior de Tecnologia da Sa\u00fade, Instituto Polit\u00e9cnico de Lisboa, 1990-096 Lisbon, Portugal"},{"name":"Centro de Estat\u00edstica e Aplica\u00e7\u00f5es, Universidade de Lisboa, 1749-016 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2986-5652","authenticated-orcid":false,"given":"Pedro","family":"Camacho","sequence":"additional","affiliation":[{"name":"H&TRC\u2014Health and Technology Research Center, ESTeSL\u2014Escola Superior de Tecnologia da Sa\u00fade, Instituto Polit\u00e9cnico de Lisboa, 1990-096 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3204-3772","authenticated-orcid":false,"given":"Vanessa","family":"Mateus","sequence":"additional","affiliation":[{"name":"H&TRC\u2014Health and Technology Research Center, ESTeSL\u2014Escola Superior de Tecnologia da Sa\u00fade, Instituto Polit\u00e9cnico de Lisboa, 1990-096 Lisbon, Portugal"},{"name":"Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Av. Professor Gama Pinto, 1649-003 Lisbon, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1038\/s41572-021-00265-2","article-title":"Age-related macular degeneration","volume":"7","author":"Fleckenstein","year":"2021","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"583","DOI":"10.2174\/0929867326666190726121711","article-title":"Pharmacological Advances in the Treatment of Age-related Macular Degeneration","volume":"27","author":"Abraldes","year":"2020","journal-title":"Curr. Med. Chem."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5397","DOI":"10.2147\/DDDT.S86269","article-title":"Intravitreal anti-VEGF injections for treating wet age-related macular degeneration: A systematic review and meta-analysis","volume":"9","author":"Yu","year":"2015","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e106","DOI":"10.1016\/S2214-109X(13)70145-1","article-title":"Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: A systematic review and meta-analysis","volume":"2","author":"Wong","year":"2014","journal-title":"Lancet Glob. Health"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kim, S., Park, S., Byun, S., Park, K.H., and Suh, H.S. (2019). Incremental economic burden associated with exudative age-related macular degeneration: A population-based study. BMC Health Serv. Res., 19.","DOI":"10.1186\/s12913-019-4666-0"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e38658","DOI":"10.2196\/38658","article-title":"The Efficacy, Safety, and Efficiency of the Off-Label Use of Bevacizumab in Patients Diagnosed With Age-Related Macular Degeneration: Protocol for a Systematic Review and Meta-Analysis","volume":"12","author":"Estarreja","year":"2023","journal-title":"JMIR Res. Protoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.2147\/CIA.S143508","article-title":"Recent developments in age-related macular degeneration: A review","volume":"12","author":"Yassin","year":"2017","journal-title":"Clin. Interv. Aging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bjophthalmol-2013-304033","article-title":"Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe: 1990\u20132010","volume":"98","author":"Bourne","year":"2014","journal-title":"Br. J. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1007\/s00018-019-03420-x","article-title":"Senescence in the pathogenesis of age-related macular degeneration","volume":"77","author":"Blasiak","year":"2020","journal-title":"Cell Mol. Life Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.mam.2012.04.005","article-title":"Understanding age-related macular degeneration (AMD): Relationships between the photoreceptor\/retinal pigment epithelium\/Bruch\u2019s membrane\/choriocapillaris complex","volume":"33","author":"Bhutto","year":"2012","journal-title":"Mol. Aspects Med."},{"key":"ref_11","first-page":"513","article-title":"The Diagnosis and Treatment of Age-Related Macular Degeneration","volume":"117","author":"Stahl","year":"2020","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"a017178","DOI":"10.1101\/cshperspect.a017178","article-title":"Clinical Characteristics and Current Treatment of Age-Related Macular Degeneration","volume":"5","author":"Yonekawa","year":"2015","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Moon, B.-H., Kim, Y., and Kim, S.-Y. (2023). Twenty Years of Anti-Vascular Endothelial Growth Factor Therapeutics in Neovascular Age-Related Macular Degeneration Treatment. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241613004"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1186\/s12967-023-03937-7","article-title":"Emerging therapeutic strategies for unmet need in neovascular age-related macular degeneration","volume":"21","author":"Khachigian","year":"2023","journal-title":"J. Transl. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1093\/postmj\/qgae016","article-title":"Advancements in the treatment of age-related macular degeneration: A comprehensive review","volume":"100","author":"Papaioannou","year":"2024","journal-title":"Postgrad. Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/11206721211001716","article-title":"Burden of disease assessment in patients with neovascular age-related macular degeneration in Spain: Results of the AMD-MANAGE study","volume":"32","author":"Paniagua","year":"2022","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_17","first-page":"552","article-title":"Age-related macular degeneration: A review of current therapies and new treatments","volume":"83","author":"Kniggendorf","year":"2020","journal-title":"Arq. Bras. Oftalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1186\/s13643-021-01864-6","article-title":"Anti-vascular endothelial growth factor therapy for age-related macular degeneration: A systematic review and network meta-analysis","volume":"10","author":"Tricco","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/s00417-019-04569-8","article-title":"Off-label use of bevacizumab for wet age-related macular degeneration in Europe","volume":"258","author":"Bro","year":"2020","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s40942-021-00325-5","article-title":"Pipeline therapies for neovascular age related macular degeneration","volume":"7","author":"Arepalli","year":"2021","journal-title":"Int. J. Retin. Vitr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1038\/s41433-021-01909-z","article-title":"On label bevacizumab for retina: Where it stands","volume":"36","author":"Sharma","year":"2022","journal-title":"Eye"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e232951","DOI":"10.1001\/jamahealthforum.2023.2951","article-title":"Medicare Part B Spending on Macular Degeneration Treatments Associated With Manufacturer Payments to Ophthalmologists","volume":"4","author":"Dickson","year":"2023","journal-title":"JAMA Heath. Forum."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Plyukhova, A., Budzinskaya, M., Starostin, K., Rejdak, R., Bucolo, C., Reibaldi, M., and Toro, M.D. (2020). Comparative Safety of Bevacizumab, Ranibizumab, and Aflibercept for Treatment of Neovascular Age-Related Macular Degeneration (AMD): A Systematic Review and Network Meta-Analysis of Direct Comparative Studies. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051522"},{"key":"ref_24","first-page":"CD011230","article-title":"Systemic safety of bevacizumab versus ranibizumab for neovascular age-related macular degeneration","volume":"9","author":"Moja","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1185\/03007995.2011.585394","article-title":"A systematic review of the efficacy and safety outcomes of anti-VEGF agents used for treating neovascular age-related macular degeneration: Comparison of ranibizumab and bevacizumab","volume":"27","author":"Mitchell","year":"2011","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s40942-021-00343-3","article-title":"Future of anti-VEGF: Biosimilars and biobetters","volume":"8","author":"Kapur","year":"2022","journal-title":"Int. J. Retin. Vitr."},{"key":"ref_27","unstructured":"Critical Appraisal Skills Programme (2023, December 19). CASP Randomised Controlled Trial Standard Checklist. Available online: https:\/\/casp-uk.net\/checklists\/casp-rct-randomised-controlled-trial-checklist-fillable.pdf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"225","DOI":"10.5935\/0004-2749.20190043","article-title":"Effectiveness of monthly and fortnightly anti-VEGF treatments for age-related macular degeneration","volume":"82","author":"Nunes","year":"2019","journal-title":"Arq. Bras. Oftalmol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.ophtha.2015.09.018","article-title":"Ranibizumab or Bevacizumab for Neovascular Age-Related Macular Degeneration According to the Lucentis Compared to Avastin Study Treat-and-Extend Protocol","volume":"123","author":"Berg","year":"2016","journal-title":"Ophthalmology"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Schauwvlieghe, A., Dijkman, G., Hooymans, J., Verbraak, F.D., Hoyng, C.B., Dijkgraaf, M.G.W., Peto, T., Vingerling, J.R., and Schlingemann, R.O. (2016). Comparing the Effectiveness of Bevacizumab to Ranibizumab in Patients with Exudative Age-Related Macular Degeneration. The BRAMD Study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153052"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta19780","article-title":"A randomised controlled trial to assess the clinical effectiveness and cost-effectiveness of alternative treatments to Inhibit VEGF in Age-related choroidal Neovascularisation (IVAN)","volume":"19","author":"Chakravarthy","year":"2015","journal-title":"Health Technol. Assess."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.ophtha.2014.07.041","article-title":"Comparison of Ranibizumab and Bevacizumab for Neovascular Age-Related Macular Degeneration According to LUCAS Treat-and-Extend Protocol","volume":"122","author":"Berg","year":"2015","journal-title":"Ophthalmology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"904","DOI":"10.5301\/ejo.5000478","article-title":"Retinal and Choroidal Thickness Changes after Single Anti-VEGF Injection in Neovascular Age-related Macular Degeneration: Ranibizumab vs Bevacizumab","volume":"24","author":"Sizmaz","year":"2014","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/s00508-014-0539-z","article-title":"Differences of frequency in administration of ranibizumab and bevacizumab in patients with neovascular AMD","volume":"126","author":"Scholler","year":"2014","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2300","DOI":"10.1016\/j.ophtha.2013.06.020","article-title":"Ranibizumab versus Bevacizumab for Neovascular Age-related Macular Degeneration: Results from the GEFAL Noninferiority Randomized Trial","volume":"120","author":"Kodjikian","year":"2013","journal-title":"Ophthalmology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1136\/bjophthalmol-2012-302391","article-title":"A randomised double-masked trial comparing the visual outcome after treatment with ranibizumab or bevacizumab in patients with neovascular age-related macular degeneration","volume":"97","author":"Krebs","year":"2013","journal-title":"Br. J. Ophthalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1016\/j.ophtha.2012.03.053","article-title":"Ranibizumab and Bevacizumab for Treatment of Neovascular Age-related Macular Degeneration","volume":"119","author":"Martin","year":"2012","journal-title":"Ophthalmology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"191","DOI":"10.4103\/0301-4738.81023","article-title":"Comparative role of intravitreal ranibizumab versus bevacizumab in choroidal neovascular membrane in age-related macular degeneration","volume":"59","author":"Biswas","year":"2011","journal-title":"Indian J. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1038\/eye.2010.147","article-title":"Bevacizumab vs ranibizumab for age-related macular degeneration: 1-year outcomes of a prospective, double-masked randomised clinical trial","volume":"24","author":"Subramanian","year":"2010","journal-title":"Eye"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.vhri.2018.11.002","article-title":"The Burden of Macular Diseases in Central and Eastern Europe\u2014Implications for Healthcare Systems","volume":"19","author":"Ernest","year":"2019","journal-title":"Value Health Reg. Issues"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1007\/s00417-014-2764-6","article-title":"Bevacizumab and ranibizumab for neovascular age-related macular degeneration: An updated meta-analysis of randomised clinical trials","volume":"252","author":"Kodjikian","year":"2014","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"The CATT Research Group (2011). Ranibizumab and Bevacizumab for Neovascular Age-Related Macular Degeneration. N. Engl. J. Med., 364, 1897\u20131907.","DOI":"10.1056\/NEJMoa1102673"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Nguyen, C., Oh, L., Wong, E., Wei, J., and Chilov, M. (2018). Anti-vascular endothelial growth factor for neovascular age-related macular degeneration: A meta-analysis of randomized controlled trials. BMC Ophthalmol., 18.","DOI":"10.1186\/s12886-018-0785-3"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1136\/bjo.2008.149674","article-title":"Duration of action of intravitreal ranibizumab and bevacizumab in exudative AMD eyes based on macular volume measurements","volume":"93","author":"Shah","year":"2009","journal-title":"Br. J. Ophthalmol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/ICU.0b013e32835f8ec0","article-title":"Ocular and systemic safety of bevacizumab and ranibizumab in patients with neovascular age-related macular degeneration","volume":"24","author":"Johnson","year":"2013","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1136\/bjophthalmol-2014-305252","article-title":"Systemic pharmacokinetics following intravitreal injections of ranibizumab, bevacizumab or aflibercept in patients with neovascular AMD","volume":"98","author":"Avery","year":"2014","journal-title":"Br. J. Ophthalmol."},{"key":"ref_47","first-page":"355","article-title":"Comparison of bevacizumab and ranibizumab in age-related macular degeneration: A systematic review and meta-analysis","volume":"7","author":"Zhang","year":"2014","journal-title":"Int. J. Ophthalmol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Daka, Q., \u0160pegel, N., Velkovska, M., Steblovnik, T., Kolko, M., Neziri, B., and Cvenkel, B. (2023). Exploring the Relationship between Anti-VEGF Therapy and Glaucoma: Implications for Management Strategies. J. Clin. Med., 12.","DOI":"10.3390\/jcm12144674"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ajo.2022.11.015","article-title":"Risk of Intraocular Pressure Increase With Intravitreal Injections of Vascular Endothelial Growth Factor Inhibitors: A Cohort Study","volume":"248","author":"Spini","year":"2023","journal-title":"Am. J. Ophthalmol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"441","DOI":"10.4103\/0301-4738.36479","article-title":"The economic implications of the use of anti-vascular endothelial growth factor drugs in age-related macular degeneration","volume":"55","author":"Azad","year":"2007","journal-title":"Indian. J. Ophthalmol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1167\/iovs.64.5.28","article-title":"Mechanisms of Acquired Resistance to Anti-VEGF Therapy for Neovascular Eye Diseases","volume":"64","author":"Sharma","year":"2023","journal-title":"Investig. Opthalmol. Vis. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Jim\u00e9nez-G\u00f3mez, Y., Alba-Molina, D., Blanco-Blanco, M., P\u00e9rez-Fajardo, L., Reyes-Ortega, F., Ortega-Llamas, L., Villalba-Gonz\u00e1lez, M., Fern\u00e1ndez-Choquet de Isla, I., Pugliese, F., and Stoikow, I. (2022). Novel Treatments for Age-Related Macular Degeneration: A Review of Clinical Advances in Sustained Drug Delivery Systems. Pharmaceutics, 14.","DOI":"10.3390\/pharmaceutics14071473"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ophtha.2019.09.024","article-title":"Age-Related Macular Degeneration Preferred Practice Pattern\u00ae","volume":"127","author":"Flaxel","year":"2020","journal-title":"Ophthalmology"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Garweg, J.G., Keiper, J., Pfister, I.B., and Schild, C. (2023). Functional Outcomes of Brolucizumab-Induced Intraocular Inflammation Involving the Posterior Segment\u2014A Meta-Analysis and Systematic Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12144671"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Page, M., McKenzie, J., Bossuyt, P., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., and Brennan, S.E. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Med., 18.","DOI":"10.1371\/journal.pmed.1003583"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-135"}],"container-title":["Pharmaceuticals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8247\/17\/8\/1000\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:25:44Z","timestamp":1760109944000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8247\/17\/8\/1000"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,29]]},"references-count":56,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["ph17081000"],"URL":"https:\/\/doi.org\/10.3390\/ph17081000","relation":{},"ISSN":["1424-8247"],"issn-type":[{"value":"1424-8247","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,29]]}}}