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Vasomotor Symptoms Associated With MenopausePhase 3OASIS-1NCT05042362

A Study to Learn More About How Well Elinzanetant Works and How Safe it is for the Treatment of Vasomotor Symptoms (Hot Flashes) That Are Caused by Hormonal Changes Over 26 Weeks in Women Who Have Been Through the Menopause

A Phase 3 study testing Elinzanetant (BAY3427080) in people with Vasomotor Symptoms Associated With Menopause and Hot Flashes, run by Bayer at 99 sites in 8 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record

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Trial summary

Researchers are looking for a better way to treat women who have hot flashes after women have been through the menopause. Hot flashes are caused by the hormonal changes that happen when a woman's body has been through the menopause. Menopause is when women stop having a menstrual cycle, also called a period. Read more about this study

Who is it for?
Ages 40 to 65 years, women only
What is being tested?
Elinzanetant (BAY3427080)
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
396 participants
Where
99 sitesin 8 countries
Study dates
27 Aug 2021to 27 Nov 2023
Phase
Phase 3

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 to 65 years
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Postmenopausal, defined as:
  • at least 12 months of spontaneous amenorrhea prior to signing of informed consent, or
  • at least 6 months of spontaneous amenorrhea prior to signing of informed consent with serum follicle-stimulating hormone (FSH) levels > 40 mIU/mL and a serum estradiol concentration of < 30 pg/mL, or
  • at least 6 months after hysterectomy at signing of informed consent with serum FSH levels > 40 mIU/mL and a serum estradiol concentration of < 30 pg/mL, or
  • surgical bilateral oophorectomy with or without hysterectomy at least 6 weeks prior to signing of informed consent.
  • Moderate to severe hot flash (HF) associated with the menopause and seeking treatment for this condition.
  • Participant has completed Hot Flash Daily Diary (HFDD) for at least 11 days during the two weeks preceding baseline visit, and participant has recorded at least 50 moderate or severe HF (including night-time HF) over the last 7 days that the HFDD was completed (assessed at the Baseline Visit).

Who cannot join

  • Any clinically significant prior or ongoing history of arrhythmias, heart block and QT prolongation either determined through clinical history or on ECG evaluation.
  • Any active ongoing condition that could cause difficulty in interpreting vasomotor symptoms (VMS) such as: infection that could cause pyrexia, pheochromocytoma, carcinoid syndrome.
  • Current or history (except complete remission for 5 years or more) of any malignancy (except basal and squamous cell skin tumors). Women receiving adjuvant endocrine therapy (e.g. tamoxifen, aromatase inhibitors, GnRH analogues) cannot be enrolled in this study.
  • Uncontrolled or treatment-resistant hypertension. Women with mild hypertension can be included in the study if these women are medically cleared prior to study participation.
  • Untreated hyperthyroidism or hypothyroidism.
  • Treated hyperthyroidism with no abnormal increase of thyroid function laboratory parameters and no relevant clinical signs for > 6 months before signing of informed consent is acceptable.
Show all 11Show fewer
  • Treated hypothyroidism with normal thyroid function test results during screening and a stable (for ≥ 3 months before signing of informed consent) dose of replacement therapy is acceptable.
  • Any unexplained post-menopausal uterine bleeding.
  • Clinically relevant abnormal findings on mammogram.
  • Abnormal liver parameters.
  • Disordered proliferative endometrium, endometrial hyperplasia, polyp, or endometrial cancer diagnosed based on endometrial biopsy during screening.

Trial locations and contacts

99 sites in 8 countries.

99 sites in 8 countries

United States55 sites
  • Velocity Clinical Research - Albuquerque

    Albuquerque, New Mexico, 87107

  • Bosque Women's Care | Albuquerque, NM

    Albuquerque, New Mexico, 87109

  • The Iowa Clinic - Ankeny

    Ankeny, Iowa, 50023

  • Medisense Inc. | Atlanta, GA

    Atlanta, Georgia, 30363

  • Elligo Health Research | Women Partners in Health PLLC

    Austin, Texas, 78705

  • Alliance Research Institute | Bell Gardens, CA

    Bell Gardens, California, 90201

  • Alabama Clinical Therapeutics | Birmingham, AL

    Birmingham, Alabama, 35205

  • Central Research Associates | Birmingham, AL

    Birmingham, Alabama, 35205

  • Investigators Research Group, LLC

    Brownsburg, Indiana, 46112

  • MUSC Women's Health - Cannon St.

