AUCTORES
Globalize your Research
Chat with us
Review Article | DOI: https://doi.org/10.31579/2640-1045/193
Evolution Research Group (ERG), NJ, USA.
*Corresponding Author: Clayton A. Dehn, Executive Vice President – Scientific Services & Therapeutic Area Lead – Metabolism & Endocrinology, Evolution Research Group (ERG), 430 Mountain Avenue Suite 302 New Providence, NJ 07974, USA.
Citation: Clayton A. Dehn, Clayton A. Dehn, (2024), Advancing FDA Guidance on Weight Management Products: Prioritizing Body Composition in Obesity Therapies, J. Endocrinology and Disorders, 8(4): DOI:10.31579/2640-1045/193
Copyright: © 2024, Clayton A. Dehn. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 12 August 2024 | Accepted: 19 August 2024 | Published: 27 August 2024
Keywords: obesity treatment; FDA guidance; body composition; lean muscle preservation; weight management; regulatory framework; incretin therapies; pharmacologic approaches
The evolving landscape of obesity treatment necessitates updates to FDA guidance on weight management products. Current regulatory frameworks, primarily focused on overall weight reduction, fall short in addressing the complexities of modern pharmacologic approaches, particularly concerning lean muscle preservation. Newer therapies, such as incretin-based drugs, have achieved unprecedented efficacy, but significant loss of lean muscle mass remains a critical issue. This article advocates for the incorporation of body composition metrics as primary endpoints in clinical trials, emphasizing the importance of skeletal muscle preservation alongside fat reduction. Advanced imaging techniques and biomarkers are proposed as tools to more accurately assess therapeutic outcomes. Public-private partnerships are highlighted as key players in driving the validation and adoption of these new metrics, ultimately leading to more comprehensive and effective obesity treatments that align with modern understandings of metabolic health and long-term patient outcomes.
Pharmacologic approaches to weight control have a long and complex history, marked by a series of advances and setbacks. Early attempts, such as the use of amphetamines in the mid-20th century, were eventually overshadowed by safety concerns, including addiction and cardiovascular risks [1]. The 1990s saw the introduction of drugs like fenfluramine and phentermine, commonly known as Fen-Phen, which were later withdrawn from the market due to associations with valvular heart disease [2]. In the early 2000s, orlistat emerged as a lipase inhibitor that reduced fat absorption, but its modest efficacy and gastrointestinal side effects limited its widespread adoption [3]. These historical challenges highlight the necessity for updating regulatory frameworks to keep pace with advancements in obesity treatments.
The introduction of liraglutide (Saxenda) in 2014, a GLP-1 receptor agonist initially developed for diabetes management, marked a significant step forward in pharmacologic weight control. Saxenda demonstrated more substantial and sustained weight loss compared to previous agents [4]. However, while Saxenda and similar therapies represented progress, the field remained limited by the moderate efficacy and side effects of available treatments [5].
The landscape of obesity treatment has shifted dramatically with the advent of newer agents such as semaglutide (Wegovy) and tirzepatide (Zepbound). These incretin therapies have achieved levels of efficacy that were previously unattainable with pharmacologic approaches, with patients experiencing an average loss of 15% or more of their body weight [6]. As a result, the global market for weight loss drugs continues to revise upward and is now projected to reach $150 billion by the year 2033 [7]. This unprecedented momentum represents a substantial opportunity for pharmaceutical companies to innovate and capture a share of this expanding market.
Evolving Needs in Weight Management: Addressing Lean Muscle Preservation
Despite the remarkable progress, these recently approved weight loss agents are not without their challenges. Studies suggest that approximately 25-35% of the total weight loss associated with these newer therapies may come from lean muscle mass [8]. While reducing fat is essential, emerging evidence suggests that effective chronic weight management should also focus on overall body composition improvements—reducing adiposity, achieving healthier fat distribution, and maintaining or improving lean muscle mass [9].
The unintentional depletion of lean muscle can have serious health implications, including decreased physical strength, increased risk of falls, overall frailty, and a reduction in energy expenditure and calorie-burning potential [10]. Moreover, even a single cycle of weight loss and regain is associated with increased risks of cardiovascular disease, insulin resistance, exacerbation of sarcopenia, and greater difficulty in achieving long-term weight management [11]. These consequences could undermine the overall health benefits of weight reduction, underscoring the need for innovative approaches that not only reduce fat but also consider the impact on overall body composition and long-term metabolic health.
