Ethical Approval

This study is conducted in compliance with the Declaration of Helsinki and Japan’s Clinical Trials Act. The study protocol was approved by the Certified Review Board of Osaka Metropolitan University, and written informed consent will be obtained from all patients before their enrollment.

Consent to Participate

All eligible participants are required to provide written informed consent before enrollment in this study.

Consent for Publication

All authors reviewed the manuscript and approved its submission.

Conflict of Interest

Kowa Company will not have any role in the analysis or interpretation of the results of this study.

SI reports receiving a lecture fee from Nippon Boehringer Ingelheim Co., Ltd. and a grant from the Japan Society for the Promotion of Science, outside the submitted work.

YN reports receiving a grant from the Osaka Medical Research Foundation for Intractable Diseases, outside the submitted work.

HF reports receiving funds from Kitano Cadet-Doctor program, outside the submitted work.

CI reports personal fees from AstraZeneca K.K.; Medtronic Japan Co., Ltd.; Novartis Pharma K.K.; Kowa Co., Ltd.; Ono Pharmaceutical Co., Ltd.; Daiichi Sankyo Co., Ltd.; Bayer Yakuhin, Ltd.; Otsuka Pharmaceutical Co., Ltd.; Pfizer Japan Inc.; Sumitomo Pharma Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; Edwards Lifesciences Corp.; Nippon Boehringer Ingelheim Co., Ltd.; Tsumura & Co.; Philips Japan, Ltd.; Eisai Co., Ltd.; Canon Medical Systems Corp.; Alnylam Japan K.K.; Janssen Pharmaceutical K.K.; Kyowa Kirin Co., Ltd.; Abbott Medical Japan LLC; Eli Lilly Japan K.K.; Astellas Pharma Inc.; Nihon Medi-Physics Co., Ltd.; and Japan Lifeline Co., Ltd., outside the submitted work.

GN has nothing to disclose.

HY has nothing to disclose.

HM has nothing to disclose.

MI reports receiving scholarship funds and personal fees from Daiichi Sankyo Co., Ltd.; Novartis Pharma K.K.; Nippon Shinyaku Co., Ltd.; Bayer Yakuhin, Ltd.; Mitsubishi Tanabe Pharma Corp.; Nippon Boehringer Ingelheim Co., Ltd.; and Otsuka Pharmaceutical Co., Ltd.; receiving scholarship funds from Teijin Pharma, Ltd.; Public Research Center; Nihon Medi-Physics Co., Ltd.; and Mochida Pharmaceutical Co., Ltd.; receiving joint research funds from Mie University, Research Institute for Production Development Japan, Janssen Pharmaceutical K.K., Nihon Kohden Corp., Nara Medical University, National Cerebral and Cardiovascular Center, and IQVIA Japan K.K.; receiving joint research funds and personal fees from Amgen Inc.; receiving personal fees from Kowa Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; AstraZeneca K.K.; Pfizer Japan Inc.; Eli Lilly Japan K.K.; Ono Pharmaceutical Co., Ltd.; and Sumitomo Dainippon Pharma Co., Ltd., outside the submitted work.

S Toyoda reports receiving funds from Assist Japan Inc.; Abbott Vascular Japan Co., Ltd.; Abbott Medical Japan LLC; EP-CRSU Co., Ltd.; Next Japan Medicalnext Co., Ltd..; GE Healthcare Pharma Ltd.; CVQuest K.K.; Cmic Co., Ltd.; Sumitomo Electric Group CSR Foundation; Life Science Institute, Inc.; Teijin Pharma, Ltd.; Terumo Corp.; Nipro Corp.; Japan Heart Foundation; Next Japan Medicalnext Co., Ltd.; Japan Lifeline Co., Ltd.; Boston Scientific Japan K.K.; and Roche Diagnostics K.K.; receiving funds and lecture fees from Astellas Pharma Inc.; Otsuka Pharmaceutical Co., Ltd.; Ono Pharmaceutical Co., Ltd.; Kyowa Kirin Co., Ltd.; Kowa Co., Ltd.; Sanofi K.K.; Daiichi Sankyo Co., Ltd.; Sumitomo Pharma Co., Ltd.; Mitsubishi Tanabe Pharma Corp.; Tsumura & Co.; Abiomed Japan K.K.; Eli Lilly Japan K.K.; Nippon Shinyaku Co., Ltd.; Nippon Boehringer Ingelheim Co., Ltd.; Medtronic Japan Co., Ltd.; Novartis Pharma K.K.; and Mochida Pharmaceutical Co., Ltd.; and receiving lecture fees from Bayer Yakuhin, Ltd.; Viatris Inc.; Novo Nordisk Pharma, Ltd.; AstraZeneca K.K.; Takeda Pharmaceutical Co., Ltd.; Janssen Pharmaceutical K.K.; Fukuda Denshi Co., Ltd.; Protea Japan Co., Ltd.; Eisai Co., Ltd.; Edwards Lifesciences Corp.; Zeria Pharmaceutical Co., Ltd.; Pfizer Japan Inc.; Bristol Myers Squibb K.K.; MSD Inc.; Amicus Therapeutics Inc.; and Toa Eiyo, Ltd., outside the submitted work.