    Charleston, South Carolina, 29425

  • OnSite Clinical Solutions - Charlotte

    Charlotte, North Carolina, 28277

  • Chattanooga Medical Research, LLC. | Chattanooga, TN

    Chattanooga, Tennessee, 37404

  • Axia Women's Health - Anderson Township

    Cincinnati, Ohio, 45242

  • Paramount Research Solutions | College Park Location

    College Park, Georgia, 30349

  • Cedar Health Research, LLC. | DFW-East Clinical Site

    Dallas, Texas, 75251

  • Revive Research Institute, Inc. - Women's Health

    Dearborn Heights, Michigan, 48127

  • Soapstone Center for Clinical Research, Inc. | Decatur, GA

    Decatur, Georgia, 30033-3500

  • Centricity Research - Women's Health - Dublin, OH

    Dublin, Ohio, 43016

  • Diagnamics | Encinitas, CA

    Encinitas, California, 92024

  • HWC Women's Research Center | Englewood, OH

    Englewood, Ohio, 45322

  • AMR - Fort Myers, FL

    Fort Myers, Florida, 33912

  • Hilltop Obstetrics & Gynecolofy

    Franklin, Ohio, 45005

  • Clinical Research Prime

    Idaho Falls, Idaho, 83404

  • Om Research LLC | Lancaster, CA

    Lancaster, California, 93534

  • Jubilee Clinical Research Inc | Las Vegas, NV

    Las Vegas, Nevada, 89106

  • Affiliated Clinical Research, Inc. | Las Vegas, NV

    Las Vegas, Nevada, 89113

  • M3 Wake Research - Clinical Research Center of Nevada

    Las Vegas, Nevada, 89123

  • The Center for Womens Health & Wellness, LLC | Lawrenceville, NJ

    Lawrenceville, New Jersey, 08648

  • Maximos Ob/Gyn

    League City, Texas, 77573

  • Women's Clinic of Lincoln, P.C. | Lincoln, NE

    Lincoln, Nebraska, 68510

  • Applied Research Center of Arkansas

    Little Rock, Arkansas, 72205

  • Drug Studies America

    Marietta, Georgia, 30060

  • Women's Care Research Institute/Marion OBGYN, Inc.

    Marion, Ohio, 43302

  • University Hospitals | UH Cleveland Medical Center - MacDonald Clinical Trials Unit