To address these challenges, several investigational therapies, including muscle-sparing or enhancing agents such as apelin, taldefgrobep alfa, bimagrumab, trevogrumab, and garetosmab, are being developed [12]-[16]. These agents represent a significant advancement in addressing the limitations of current pharmacologic strategies for obesity management. For these improved therapies to reach patients, the FDA’s criteria for evaluating weight management products must evolve to include endpoints that assess not only the quantity but also the quality of weight loss.
Current FDA Guidance and Its Limitations
The FDA Guidance for Industry on Developing Products for Weight Management, last revised in 2007, has served as a foundational document for the approval and development of anti-obesity therapies [17]. Appropriate for that time, the guidance provided essential benchmarks, including the minimum threshold requiring that at least 35% of subjects in the active group lose at least 5% of baseline body weight. However, this threshold now appears modest compared to the outcomes achieved by recently approved therapies, which often result in significantly greater weight reduction [6]. The efficacy standards established when more modest weight loss was the norm may no longer fully address the capabilities of these newer therapies.
Although the guidance emphasizes that safety assessments should ensure weight loss is primarily due to fat reduction rather than lean mass loss, this approach is increasingly inadequate for the current state of drug development [18]. As newer therapies achieve more substantial weight loss, the risk of disproportionately reducing muscle tissue rather than fat becomes a critical concern—one that existing standards do not sufficiently address [19]. Moreover, relying solely on body weight as the primary endpoint may obscure important efficacy signals, particularly in muscle-stimulating therapies. This highlights the urgent need to update the regulatory framework to include more nuanced measures that better reflect changes in fat mass and muscle mass, rather than focusing exclusively on overall weight loss.
Amidst the rapid innovation and significant advancements in anti-obesity treatments and therapeutic strategies, it has become increasingly clear that the current guidance may no longer fully address the complexities of modern obesity treatments [20]. Despite these evolving needs, there is no indication that a revised regulatory pathway is forthcoming, highlighting a critical gap in the current regulatory approach. Addressing this gap is essential to ensure that both the safety and efficacy of new treatments are accurately evaluated, ultimately supporting better health outcomes for patients.
Proposed Considerations for FDA Guidance
As the landscape of obesity treatment evolves, it is imperative for the FDA to consider incorporating body composition as a critical endpoint in the evaluation of weight management products. Specifically, the retention of skeletal muscle mass could be regarded as a primary efficacy endpoint in clinical trials. Advanced imaging technologies such as Dual-Energy X-ray Absorptiometry (DXA) and Magnetic Resonance Imaging (MRI) are available and could provide accurate assessments of changes in muscle mass and fat distribution [21]. By integrating these techniques, a more nuanced understanding of how new therapies affect body composition could be achieved.
In addition to the primary focus on weight loss, advancing body composition metrics as secondary endpoints would offer deeper insights into treatment effectiveness. Metrics such as visceral fat reduction and lean muscle conservation could provide a more comprehensive view of therapeutic outcomes [22]. Techniques like Bioelectrical Impedance Analysis (BIA) and 3D optical imaging, which are scalable for real-world clinical settings, might facilitate comprehensive patient monitoring and contribute to a more thorough evaluation of these outcomes [23].
Furthermore, other biomarkers, including circulating markers, could provide meaningful and relevant information about the physiological impacts of weight management therapies [24]. These biomarkers could complement body composition assessments by offering additional insights into metabolic changes and overall health status.
Current benchmarks that prioritize achieving a 5% reduction in body weight might also be expanded to reflect improvements in body composition. This could include maintaining or increasing muscle mass while reducing fat mass, particularly visceral fat, which is known to carry significant metabolic risks [25]. By considering these additional factors, efficacy benchmarks could be redefined to better align with modern understandings of health and obesity management.
Moreover, the development and approval of combination therapies that address both weight loss and muscle preservation should be encouraged. Updated guidance outlining clear pathways for the approval of such multi-modal treatments could foster innovation and lead to more comprehensive solutions for patients struggling with obesity [26], [27].
Leveraging the FDA Biomarker Qualification Program and Public-Private Partnerships for Advancing Body Composition Metrics
The FDA Biomarker Qualification Program plays a pivotal role in the development and validation of biomarkers that can be used as endpoints in drug development and regulatory decision-making. This program provides a formal process through which biomarkers can be evaluated and qualified for specific uses in clinical trials, including those that may serve as endpoints for drug registration [28]. The process involves rigorous scientific assessment, and once a biomarker is qualified, it can be used across multiple drug development programs, reducing redundancy and accelerating innovation [29].
