Published October 29, 2025 N Engl J Med 2025;393:1669-1680 DOI: 10.1056/NEJMoa2503223 For permission requests, please contact NEJM Reprints at reprints@nejm.org Are you a member of an institution such as a university or hospital?Learn more about Institutional Access Notes This article was updated on October 30, 2025, at NEJM.org. A data sharing statement provided by the authors is available with the full text of this article at NEJM.org.