    Mayfield Heights, Ohio, 44124

  • Mesa Obstetricians and Gynecologists | Research Department

    Mesa, Arizona, 85206

  • Southern Clinical Research Associates | Metairie, LA

    Metairie, Louisiana, 70001

  • Venus Gynecology, LLC | Myrtle Beach, SC

    Myrtle Beach, South Carolina, 29572

  • Rutgers Robert Wood Johnson Medical School

    New Brunswick, New Jersey, 08901

  • Coastal Carolina Research Center

    North Charleston, South Carolina, 29405

  • Suncoast Clinical Research Inc | Pinellas

    Palm Harbor, Florida, 34684

  • Clinical Research Philadelphia | Philadelphia, PA

    Philadelphia, Pennsylvania, 19114

  • M3 Wake Research | Raleigh, NC

    Raleigh, North Carolina, 27612

  • Northern California Research | Sacramento

    Sacramento, California, 95821

  • Valley OBGYN

    Saginaw, Michigan, 48602

  • Northeast Clinical Research of San Antonio, LLC

    San Antonio, Texas, 78233

  • M3 Wake Research Atlanta

    Sandy Springs, Georgia, 30126

  • Physician Care Clinical Research LLC | Sarasota, FL

    Sarasota, Florida, 34239

  • MomDoc Women's Health Research | Scottsdale, AZ

    Scottsdale, Arizona, 85251

  • Seattle Women's | Seattle, WA

    Seattle, Washington, 98105

  • Continental Clinical Solutions | Towson, MD

    Towson, Maryland, 21204

  • Noble Clinical Research | Tucson, AZ

    Tucson, Arizona, 85704

  • Del Sol Research | Women Health studies

    Tucson, Arizona, 85715

  • IntimMedicine | Washington, DC

    Washington D.C., District of Columbia, 20036

  • Circuit Clinical | OB GYN Associates of WNY

    West Seneca, New York, 14224

  • Unified Women's Clinical Research | Lyndhurst Clinical Research, Winston-Salem, NC

    Winston-Salem, North Carolina, 27103

Other trials in United States

Czechia10 sites
  • Gynekologie MEDA s.r.o.

    Brno, 602 00

  • G-Centrum Olomouc s.r.o. Dr. Skrivanek

    České Budějovice, 370 01

  • GYN-MIKA s.r.o.

    České Budějovice, 370 01

  • Gynekologie Cheb s.r.o.

    České Budějovice, 370 01

  • MUDr. Stepan s.r.o.

    České Budějovice, 370 01

  • GYN-F s.r.o.

    Hradec Králové, 500 03

  • Kestr-gyn s.r.o.

    Náchod, 547 01

  • PT-MEDICA s.r.o.

    Prachatice, 383 01

  • GYNERA

    Prague, 156 00

  • Gynekologie Studentsky dum s.r.o.

    Prague, 160 00

Other trials in Czechia

Greece7 sites
  • ARETAIEION University Hospital

    Athens, 11528

  • University General Hospital of Athens "ATTIKON"

    Chaïdári, 12462

  • University General Hospital of Heraklion - Department of Paediatrics

    Heraklion, 711 10

  • Univ. General Hospital of Ioannina - Department of Paediatrics, Nephrology Unit

    Ioannina, 45500

  • University General Hospital of Patras | Univ Obs & Gynae Cli

    Pátrai, 26504

  • Hippokration General Hospital of Thessaloniki

    Thessaloniki, 54642

  • General Hospital of Thessaloniki Papageorgiou

    Thessaloniki, 56403

Other trials in Greece

Italy7 sites
  • Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco Di Catania

    Catania, Sicily, 95123

  • University Hospital Of Ferrara - Ostetricia e Ginecologia

    Ferrara, Emilia-Romagna, 44124

  • Careggi University Hospital

    Florence, Tuscany, 50134

  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

    Milan, Lombardy, 20122

  • Ospedale San Raffaele s.r.l. - Ginecologia Ostetricia e Medicina della Riproduzione

    Milan, Lombardy, 20132

  • IRCCS Fondazione Policlinico San Matteo

    Pavia, Lombardy, 27100

  • Azienda Ospedaliero Universitaria Pisana

    Pisa, Tuscany, 56126

Other trials in Italy

Hungary6 sites
  • TritonLife Medical Center, XIII.kerulet

    Budapest, 1134

  • NAP-MED Egeszsegugyi Szolgaltato Kft

    Debrecen, 4028

  • Debreceni Egyetem Klinikai Kozpont

    Debrecen, 4032

  • Komaromi Selye Janos Korhaz

    Komárom, 2900

  • SZTE ÁOK Szent Györgyi Albert Klinikai Kozpont

    Szeged, 6720

  • Rub-Int Noi Egeszsegcentrum

    Székesfehérvár, 8000

Other trials in Hungary

Israel6 sites
  • HaEmek Medical Center | Internal Medicine C Department - Research Unit

    Afula, 1834111

  • Mayanei HaYeshua Medical Center

    Bnei Brak, 5154475

  • Hillel Yaffe Medical Center

    Hadera, 3810101

  • Hadassah Hebrew University Hospital Ein Kerem

    Jerusalem, 9112001

  • Meir Medical Center

    Kfar Saba, 4428164

  • Health Corporation of Galilee Medical Center

    Nahariya, 2210001

Other trials in Israel

Austria5 sites
  • Medical University of Graz | Division of Gynecology and Obstetrics

