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. 2026 Jul 3;16:1881347. doi: 10.3389/fcimb.2026.1881347

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Copyright © 2026 Wang, Wang, Shi, Chen, Yang, Fei, Huang, Zhang, Wang, Gao and Zhang.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Flowchart depicting patient progression in a clinical study: nine hundred fifty-three screened, three hundred seventy-four declined, five hundred seventy-nine randomized into three groups (VBQ, VA, VD; one hundred ninety-three each), with losses and withdrawals detailed. Modified intention-to-treat (mITT) and per-protocol (PP) analyses performed, including counts for medication adherence below eighty percent. — Study flow diagram.