{
  "schema_version": "chamgap-public-evidence-check-1.0",
  "public_id": "v2937-s2",
  "verdict_number": "2937",
  "title": "Antidepressant maintenance × complete relapse prevention — evidence sheet distinguishing remaining 52-week events",
  "view_version": "1.0",
  "view_created_date": "2026-10-11",
  "criteria_version": "1.0",
  "criteria_date": "2026-10-06",
  "review_date": null,
  "legacy_evidence_date": "2026-08-26",
  "review_scope": {
    "materials_read": "Existing review summaries and stored records of methodological application",
    "clinical_papers_directly_read": false,
    "new_clinical_search": false,
    "limitation": "The complete existing review summary was read for production and existing links, identifiers and DOIs linked. No new reading or testing of external abstracts, full texts, registrations, protocols or SAP was performed.",
    "date_meaning": "This is the date the stored materials were checked, not the date of a new search of the clinical literature."
  },
  "claim_context": {
    "population": "Adults on long-term treatment who felt well enough to consider discontinuation; at least two previous episodes or at least two years of treatment; UK primary care",
    "intervention": "Historical study exposure to long-term maintenance of four specific antidepressants; not a recommendation to maintain treatment",
    "dose": "Original included medications and doses are preserved in the complete summary; no individual medication, tapering, discontinuation or restarting instructions are created",
    "comparator": "Tapering to matching placebo in the original trial; usual concomitant treatment and detailed actual exposure remain unread",
    "endpoint": "Selected complete-relapse-prevention claim; distinguish average reduction from the direct original finding of 92/238 (39%) maintenance participants relapsing by 52 weeks",
    "duration": "Original duration 52 weeks; the original 1~2-month taper and 12-week withdrawal measurement are historical study conditions and measurement times, not instructions",
    "excluded_extensions": [
      "Repurposing average reduction as complete prevention for every person or duration",
      "Mixing the 468-participant time-to-event denominator with the 478-participant absolute-event denominator",
      "Merging withdrawal, relapse, restarting and SAE as the same events",
      "Certifying all medications, populations, lifelong prevention or individual prediction",
      "Recommendations to maintain, discontinue, taper or restart treatment"
    ]
  },
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Comparative efficacy",
      "question": "Have the complete-prevention claim, subclaim grade D and parent relapse-reduction grade B been kept separate?",
      "needed": "Separate preservation of the subclaim wording, grade and note and the parent verdict",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Separate preservation of the subclaim wording, grade and note and the parent verdict",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Link additional materials while distinguishing complete prevention from average relapse reduction.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The selected existing claim is ‘Maintenance completely prevents relapse’, with original grade D and a note that 39% relapsed despite maintenance. The parent concerns average relapse reduction, B with 70 points and Caution.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Absent subclaim score, status and axes are not filled with parent values. This is not a new grade assessment.",
      "missingness": "Absent subclaim score, status and axes are not filled with parent values. This is not a new grade assessment.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Absent subclaim score, status and axes are not filled with parent values. This is not a new grade assessment."
    },
    {
      "item_id": "N02",
      "question_type": "Comparative efficacy",
      "question": "What were the original population's remission, long-term use and consideration of discontinuation conditions?",
      "needed": "Age, remission, previous episodes, treatment history, eligibility and denominators",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Age, remission, previous episodes, treatment history, eligibility and denominators",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original eligibility, baseline characteristics, remission assessment and relapse history.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "Participants were adults who felt well enough to consider discontinuation, had at least two previous depressive episodes or at least two years of treatment, and were long-term users. The trial included 150 UK general practices.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. The findings are not automatically applied to other diseases, treatment durations, remission states or populations. Detailed baseline and eligibility tables remain unread.",
      "missingness": "The findings are not automatically applied to other diseases, treatment durations, remission states or populations. Detailed baseline and eligibility tables remain unread.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The findings are not automatically applied to other diseases, treatment durations, remission states or populations. Detailed baseline and eligibility tables remain unread."
    },
    {
      "item_id": "N03",
      "question_type": "Comparative efficacy",
      "question": "Have the four antidepressants' specific study conditions been extended to all medications?",
      "needed": "Recording included medications, original study doses, exposure and group composition",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Recording included medications, original study doses, exposure and group composition",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain medication-specific inclusion, baseline exposure, denominators and prespecified subgroup materials.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "ANTLER included users of specified doses of citalopram, fluoxetine, sertraline and mirtazapine. Original doses are preserved in the complete existing review summary.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Do not extend the finding to complete prevention with other medications, doses or patient groups or create instructions for taking, maintaining or discontinuing medication. Original medication-specific denominators and effects remain unread.",
      "missingness": "Do not extend the finding to complete prevention with other medications, doses or patient groups or create instructions for taking, maintaining or discontinuing medication. Original medication-specific denominators and effects remain unread.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not extend the finding to complete prevention with other medications, doses or patient groups or create instructions for taking, maintaining or discontinuing medication. Original medication-specific denominators and effects remain unread."