    Graz, Styria, 8036

  • Medizinische Universitat Innsbruck | Klinik fur Gyn Endokrinologie und Reproduktionsmedizin

    Innsbruck, Tyrol, 6020

  • Kepler Campus IV | Gyn, Gburtshilfe & gyn. Endokrinologie

    Linz, Upper Austria, 4020

  • AKH Wien | Allg. Gynaekologie & gynaekologische Onkologie

    Vienna, 1090

  • Medizinische Universitat Wien | Universitatsklinik fur Frauenheilkunde Klinische Abteilung fur Gynakologische Endokrinologie

    Vienna, 1090

Other trials in Austria

Netherlands3 sites
  • Flevoziekenhuis

    Almere Stad, MISSING

  • St. Antonius Ziekenhuis | Utrecht - R&D Interne Geneeskunde

    Nieuwegein, 3435 CM

  • Diakonessenhuis

    Utrecht, 3582 KE

Other trials in Netherlands

About this study

Official title: A Double-blind, Randomized, Placebo-controlled Multicenter Study to Investigate Efficacy and Safety of Elinzanetant for the Treatment of Vasomotor Symptoms Over 26 Weeks in Postmenopausal Women

Researchers are looking for a better way to treat women who have hot flashes after women have been through the menopause. Hot flashes are caused by the hormonal changes that happen when a woman's body has been through the menopause. Menopause is when women stop having a menstrual cycle, also called a period. During the menopause, the ovaries increasingly produce less sex hormones as a result of the natural ageing process and related hormonal adjustments. The decline in hormone production can lead to various symptoms which, in some cases, can have a very adverse effect on a menopausal woman's quality of life.

The study treatment, elinzanetant, was developed to treat symptoms caused by hormonal changes. It works by blocking a protein called neurokinin from sending signals to other parts of the body, which is thought to play a role in starting hot flashes. There are treatments for hot flashes in women who have been through the menopause, but may cause medical problems for some people.

Read more

In this study, the researchers will learn how well elinzanetant works compared to a placebo in women who have been through the menopause and have hot flashes. A placebo looks like a treatment but does not have any medicine in it. To compare these study treatments, the doctors will ask the participants to record information about the participants' hot flashes in an electronic diary. The researchers will study the number of hot flashes the participants have and how severe the hot flashes are. The researchers will look at the results from before treatment, after 4 weeks, and after 12 weeks of treatment.

The participants in this study will take two capsules of either elinzanetant or the placebo once a day. The participants who take elinzanetant will take it for 26 weeks. The participants who take the placebo will take it for 12 weeks and then take elinzanetant for the next 14 weeks.

During the study, the participants will visit the site approximately 9 times and perform 1 visit by phone. Each participant will be in the study for approximately 36 weeks. The treatment duration will be 26 weeks.

During the study, the participants will:

  • record information about the participants' hot flashes in an electronic diary
  • answer questions about the participants' symptoms

The doctors will:

  • check the participants' health
  • take blood samples
  • ask the participants questions about what medicines the participants are taking and if the participants are having adverse events An adverse event is any medical problem that a participant has during a study. Doctors keep track of all adverse events that happen in studies, even if doctors do not think the adverse events might be related to the study treatments.
Being tested
Elinzanetant (BAY3427080), Placebo
Keywords
Menopause
Medical subject headings
Hot Flashes

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Elinzanetant (BAY3427080)Drug

    120 mg elinzanetant orally once daily

  • PlaceboDrug

    Matching placebo orally once daily

Study groups in NCT05042362
Study groupRoleWhat they receive
Elinzanetant (BAY3427080)ExperimentalParticipants will receive 120 mg elinzanetant orally once daily for 26 weeks.
Receives: Drug: Elinzanetant (BAY3427080)
Placebo + elinzanetantPlacebo comparatorParticipants will receive matching placebo orally once daily for 12 weeks, followed by elinzanetant 120 mg for 14 weeks.
Receives: Drug: Elinzanetant (BAY3427080); Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Mean Change in Frequency of Moderate to Severe HF From Baseline to Week 4 (Assessed by Hot Flash Daily Diary [HFDD]).