Qualifying endpoints that reflect changes in body composition, such as skeletal muscle mass and visceral fat, is critical for the approval of weight management therapies. These endpoints provide a closer inspection of therapeutic effects, revealing nuances that simple reductions in body weight might obscure [30]. For instance, a therapy that effectively reduces adiposity while preserving or even increasing muscle mass might result in less impressive changes to overall body weight. In such cases, relying solely on body weight as a metric could lead to misinterpretation of the therapy’s efficacy, potentially undervaluing treatments that offer substantial health benefits by improving body composition [31]. Incorporating these qualified biomarkers into the regulatory framework ensures a more accurate assessment of new obesity treatments, focusing not only on weight reduction but also on the preservation and enhancement of muscle mass, which is crucial for overall health and the prevention of conditions like sarcopenia [32].
The Role of Public-Private Partnerships in Biomarker Qualification
Public-private partnerships (PPPs) offer an effective platform for advancing the development and qualification of biomarkers, including those relevant to chronic weight management, obesity, and body composition. These collaborations bring together diverse stakeholders from academia, industry, government agencies, and patient advocacy groups to work towards shared goals in advancing healthcare innovation [33].
One of the critical roles that PPPs can play is in facilitating collaborative research and data sharing. By pooling resources and data from multiple organizations, PPPs can significantly accelerate the validation of new biomarkers for skeletal muscle preservation and body composition. This collaborative approach enables large-scale clinical trials, meta-analyses, and the generation of real-world evidence, all aimed at demonstrating the clinical significance and utility of these biomarkers [34]. By focusing on detailed body composition metrics rather than just overall weight loss, these efforts ensure that the true health benefits of a therapy are recognized and not obscured by an unchanged or minimally changed body weight [35]. This nuanced understanding is essential for accurately evaluating the effectiveness of obesity treatments [36].
In addition to research and data sharing, PPPs play a vital role in engaging with regulatory bodies such as the FDA. Consortia formed within these partnerships can serve as a unified voice to advocate for the inclusion of new biomarkers and body composition metrics in regulatory guidance. By presenting comprehensive, high-quality evidence generated through collaboration, these groups can more effectively influence regulatory decision-making [37]. This engagement is crucial for ensuring that new biomarkers are recognized and accepted as valid endpoints in clinical trials [38].
Furthermore, PPPs are instrumental in the development and promotion of best practices and standards for the use of body composition metrics in clinical trials. Establishing standardized methods for measuring skeletal muscle mass, visceral fat, and other relevant endpoints is essential for ensuring consistency and reliability across studies [39]. These standards are crucial for the broad adoption of new biomarkers in both clinical and regulatory settings. By fostering uniformity in measurement and evaluation, PPPs contribute to a more nuanced and accurate assessment of therapeutic interventions, enabling a better understanding of their impact on patient health [40].
Public-private partnerships also play a key role in educating stakeholders—including clinicians, researchers, and policymakers—on the importance of body composition in obesity management. Outreach efforts by PPPs might include workshops, conferences, and publications that disseminate best practices and raise awareness about the need for regulatory reform [41]. Educating these groups is vital for fostering an environment where new biomarkers are understood, accepted, and effectively implemented in clinical practice. This educational component helps reduce the risk of misinterpreting therapeutic outcomes and supports the adoption of more comprehensive evaluation criteria in obesity treatment [42].
Through the collaboration and synergy provided by PPPs, the biomarker qualification process can be streamlined, leading to the establishment of more robust and clinically meaningful endpoints in obesity treatment. These efforts can ultimately result in the development of therapies that not only promote weight loss but also ensure the preservation or enhancement of muscle mass, thereby improving overall patient health outcomes [43]. By focusing on the quality of weight loss—rather than just the quantity—these innovations can better address the complexities of obesity management and enhance the precision of therapeutic evaluations [44].
The need to update the FDA’s guidance on weight management products is clear. Incorporating endpoints that assess skeletal muscle preservation and advanced body composition metrics will ensure that new therapies not only reduce weight but also improve overall health and quality of life for patients [45]. While a revised regulatory pathway is not known to be forthcoming, the evolving landscape of obesity treatment strongly suggests that such a revision is necessary [46].
To address this critical need, we call on industry stakeholders, healthcare professionals, and researchers to actively engage with the FDA and other regulatory bodies. By advocating for the integration of body composition metrics into clinical trial endpoints, we can collectively drive the evolution of obesity treatment standards [47]. Collaboration through public-private partnerships is essential to accelerate the development and validation of these biomarkers, ensuring that they are widely adopted and recognized in both clinical and regulatory settings [48].
Now is the time to push for these advancements. By working together, we can help shape a regulatory framework that supports the development of innovative, effective, and comprehensive obesity treatments—ultimately leading to better long-term metabolic health outcomes for millions of patients [49].
The author has no conflicts of interest to declare.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