    },
    {
      "item_id": "N04",
      "question_type": "Comparative efficacy",
      "question": "What was the actual comparison between maintenance and tapering to matching placebo?",
      "needed": "Historical interventions, placebo switching, common treatments and actual exposure",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Historical interventions, placebo switching, common treatments and actual exposure",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original intervention, placebo, actual exposure, common-treatment and change materials.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The randomized comparison was long-term maintenance versus tapering and switching to matching placebo. The original study's 1~2-month taper is preserved only as a historical condition.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. This is not equated with abrupt discontinuation or every discontinuation method. No new taper schedule, medication instructions or treatment substitution is created.",
      "missingness": "This is not equated with abrupt discontinuation or every discontinuation method. No new taper schedule, medication instructions or treatment substitution is created.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "This is not equated with abrupt discontinuation or every discontinuation method. No new taper schedule, medication instructions or treatment substitution is created."
    },
    {
      "item_id": "N05",
      "question_type": "Comparative efficacy",
      "question": "Are the 478 randomized participants and group-specific absolute relapse denominators preserved?",
      "needed": "Randomization, analysis, group-specific absolute events and follow-up denominators",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Randomization, analysis, group-specific absolute events and follow-up denominators",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original participant flow, allocation, absolute event tables and missing-data mapping by group.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The 478 participants were allocated to maintenance, 238, or tapering to placebo, 240. Absolute relapse counts were 92/238 versus 135/240.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Two reports of the same trial, multiple medications and other subclaims are not added as new participants.",
      "missingness": "Two reports of the same trial, multiple medications and other subclaims are not added as new participants.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Two reports of the same trial, multiple medications and other subclaims are not added as new participants."
    },
    {
      "item_id": "N06",
      "question_type": "Comparative efficacy",
      "question": "Does the complete-prevention claim agree with the actual maintenance-group events?",
      "needed": "Direct evidence for the selected duration, group, relapse definition and event counts",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Direct evidence for the selected duration, group, relapse definition and event counts",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Link original relapse definitions, ascertainment, events by duration and scope of individual applicability.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The existing review summary and note record relapse within 52 weeks in 92/238 (39%) of the maintenance group. The preserved summary explicitly states that maintenance did not eliminate relapse.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Average reduction is not converted into complete prevention for every person or duration. No new individual prediction or guarantee is made.",
      "missingness": "Average reduction is not converted into complete prevention for every person or duration. No new individual prediction or guarantee is made.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Average reduction is not converted into complete prevention for every person or duration. No new individual prediction or guarantee is made."
    },
    {
      "item_id": "N07",
      "question_type": "Comparative efficacy",
      "question": "What were the relapse symptom instrument, assessment and ascertainment times?",
      "needed": "Instrument, episode definition, ascertainment, measurement times and group denominators",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Instrument, episode definition, ascertainment, measurement times and group denominators",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original relapse definitions, instrument, assessments, ascertainment times and tables.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The preserved summary records relapse assessed with a depression symptom instrument as a patient-important treatment target and analyzes time to first relapse over 52 weeks.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Do not invent an instrument name, exact diagnostic criteria, measurement schedule or assessor details absent from the original material.",
      "missingness": "Do not invent an instrument name, exact diagnostic criteria, measurement schedule or assessor details absent from the original material.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not invent an instrument name, exact diagnostic criteria, measurement schedule or assessor details absent from the original material."
    },
    {
      "item_id": "N08",
      "question_type": "Comparative efficacy",
      "question": "Are 39% versus 56% and the absolute 17%p difference preserved as originally recorded?",
      "needed": "Relapsing participants, denominators, original proportions, absolute difference and uncertainty by group",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Relapsing participants, denominators, original proportions, absolute difference and uncertainty by group",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original absolute-difference, CI, denominator and test materials.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "Preserve the original wording: maintenance 92/238 (39%) versus discontinuation 135/240 (56%), an absolute difference of 17%p.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. No new proportions, risk differences, RR, NNT, absolute-difference CI or event examples are calculated. Average reduction is not complete prevention.",
      "missingness": "No new proportions, risk differences, RR, NNT, absolute-difference CI or event examples are calculated. Average reduction is not complete prevention.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "No new proportions, risk differences, RR, NNT, absolute-difference CI or event examples are calculated. Average reduction is not complete prevention."
    },
    {
      "item_id": "N09",
      "question_type": "Comparative efficacy",
      "question": "Are the discontinuation-versus-maintenance HR direction, CI and P preserved?",
      "needed": "Time-to-event effect, comparison direction, CI, test and model",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Time-to-event effect, comparison direction, CI, test and model",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain the original effect of interest, HR direction, model, tests and denominators.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The discontinuation-versus-maintenance HR is 2.06 (95% CI 1.56~2.70), P<0.001.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Do not invert this into a maintenance-versus-discontinuation HR or convert it into a relapse risk ratio or individual complete-protection rate. Detailed model and adjustment variables remain unread.",
      "missingness": "Do not invert this into a maintenance-versus-discontinuation HR or convert it into a relapse risk ratio or individual complete-protection rate. Detailed model and adjustment variables remain unread.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not invert this into a maintenance-versus-discontinuation HR or convert it into a relapse risk ratio or individual complete-protection rate. Detailed model and adjustment variables remain unread."