    The frequency of moderate to severe HF for each week during the treatment period was calculated using the available data during that particular week. Specifically for Week 4, Days 22-28 were used (Day 1 corresponds to start of treatment). Mean daily frequency is calculated as total number of moderate to severe HF during that week divided by the total number of available days with data during that week

    Measured: From baseline to Week 4

  2. Mean Change in Frequency of Moderate to Severe HF From Baseline to Week 12 (Assessed by HFDD).

    The frequency of moderate to severe HF for each week during the treatment period was calculated using the available data during that particular week. Specifically for Week 12, Days 78-84 were used (Day 1 corresponds to start of treatment). Mean daily frequency is calculated as total number of moderate to severe HF during that week divided by the total number of available days with data during that week

    Measured: From baseline to Week 12

  3. Mean Change in Severity of Moderate to Severe HF From Baseline to Week 4 (Assessed by HFDD).

    In the HFDD, hot flash (HF) severity is scored as 1=mild, 2=moderate, and 3=severe; a decrease indicates improvement. The diary records the number of mild, moderate, and severe HFs during day and night. Mild HFs are a "sensation of heat without sweating"; moderate are "heat with sweating but able to continue activity"; severe are "heat with sweating that stops activity."

    Baseline mean daily severity is calculated as:

    (2×moderateHFs+3×severeHFs)÷(totalmoderate+severeHFs).(2 × moderate HFs + 3 × severe HFs) ÷ (total moderate + severe HFs).(2×moderateHFs+3×severeHFs)÷(totalmoderate+severeHFs).

    If none occur, severity=0. Weekly severity during treatment is based on available days (Week 4: Days 22-28; Week 12: Days 78-84; Day 1=start of treatment), averaging the mean daily severity for that week. If more than 2 days are missing, the weekly value is set to missing.

    Measured: From baseline to Week 4

  4. Mean Change in Severity of Moderate to Severe HF From Baseline to Week 12 (Assessed by HFDD).

    In the HFDD, hot flash (HF) severity is categorized as 1=mild, 2=moderate, 3=severe; thus, a decrease indicates improvement. The HFDD records the number of mild, moderate, and severe HFs during day and night. Mild HFs are a "sensation of heat without sweating"; moderate involve "heat with sweating but able to continue activity"; severe involve "heat with sweating that stops activity."

    Mean daily severity at baseline is calculated as:

    (2 × moderate HFs) + (3 × severe HFs)\] ÷ (total moderate + severe HFs). If none occur, severity is set to 0. Weekly severity during treatment is based on available days (Week 4: Days 22-28; Week 12: Days 78-84; Day 1=start of treatment), averaging mean daily severity across that week. If more than 2 days are missing, the week is set to missing.

    Measured: From baseline to Week 12

Secondary outcomes (6)
  1. Mean Change in Frequency of Moderate to Severe HF From Baseline to Week 1 (Assessed by HFDD).

    The frequency of moderate to severe HF for each week during the treatment period was calculated using the available data during that particular week. Specifically for Week 1, Days 2-8 were used (Day 1 corresponds to start of treatment). Mean daily frequency is calculated as total number of moderate to severe HF during that week divided by the total number of available days with data during that week

    Measured: From baseline to Week 1

  2. Mean Change in Frequency of Moderate to Severe HF From Baseline Over Time.

    The frequency of moderate to severe HF for each week during the treatment period was calculated using the available data during that particular week. Specifically, for Week 1 Days 2-8 were used instead of 1-7, because the intake started on Day 1 only before going to bed, for Week 4 Days 22-28 were used and for Week 12 Days 78-84 were used (Day 1 corresponds to start of treatment). These data were aggregated to a mean daily frequency as (total number of moderate to severe HF during that week) / (total number of available days with data during that week). In case data was not available for more than 2 days within a week, the value for that particular week was set to missing.