S Takiuchi has nothing to disclose.

TK reports receiving personal fees from Kaneka Corp. and Philips Japan, Ltd., and receiving lecture fees from Kowa Co., Ltd.; Otsuka Pharmaceutical Co., Ltd.; Novartis Pharma K.K.; Nippon Boehringer Ingelheim Co., Ltd.; Daiichi Sankyo Co., Ltd.; Ono Pharmaceutical Co., Ltd.; Tsumura & Co.; Toa Eiyo, Ltd.; AstraZeneca K.K.; Bayer Yakuhin, Ltd.; Boston Scientific Japan K.K.; Terumo Corp.; Nipro Corp.; and Abbott Medical Japan LLC, outside the submitted work.

YI reports receiving lecture fees from Pfizer Japan Inc.; Nippon Boehringer Ingelheim Co., Ltd.; Sanofi K.K.; Medtronic Japan Co., Ltd.; AstraZeneca K.K.; Toa Eiyo, Ltd.; Bayer Yakuhin, Ltd.; Takeda Pharmaceutical Co.; Ltd.; Sumitomo Pharma Co., Ltd.; Janssen Pharmaceutical K.K.; Otsuka Pharmaceutical Co., Ltd.; Kowa Co., Ltd.; Novartis Pharma K.K.; Mitsubishi Tanabe Pharma Corp.; Viatris Inc.; Nippon Shinyaku Co., Ltd.; Kyowa Kirin Co., Ltd.; Alnylam Japan K.K.; Eli Lilly Japan K.K.; JCR Pharmaceuticals Co., Ltd.; Amicus Therapeutics Inc.; Ono Pharmaceutical Co., Ltd.; Abbott Japan LLC; and GlaxoSmithKline Consumer Healthcare Japan K.K.; and receiving grants from Daiichi Sankyo Co., Ltd., outside the submitted work.

YA reports receiving personal fees from Abbott Medical Japan LLC; Astellas Pharma Inc.; AstraZeneca K.K.; Bayer Yakuhin, Ltd.; Daiichi Sankyo Co., Ltd.; Edwards Lifesciences Corp.; Eli Lilly Japan K.K.; GE Healthcare Japan Corp.; Mallinckrodt Pharma K.K.; Nippon Boehringer Ingelheim Co., Ltd.; Novartis Pharma K.K.; Ono Pharmaceutical Co., Ltd.; Otsuka Pharmaceutical Co., Ltd.; and Toa Eiyo, Ltd., outside the submitted work.

TS has nothing to disclose.

YS reports receiving personal fees from Daiichi Sankyo Co., Ltd.; Novartis Pharma K.K.; Nippon Boehringer Ingelheim Co., Ltd.; Otsuka Pharmaceutical Co., Ltd.; AstraZeneca K.K.; and Bayer Yakuhin, Ltd., outside the submitted work.

ME reports receiving grants from Mitsubishi Tanabe Pharma Corp.; Eisai Co., Ltd.; Chugai Pharmaceutical Co., Ltd.; and Bayer Yakuhin, Ltd.; receiving personal lecture fees from Novo Nordisk Pharma, Ltd.; Sanofi K.K.; AstraZeneca K.K.; MSD Inc.; Kowa Co., Ltd.; Teijin Pharma, Ltd.; Sanwa Co., Ltd.; Eli Lilly Japan K.K.; and Astellas Pharma Inc.; and receiving grants and personal lecture fees from Nippon Boehringer Ingelheim Co., Ltd.; Ono Pharmaceutical Co., Ltd.; Sumitomo Pharma Co., Ltd.; and Kyowa Kirin Co., Ltd., outside the submitted work.

TI reports personal fees from Kowa Co., Ltd.; Ono Pharmaceutical Co., Ltd.; Daiichi Sankyo Co., Ltd.; Mochida Pharmaceutical Co., Ltd.; Otsuka Pharmaceutical Co., Ltd.; AstraZeneca K.K.; Eisai Co., Ltd.; Mitsubishi Tanabe Pharma Corp.; Novo Nordic Pharma, Ltd.; and receiving grants from Fukuda Denshi Co., Ltd., outside the submitted work.

MK reports receiving personal fees from Daiichi Sankyo Co., Ltd.; Viatris Inc.; Otsuka Pharmaceutical Co., Ltd.; and Eli Lilly Japan K.K.; receiving grants and personal fees from Ono Pharmaceutical Co., Ltd.; Mitsubishi Tanabe Pharma Corp.; AstraZeneca K.K.; and Nippon Boehringer Ingelheim Co., Ltd.; receiving grants from Novartis Pharma K.K.; Takeda Pharmaceutical Co., Ltd.; and Kowa Co., Ltd., outside the submitted work.