    },
    {
      "item_id": "N10",
      "question_type": "Comparative efficacy",
      "question": "Are the 468 participants in the primary time-to-event analysis the same denominator as the 478 for absolute relapse counts?",
      "needed": "Mapping relapse timing, event occurrence, complete-case exclusions and denominators",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Mapping relapse timing, event occurrence, complete-case exclusions and denominators",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original analysis populations, missing timing, group denominators and event mapping.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The 10 participants without relapse timing, 6 maintenance and 4 discontinuation, were excluded from the primary time-to-event analysis but included in absolute relapse counts. The evidence list records 468 participants in the primary analysis.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Do not change the absolute-event denominator to 468 or newly certify the primary analysis as an all-participant ITT analysis. No new group-specific complete-case counts are calculated.",
      "missingness": "Do not change the absolute-event denominator to 468 or newly certify the primary analysis as an all-participant ITT analysis. No new group-specific complete-case counts are calculated.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not change the absolute-event denominator to 468 or newly certify the primary analysis as an all-participant ITT analysis. No new group-specific complete-case counts are calculated."
    },
    {
      "item_id": "N11",
      "question_type": "Comparative efficacy",
      "question": "Are the best- and worst-case sensitivity analyses and gaps in effect magnitude retained?",
      "needed": "Missing-data assumptions, omissions by group, sensitivity models, effects and intervals",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Missing-data assumptions, omissions by group, sensitivity models, effects and intervals",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original sensitivity-analysis plans, assumptions, effects, intervals and denominators.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The preserved summary records that sensitivity analyses using best- and worst-case assumptions remained in the same direction.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Consistent direction is not used to certify resolution of all missing-data bias, an exact effect or complete follow-up. Detailed numbers remain unread.",
      "missingness": "Consistent direction is not used to certify resolution of all missing-data bias, an exact effect or complete follow-up. Detailed numbers remain unread.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Consistent direction is not used to certify resolution of all missing-data bias, an exact effect or complete follow-up. Detailed numbers remain unread."
    },
    {
      "item_id": "N12",
      "question_type": "Comparative efficacy",
      "question": "Are adherence of 70% and 52% and restarting of 39% distinguished from relapse proportions?",
      "needed": "Actual exposure, adherence definitions, restarting, duration and event relationships",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Actual exposure, adherence definitions, restarting, duration and event relationships",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original exposure, adherence, restarting, timing, event mapping and effects of interest.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "Adherence was 70% in maintenance and 52% in discontinuation; 39% of the discontinuation group restarted a clinician-prescribed antidepressant before trial end.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Do not merge 39% restarting in discontinuation with 39% relapse in maintenance as the same event. No new adherer effects, reasons for restarting or denominators are calculated.",
      "missingness": "Do not merge 39% restarting in discontinuation with 39% relapse in maintenance as the same event. No new adherer effects, reasons for restarting or denominators are calculated.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not merge 39% restarting in discontinuation with 39% relapse in maintenance as the same event. No new adherer effects, reasons for restarting or denominators are calculated."
    },
    {
      "item_id": "N13",
      "question_type": "Comparative efficacy",
      "question": "Has the magnitude of possible withdrawal-versus-relapse misclassification been established?",
      "needed": "Distinguishing withdrawal and relapse, measurement, original models and sensitivity analyses",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Distinguishing withdrawal and relapse, measurement, original models and sensitivity analyses",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original withdrawal and relapse definitions, timing, assessment, sensitivity and distinction analyses.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The preserved summary states that withdrawal symptoms were greater at 12 weeks in discontinuation and possible relapse misclassification could explain some findings, but its magnitude was not established.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Do not assert that withdrawal explains the entire difference or newly certify that there was no misclassification.",
      "missingness": "Do not assert that withdrawal explains the entire difference or newly certify that there was no misclassification.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not assert that withdrawal explains the entire difference or newly certify that there was no misclassification."
    },
    {
      "item_id": "N14",
      "question_type": "Comparative efficacy",
      "question": "Have the original modified DESS means, difference, CI and direction been kept separate?",
      "needed": "Withdrawal instrument, time point, group order, original difference, interval and denominators",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Withdrawal instrument, time point, group order, original difference, interval and denominators",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original DESS measurements, model, recorded difference, group denominators and repeated time points.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "At 12 weeks, modified DESS was 3.1 in discontinuation versus 1.3 in maintenance, with the original between-group difference 1.9 (95% CI 1.5~2.3).",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Do not subtract the means again to revise the recorded difference or convert it into a new P, CI, denominator or relapse count. Adjustment and instrument definitions remain unread.",
      "missingness": "Do not subtract the means again to revise the recorded difference or convert it into a new P, CI, denominator or relapse count. Adjustment and instrument definitions remain unread.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not subtract the means again to revise the recorded difference or convert it into a new P, CI, denominator or relapse count. Adjustment and instrument definitions remain unread."