    Measured: From baseline to Week 30

  3. Mean Change in Patient-reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b (PROMIS SD SF 8b) Total T-score From Baseline to Week 12.

    In controversy of what you have been proposing above here you are just explaining the PROMIS SD SF 8b scores, not the secondary endpoint which is the change in the T-scores from BL to week 12

    The PROMIS Sleep Disturbance Short Form 8b (PROMIS SD SF 8b) measures sleep disturbance over the past 7 days using 8 items assessing sleep quality, depth, restorative sleep, difficulty falling or staying asleep, and perceptions of sleep adequacy and satisfaction. Items use 5-point response options that vary by item (e.g., Not at all → Very much; Never → Always; Very poor → Very good). Item scores sum to a raw score of 8-40, which is converted to a T-score (mean 50, SD 10; range 28.9-76.5). Higher scores reflect greater sleep disturbance. PROMIS cut points classify T-scores of 55-59 as mild, 60-69 as moderate, and ≥70 as severe disturbance.

    Measured: From baseline to Week 12

  4. Mean Menopause Specific Quality of Life Scale (MENQOL) Total Score From Baseline to Week 12.

    The MENQOL questionnaire was comprised of 29 items assessing the presence of menopausal symptoms and the impact of menopause on health-related quality of life over the past week. The items assessed four domains of symptoms and functioning: VMS, psychosocial functioning, physical functioning, and sexual functioning. For each item, the participant indicated if they had experienced the symptom (yes/no). If participants selected yes, participants rated how bothered they were by the symptom using a six-point verbal descriptor scale, with response options ranging from 0 'not at all bothered' to 6 'extremely bothered'. Based on the individual responses, item scores, domain scores, and a total MENQOL score were calculated. Each score ranged from 1-8, higher scores indicated greater bother.

    Measured: From baseline to Week 12

  5. Mean Beck Depression Inventory (BDI-II) Total Score From Baseline to Week 12.

    The BDI-II was a 21-item questionnaire assessed the intensity of depressive symptoms over the past 2 weeks. Each item was a list of four statements arranged in increasing levels of severity about a particular symptom of depression. Items used a 4-point verbal response scale ranging from 0 (not at all) to 3 (extreme form of each symptom); specific response options were tailored to the aspect of depression being measured in each item. A total score ranging from 0 to 63 was calculated with scores of 0-13 indicating mild minimal range, 14 - 19 mild depression, 20 - 28 indicating moderate and 29 - 63 severe depression (higher score = greater depression).

    Measured: From baseline to Week 12

  6. Mean Change in BDI-II Total Score From Baseline to Week 26.

    The BDI-II was a 21-item questionnaire assessing the intensity of depressive symptoms over the past 2 weeks. Each item was a list of four statements arranged in increasing levels of severity about a particular symptom of depression. Items used a 4-point verbal response scale ranging from 0 (not at all) to 3 (extreme form of each symptom); specific response options were tailored to the aspect of depression being measured in each item. A total score ranging from 0 to 63 was calculated with scores of 0-13 indicating mild minimal range, 14 - 19 mild depression, 20 - 28 indicating moderate and 29 - 63 severe depression (higher score = greater depression).

    Measured: From baseline to Week 26

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Sep 2021
  2. Study start27 Aug 2021
  3. Primary completion25 Jul 2023
  4. Study completion27 Nov 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
396 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05042362
Sponsor's protocol ID
21651
Other IDs
2020-004908-33
Acronym
OASIS-1
Status last verified
Jan 2026
First submitted
26 Aug 2021
Last updated
12 Feb 2026
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Pinkerton JV, Simon JA, Joffe H, Maki PM, Nappi RE, Panay N, Soares CN, Thurston RC, Caetano C, Haberland C, Haseli Mashhadi N, Krahn U, Mellinger U, Parke S, Seitz C, Zuurman L. Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause: OASIS 1 and 2 Randomized Clinical Trials. JAMA. 2024 Aug 22;332(16):1343-54. doi: 10.1001/jama.2024.14618. Online ahead of print.

    PubMed 39172446

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