    },
    {
      "item_id": "N15",
      "question_type": "Comparative efficacy",
      "question": "Have matching-tablet blinding and limitations of actual allocation guesses been distinguished?",
      "needed": "Allocation, concealment, blinding, allocation guesses and analyst procedures",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Allocation, concealment, blinding, allocation guesses and analyst procedures",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original blinding, guessing, allocation, measurement and analysis procedures.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The existing review summary records a double-blind trial using matching tablets, but discontinuation participants guessed allocation better.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Nominal blinding alone does not certify complete actual blinding or resolution of all bias. Guessing proportions and allocation-concealment details remain unread.",
      "missingness": "Nominal blinding alone does not certify complete actual blinding or resolution of all bias. Guessing proportions and allocation-concealment details remain unread.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Nominal blinding alone does not certify complete actual blinding or resolution of all bias. Guessing proportions and allocation-concealment details remain unread."
    },
    {
      "item_id": "N16",
      "question_type": "Comparative efficacy",
      "question": "Are the prespecified first-relapse endpoint, registration and analysis hierarchy actually linked?",
      "needed": "Registration, protocol, SAP, original primary endpoint, changes and multiplicity plans",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Registration, protocol, SAP, original primary endpoint, changes and multiplicity plans",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original registration, plans, analysis hierarchy and change history.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The evidence-list endpoint is time to first relapse over 52 weeks, and the registration identifiers are ISRCTN15969819 · EudraCT2015-004210-26.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. No new registration or SAP reading or registration URL construction is performed. Complete prevention is not created as a separate prespecified endpoint of the original trial.",
      "missingness": "No new registration or SAP reading or registration URL construction is performed. Complete prevention is not created as a separate prespecified endpoint of the original trial.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "No new registration or SAP reading or registration URL construction is performed. Complete prevention is not created as a separate prespecified endpoint of the original trial."
    },
    {
      "item_id": "N17",
      "question_type": "Comparative efficacy",
      "question": "Do gaps in secondary outcomes, medication or baseline-history subgroups and individual prediction remain?",
      "needed": "Prespecified subgroups, interactions, denominators, effects and prediction materials",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Prespecified subgroups, interactions, denominators, effects and prediction materials",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original subgroup, interaction, individual-prediction and secondary-outcome plans and denominators.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The preserved summary states that the trial did not identify who could discontinue safely.",
      "condition_status": "Unverified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Do not create universal protection with maintenance, individual safe discontinuation, medication rankings or baseline-history effects.",
      "missingness": "Do not create universal protection with maintenance, individual safe discontinuation, medication rankings or baseline-history effects.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not create universal protection with maintenance, individual safe discontinuation, medication rankings or baseline-history effects."
    },
    {
      "item_id": "N18",
      "question_type": "Comparative efficacy",
      "question": "Is the relationship to the other claim about 44% without relapse in discontinuation retained?",
      "needed": "Relationships among shared participants, relapse or non-relapse and other subclaims",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Relationships among shared participants, relapse or non-relapse and other subclaims",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Link the two subclaims while retaining their relationship to the same trial, duration and denominators.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The existing review summary and sibling subclaim preserve the wording that 44% of the discontinuation group did not relapse within 52 weeks.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. This value is not newly calculated or converted into advice that every person can or cannot discontinue safely.",
      "missingness": "This value is not newly calculated or converted into advice that every person can or cannot discontinue safely.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "This value is not newly calculated or converted into advice that every person can or cannot discontinue safely."
    },
    {
      "item_id": "N19",
      "question_type": "Comparative efficacy",
      "question": "Has the 52-week effect been kept from extending to permanent prevention or other clinical outcomes?",
      "needed": "Direct outcomes including long-term follow-up, episodes, function and deaths",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Direct outcomes including long-term follow-up, episodes, function and deaths",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain direct relapse, clinical-function and long-term outcome materials separately by duration.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The selected original materials' central duration is 52 weeks, and maintenance participants also relapsed.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. The 52-week reduction is not extended to lifelong absence of relapse, function, quality of life, survival or treatment benefit for every disease.",
      "missingness": "The 52-week reduction is not extended to lifelong absence of relapse, function, quality of life, survival or treatment benefit for every disease.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The 52-week reduction is not extended to lifelong absence of relapse, function, quality of life, survival or treatment benefit for every disease."
    },
    {
      "item_id": "N20",
      "question_type": "Comparative efficacy",
      "question": "Do Kato's 40 studies, 8,890 participants and original responses concern the same population as ANTLER?",
      "needed": "Review populations, post-acute maintenance, durations, denominators and trial mapping",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Review populations, post-acute maintenance, durations, denominators and trial mapping",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain the review's original eligibility, included trials, durations, denominators and relationship to ANTLER.",
      "current_reports": [
        "R03"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "Kato pooled 40 studies and 8,890 participants from varied post-acute-treatment maintenance-versus-placebo-switch trials.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. This is not treated as the same direct comparison as the real discontinuation decision among long-term primary-care users. Populations, durations and overlap by included trial remain unread.",
      "missingness": "This is not treated as the same direct comparison as the real discontinuation decision among long-term primary-care users. Populations, durations and overlap by included trial remain unread.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "This is not treated as the same direct comparison as the real discontinuation decision among long-term primary-care users. Populations, durations and overlap by included trial remain unread."
    },
    {
      "item_id": "N21",
      "question_type": "Comparative efficacy",
      "question": "Are review results of 20.9% maintenance versus 39.7% placebo and the OR, CI and P preserved within their original scope?",
      "needed": "Pooled relapse effects, group proportions, OR, intervals, tests and denominators",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Pooled relapse effects, group proportions, OR, intervals, tests and denominators",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original pooled models, trial-specific effects, denominators, definitions and heterogeneity.",
      "current_reports": [
        "R03"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The review reports maintenance 20.9% versus placebo switch 39.7%, OR 0.38 (95% CI 0.33~0.43), P<0.00001.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Maintenance 20.9% also does not mean complete prevention. The original OR is not converted into ANTLER's HR or an individual protection rate. No new proportions or differences are calculated.",
      "missingness": "Maintenance 20.9% also does not mean complete prevention. The original OR is not converted into ANTLER's HR or an individual protection rate. No new proportions or differences are calculated.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Maintenance 20.9% also does not mean complete prevention. The original OR is not converted into ANTLER's HR or an individual protection rate. No new proportions or differences are calculated."
    },
    {
      "item_id": "N22",
      "question_type": "Comparative efficacy",
      "question": "Have NEJM, the detailed NIHR report and the review been kept from being added as new independent trials?",
      "needed": "Relationships among original trials, additional reports, pooled materials, shared participants and sibling questions",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Relationships among original trials, additional reports, pooled materials, shared participants and sibling questions",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Link additional reports through original identifiers and preserve relationships among shared populations and included trials.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "NEJM and NIHR HTA are two reports of the same ANTLER trial. The preserved summary states that the review supports the same direction but was not counted as an independent repeat of the ANTLER question.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Reports, medications, subclaims and the review's 40 studies are not added as new independent trials or participants. Final independent counts and total participant sums remain unrecorded.",
      "missingness": "Reports, medications, subclaims and the review's 40 studies are not added as new independent trials or participants. Final independent counts and total participant sums remain unrecorded.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Reports, medications, subclaims and the review's 40 studies are not added as new independent trials or participants. Final independent counts and total participant sums remain unrecorded."
    },
    {
      "item_id": "N23",
      "question_type": "Comparative efficacy",
      "question": "Have gaps in public funding, sponsorship, product supply, affiliations and external analysis been distinguished?",
      "needed": "Cash support, medication or placebo supply, affiliations, external analysis and design or writing roles",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Cash support, medication or placebo supply, affiliations, external analysis and design or writing roles",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original support, supply, affiliations, research roles and analysis disclosures separately.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "Preserve NIHR HTA 13/115/48, PRIMENT NIHR core support and UCL sponsorship. The preserved summary records that donated trial medication or placebo from a pharmaceutical company was not described in the NEJM or NIHR reports.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Original non-reporting is not converted into certification of no donated supply. Detailed company affiliations and external-analysis roles remain unread.",
      "missingness": "Original non-reporting is not converted into certification of no donated supply. Detailed company affiliations and external-analysis roles remain unread.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original non-reporting is not converted into certification of no donated supply. Detailed company affiliations and external-analysis roles remain unread."
    },
    {
      "item_id": "N24",
      "question_type": "Comparative efficacy",
      "question": "Is the original information level for review funding and involvement in included trials retained?",
      "needed": "Review support, funding by original trial, authors and product or analysis roles",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Review support, funding by original trial, authors and product or analysis roles",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original review and trial-specific support, affiliations, products and analysis relationships.",
      "current_reports": [
        "R03"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The existing review summary records Japanese Ministry of Health, Labour and Welfare grants H29-SEISHIN-ippan-001 and 19GC1012 for the review.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Review support is not extended to certification that all 40 included studies had public funding, independence or no product supply.",
      "missingness": "Review support is not extended to certification that all 40 included studies had public funding, independence or no product supply.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Review support is not extended to certification that all 40 included studies had public funding, independence or no product supply."
    },
    {
      "item_id": "N25",
      "question_type": "Supplementary harm evidence",
      "question": "Are serious-adverse-event participant counts, proportions and denominators distinguished from relapse?",
      "needed": "SAE definitions, participants versus events, group denominators, relatedness and exposure tables",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "SAE definitions, participants versus events, group denominators, relatedness and exposure tables",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original SAE definitions, group-specific events and participants, denominators, relatedness, exposure and discontinuation.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "Original safety information records serious adverse events in 9 maintenance participants (4%) versus 8 discontinuation participants (3%).",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Do not convert these into event counts, medication-related harms or statistically significant safety differences. No new differences, P, CI or proportions are calculated. Denominator, collection and relatedness details remain unread.",
      "missingness": "Do not convert these into event counts, medication-related harms or statistically significant safety differences. No new differences, P, CI or proportions are calculated. Denominator, collection and relatedness details remain unread.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not convert these into event counts, medication-related harms or statistically significant safety differences. No new differences, P, CI or proportions are calculated. Denominator, collection and relatedness details remain unread."
    },
    {
      "item_id": "N26",
      "question_type": "Supplementary harm evidence",
      "question": "Have the original duration and scope of 0 deaths or suicide attempts been distinguished from long-term absence of risk?",
      "needed": "Event definitions, collection, duration, exposure, denominators and rare-harm materials",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Event definitions, collection, duration, exposure, denominators and rare-harm materials",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original event collection, exposure, denominators, duration and long-term rare-harm materials.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "Original safety information records 0 deaths and suicide attempts in both groups.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Zero events are not extended to absence of every rare harm, long-term safety or longevity benefit. No new risk CI or numerical examples are created.",
      "missingness": "Zero events are not extended to absence of every rare harm, long-term safety or longevity benefit. No new risk CI or numerical examples are created.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Zero events are not extended to absence of every rare harm, long-term safety or longevity benefit. No new risk CI or numerical examples are created."
    },
    {
      "item_id": "N27",
      "question_type": "Supplementary harm evidence",
      "question": "Do gaps remain in withdrawal symptoms, other maintenance-treatment harms and discontinuation applicability?",
      "needed": "Separate records of withdrawal, medication harms, discontinuation, exposure and long-term follow-up",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Separate records of withdrawal, medication harms, discontinuation, exposure and long-term follow-up",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Obtain original withdrawal, maintenance-medication harm, exposure, discontinuation and long-term materials separately.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The preserved summary records increased withdrawal symptoms 12 weeks after discontinuation and possible misclassification of some relapse events. The parent safety status is Caution.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Withdrawal is not wholly equated with relapse or maintenance-medication harm. No long-term harm rates or maintenance or discontinuation instructions outside the original materials are created.",
      "missingness": "Withdrawal is not wholly equated with relapse or maintenance-medication harm. No long-term harm rates or maintenance or discontinuation instructions outside the original materials are created.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Withdrawal is not wholly equated with relapse or maintenance-medication harm. No long-term harm rates or maintenance or discontinuation instructions outside the original materials are created."
    },
    {
      "item_id": "N28",
      "question_type": "Supplementary harm evidence",
      "question": "Have repeated harms and applicability to other medications, populations and exposures been kept from new certification?",
      "needed": "Direct effects or harms and report relationships by population, medication and duration",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Direct effects or harms and report relationships by population, medication and duration",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Link direct comparisons and harm materials for new populations, medications and exposures separately.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "Current materials compare maintenance with tapering to placebo among particular long-term users in remission; the review concerns varied maintenance trials.",
      "condition_status": "Unverified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Do not advise an individual to maintain, discontinue, taper or restart medication or certify complete prevention or safety for all medications and populations.",
      "missingness": "Do not advise an individual to maintain, discontinue, taper or restart medication or certify complete prevention or safety for all medications and populations.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not advise an individual to maintain, discontinue, taper or restart medication or certify complete prevention or safety for all medications and populations."
    },
    {
      "item_id": "N29",
      "question_type": "Comparative efficacy",
      "question": "Are the summary, three article URLs, registration records and original-material access distinguished?",
      "needed": "Individual bibliography, DOI, summary, external abstracts or full texts and registration or plan records",
      "role": "Required",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Individual bibliography, DOI, summary, external abstracts or full texts and registration or plan records",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Link original materials supplied by the user with individual types and actual access status.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "The complete parent verdict summary was read for production, and three PubMed URLs, original DOIs and registration strings were linked.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. No new URLs are constructed from identifiers. External abstracts, full texts, registrations, protocols and SAP remain unread, with no separate link test.",
      "missingness": "No new URLs are constructed from identifiers. External abstracts, full texts, registrations, protocols and SAP remain unread, with no separate link test.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "No new URLs are constructed from identifiers. External abstracts, full texts, registrations, protocols and SAP remain unread, with no separate link test."
    },
    {
      "item_id": "N30",
      "question_type": "Comparative efficacy",
      "question": "Are the cutoff date, languages, empty values, original verdict, candidate history and production status preserved?",
      "needed": "Distinguishing the complete preserved summary, subclaim record, parent values, corrections and current review",
      "role": "Supplementary",
      "role_reason": "Individual production condition recording the selected claim, original events, denominators, duration and interpretive boundaries",
      "application_exception": "Unread external material, other questions or out-of-scope outcomes do not substitute for satisfied conditions, zero effect or safety.",
      "criterion": "Distinguishing the complete preserved summary, subclaim record, parent values, corrections and current review",
      "basis": "Maintenance completely prevents relapse",
      "condition_origin": "Individual production conditions; not completed review or automatic satisfaction of common definitions",
      "proposed_research": "Proposal: Reflect additional materials and decisions through preservation of original wording and separate events.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Material information recorded in the existing review summary",
      "acquired_read": "Summary read; external materials not read",
      "observation": "Preserve 2026-08-26, empty correction and deliberation values, Korean and English drafts, parent B70, Caution and axes, and subclaim grade D. Original review-pending and production-eligibility markers are historical records.",
      "condition_status": "Partly verified",
      "status_reason": "Only relevant preserved-summary information has been recorded; detailed original materials remain unread and existing content review is incomplete. Absent subclaim scores are not filled. Existing content review remains incomplete; review-pending activation and completion markers are false, new units are 0 and the final independent total is unrecorded.",
      "missingness": "Absent subclaim scores are not filled. Existing content review remains incomplete; review-pending activation and completion markers are false, new units are 0 and the final independent total is unrecorded.",
      "uncertainty": "Unread/unverified does not mean zero effect, zero events, safety or new clinical certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Absent subclaim scores are not filled. Existing content review remains incomplete; review-pending activation and completion markers are false, new units are 0 and the final independent total is unrecorded."
    }
  ],
  "reports": [
    {
      "report_id": "R01",
      "title": "Lewis G, Marston L, Duffy L, et al. Maintenance or Discontinuation of Antidepressants in Primary Care. N Engl J Med. 2021;385:1257-1267. PMID: 34587384. DOI: 10.1056/NEJMoa2106356.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/34587384/",
      "report_type": "Reports of the same ANTLER trial",
      "existence": "Material preserved in the original citation/evidence lists",
      "acquired_read": "Summary read; external materials not read",
      "study_family": "F01",
      "independent_replication": false,
      "observed_result": "Relapse 92/238 (39%) versus 135/240 (56%); discontinuation-versus-maintenance HR 2.06 (95% CI 1.56~2.70), P<0.001; absolute difference 17%p",
      "result_level": "Preserved summary; not the result of individually comparing the original texts of the two ANTLER reports",
      "source_evidence_date": "2026-08-26",
      "materials": [
        {
          "material_type": "local_summary",
          "public_status": "Existing link preserved",
          "access_status": "Summary read",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-08-26",
          "qualification": "Stored parent-verdict summary"
        },
        {
          "material_type": "abstract",
          "public_status": "Existing link preserved",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External material unread; a URL does not mean acquisition, reading or completed review"
        },
        {
          "material_type": "fulltext",
          "public_status": "No separate URL in the original material",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External material unread; a URL does not mean acquisition, reading or completed review"
        },
        {
          "material_type": "registration",
          "public_status": "No separate URL in the original material",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External material unread; a URL does not mean acquisition, reading or completed review"
        },
        {
          "material_type": "protocol_sap",
          "public_status": "No separate URL in the original material",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External material unread; a URL does not mean acquisition, reading or completed review"
        }
      ],
      "links": [
        {
          "label": "Publisher",
          "url": "https://doi.org/10.1056/NEJMoa2106356"
        },
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34587384/"
        }
      ]
    },
    {
      "report_id": "R02",
      "title": "Duffy L, Clarke CS, Lewis G, et al. Antidepressant medication to prevent depression relapse in primary care: the ANTLER RCT. Health Technol Assess. 2021;25(69):1-62. PMID: 34842135. DOI: 10.3310/hta25690.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/34842135/",
      "report_type": "Reports of the same ANTLER trial",
      "existence": "Material preserved in the original citation/evidence lists",
      "acquired_read": "Summary read; external materials not read",
      "study_family": "F01",
      "independent_replication": false,
      "observed_result": "Relapse 92/238 (39%) versus 135/240 (56%); discontinuation-versus-maintenance HR 2.06 (95% CI 1.56~2.70), P<0.001; absolute difference 17%p",
      "result_level": "Preserved summary; not the result of individually comparing the original texts of the two ANTLER reports",
      "source_evidence_date": "2026-08-26",
      "materials": [
        {
          "material_type": "local_summary",
          "public_status": "Existing link preserved",
          "access_status": "Summary read",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-08-26",
          "qualification": "Stored parent-verdict summary"
        },
        {
          "material_type": "abstract",
          "public_status": "Existing link preserved",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External material unread; a URL does not mean acquisition, reading or completed review"
        },
        {
          "material_type": "fulltext",
          "public_status": "No separate URL in the original material",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External material unread; a URL does not mean acquisition, reading or completed review"
        },
        {
          "material_type": "registration",
          "public_status": "No separate URL in the original material",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External material unread; a URL does not mean acquisition, reading or completed review"
        },
        {
          "material_type": "protocol_sap",
          "public_status": "No separate URL in the original material",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External material unread; a URL does not mean acquisition, reading or completed review"
        }
      ],
      "links": [
        {
          "label": "Publisher",
          "url": "https://doi.org/10.3310/hta25690"
        },
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34842135/"
        }
      ]
    },
    {
      "report_id": "R03",
      "title": "Kato M, Hori H, Inoue T, et al. Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder: a systematic review and meta-analysis. Mol Psychiatry. 2021;26:118-133. PMID: 32704061. DOI: 10.1038/s41380-020-0843-0.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/32704061/",
      "report_type": "Systematic review",
      "existence": "Material preserved in the original citation/evidence lists",
      "acquired_read": "Summary read; external materials not read",
      "study_family": "F02",
      "independent_replication": false,
      "observed_result": "Maintenance 20.9% versus placebo switch 39.7%, OR 0.38 (95% CI 0.33~0.43), P<0.00001",
      "result_level": "Preserved summary; not the result of individually comparing the original texts of the two ANTLER reports",
      "source_evidence_date": "2026-08-26",
      "materials": [
        {
          "material_type": "local_summary",
          "public_status": "Existing link preserved",
          "access_status": "Summary read",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-08-26",
          "qualification": "Stored parent-verdict summary"
        },
        {
          "material_type": "abstract",
          "public_status": "Existing link preserved",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External material unread; a URL does not mean acquisition, reading or completed review"
        },
        {
          "material_type": "fulltext",
          "public_status": "No separate URL in the original material",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External material unread; a URL does not mean acquisition, reading or completed review"
        },
        {
          "material_type": "registration",
          "public_status": "No separate URL in the original material",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External material unread; a URL does not mean acquisition, reading or completed review"
        },
        {
          "material_type": "protocol_sap",
          "public_status": "No separate URL in the original material",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External material unread; a URL does not mean acquisition, reading or completed review"
        }
      ],
      "links": [
        {
          "label": "Publisher",
          "url": "https://doi.org/10.1038/s41380-020-0843-0"
        },
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/32704061/"
        }
      ]
    }
  ],
  "method_sources": [
    {
      "id": "M03",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2023-08",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03",
      "section": "§3.1, §3.2.1–3.2.3, MECIR C5/C7/C13",
      "official_principle": "Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions.",
      "review_level": "Preserved methodology connections were reused for preparation. No new review of methodological content, reassessment or external-link checks were performed."
    },
    {
      "id": "M04",
      "version": "Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04",
      "section": "§4.5, §4.6.1–4.6.3, MECIR C42",
      "official_principle": "Distinguish studies from reports and link them; do not omit a study solely because results are unreported.",
      "review_level": "Preserved methodology connections were reused for preparation. No new review of methodological content, reassessment or external-link checks were performed."
    },
    {
      "id": "M08",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2019-10",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08",
      "section": "§8.1–8.2.3, Table 8.2.a",
      "official_principle": "Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting.",
      "review_level": "Preserved methodology connections were reused for preparation. No new review of methodological content, reassessment or external-link checks were performed."
    },
    {
      "id": "M15",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2023-08",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15",
      "section": "§15.2.4, §15.3.1–15.3.3",
      "official_principle": "Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision.",
      "review_level": "Preserved methodology connections were reused for preparation. No new review of methodological content, reassessment or external-link checks were performed."
    },
    {
      "id": "M19",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2019-10",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19",
      "section": "§19.1.2, §19.2.1–19.2.4",
      "official_principle": "Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates.",
      "review_level": "Preserved methodology connections were reused for preparation. No new review of methodological content, reassessment or external-link checks were performed."
    }
  ],
  "status_dictionary": {
    "Partly verified": "Some information exists in the preserved review summary; detailed original materials remain unverified. This does not certify a passed review or clinical efficacy.",
    "Unverified": "Detailed materials for the selected condition could not be established within the stored scope; this does not mean zero effect, zero studies or safety",
    "Review incomplete": "Existing content review pending",
    "Met": "Use only within the relevant conditions after existing content review; no automatic designation in this preparation",
    "Not reported": "Distinguish only within materials actually read; do not turn unread external materials into unreported findings",
    "Inaccessible": "Not applied during this preparation because actual access was not tested",
    "Not applicable": "Use with a reason for non-applicability based on an explicit question boundary",
    "Conflicting data": "Judge after actual material comparison; review was not performed during this preparation",
    "Insufficient evidence for the conditions": "Do not use as a clinical grade encompassing currently unread materials"
  },
  "study_overlap": {
    "state": "Unverified",
    "unique_trial_count": null,
    "unique_participant_count": null,
    "reason": "NEJM and NIHR HTA reports of the same ANTLER trial share the same participants across three subclaims. The 40-study meta-analysis was not originally counted as an independent repeat of the ANTLER question; overlap among included trials and participants remains unread. Study-family identifiers link relationships and do not certify unique trial counts. Additional reports, medications, sibling questions, reviews and shared participants are not newly added as independent evidence."
  },
  "history": [
    {
      "date": "2026-10-11",
      "kind": "Separation of public-facing pages and materials",
      "view_version": "1.0",
      "change": "The public page and data were prepared from the existing 30 items. No new clinical search, verification-status change or scoring was performed."
    }
  ],
  "language": "en",
  "translation_date": "2026-10-11"
}