AUCTORES
Globalize your Research
Mini Review
*Corresponding Author: Nasser Mikhail, Endocrinology Division, Department of Medicine, Olive View-UCLA Medical Center, David-Geffen UCLA Medical School, CA, USA.
Citation: Nasser Mikhail. (2021) Once weekly semaglutide for treatment of obesity. Journal of Clinical and Laboratory Research. 2(3) DOI: 10.31579/2768-0487/015
Copyright: © 2021 Nasser Mikhail. 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: 23 March 2021 | Accepted: 07 April 2021 | Published: 09 April 2021
Keywords: obesity; semaglutide; glucagon-like polypeptide 1; safety, weight loss
Background: Once weekly (OW) semaglutide 0.5-1.0 mg is a glucagon-like type-1 receptor agonist (GLR-1 RA) approved for treatment of type 2 diabetes and is currently under evaluation for treatment of obesity at a higher dose of 2.4 mg OW.
Objective: to provide an appraisal of WO semaglutide 2.4 mg for treatment of obesity.
Methods: Pubmed research up to March 22. Randomized trials, pertinent animal studies, and reviews are included. Search terms were glucagon-like type 1 receptor agonists, weight loss, obesity, semaglutide, safety, efficacy.
Results: WO semaglutide 2.4 mg was evaluated as a weight loss agent in 3 well-designed clinical trials of 68 week-duration. In one trial including patients with type 2 diabetes, the difference in weight loss from baseline to week 68 between OW semaglutide and placebo was - 6.2 percentage points (95% CI, -7.3 to -5.2; P<0.0001). In the other 2 studies that excluded patients with diabetes, the difference in weight loss between OW semaglutide and placebo ranged between -10.3% and -12.4%. A significantly higher proportion of participants in the semaglutide groups vs placebo groups achieved at least 5% of weight loss. The most common adverse effects of semaglutide were related to the gastrointestinal (GI) system. Across these 3 trials, premature discontinuation of OW semaglutide occurred in 6-7% vs 3% in placebo groups.
Conclusions: OW semaglutide may be a promising agent for treatment of obesity irrespective of presence of type 2 diabetes. Further studies are needed to establish its long-term safety and efficacy.
GLP-1 RAs are approved for treatment of type 2 diabetes. The drug profile of these drugs is characterized by mild dose-related weight loss of approximately 2-6 kg [1]. Currently, liraglutide is the only GLP-1 RA approved for treatment of obesity in a dose higher than that approved for type 2 diabetes (3 mg daily for treatment of obesity as opposed to maximum dose of 1.8 mg/d in type 2 diabetes) [2]. Semaglutide is a long-acting GLP-1 RA that can be administered once weekly in a dose of 0.5-1.0 mg for treatment of type 2 diabetes [3]. Since the magnitude of weight loss increases with the dose of GLP-1 RA, semaglutide is being evaluated as weight-loss agent at a higher weekly dose of 2.4 mg [4-7]. The Semaglutide Treatment Effect in People with obesity (STEP) development program includes 5 phase 3 clinical trials (STEP 1 to 5) to evaluate efficacy and safety of OW semaglutide at this high dose of 2.4 mg for treatment of obesity in patients with and without diabetes [4]. Three trials of the STEP program have been published [5-7]. The purpose of this article is to provide an appraisal of OW semaglutide for treatment of obesity, with special emphasis on its efficacy and safety in this setting.
Rationale for evaluation of semaglutide as treatment of obesity
Data from trials of patients with type 2 diabetes suggest that OW 1.0 mg semaglutide is superior to other GLP-1 RAs such OW exenatide ER 2 mg, OW dulaglutide 1.5 mg, and daily liraglutide 1.2 mg in terms of reduction of weight and hemogolobin A1c (HbA1c) levels [1,8,9]. In addition, a meta-analysis of indirect comparison between semaglutide and the sodium-glucose transporter 2 inhibitor empagliflozin has shown that OW 1.0 mg semaglutide was more effective than empagliflozin 25 mg/d in reducing weight (estimated treatment difference -1.65 kg, 95% CI, -2.22 to -1.08, P<0.0001) [10]. Furthermore, OW 1.0 mg semaglutide has been shown to decrease cardiovascular (CV) events in patients with type 2 diabetes who were at high cardiovascular risk [11]. Therefore, the STEP program was launched to evaluate the weight-loss effects of WO semaglutide 2.4 mg. This program consists of 5 trials, three of them were published [4-7].
Mechanisms of weight loss by semaglutide
In a randomized, double-blind trial including 72 obese subjects (mean weight 105.5kg), OW semaglutide was associated with 35% ad libitum energy intake compared with placebo after 20 weeks [12]. In addition, semaglutide significantly reduced hunger and food craving, and increased satiety and fullness versus placebo [12]. Importantly, gastric emptying, evaluated indirectly via paracetamol absorption, was not delayed in the semaglutide group after controlling for difference in weight between the semaglutide group and placebo group [12]. Animal studies have shown that the anorexigenic of semaglutide is mediated by GLP-1 receptors in the hypothalamus and hind brain [13,14].
STEP program
STEP 1 to 3 trials are generally well-designed studies comparing OW 2.4 mg semaglutide with placebo in obese individuals (defined as BMI of ≥ 30 kg/m2, over ≥ 27 kg/m2 with ≥ 1 weight-related coexisting condition e.g. hypertension, dyslipidemia, cardiovascular disease, or obstructive sleep apnea) for 68 week-duration [5-7]. Overview of STEP trials was summarized in table 1, Trials STEP 1 and 3 excluded patients with diabetes, whereas STEP 2 included exclusively patients with type 2 diabetes. In addition, STEP 2 included a third group of individuals randomized to the smaller anti-diabetic dose of semaglutide (OW 1.0 mg) [6]. In STEP 1 and 2, all participants receive lifestyle intervention defined as a 500 kcal deficit relative to the estimated energy expenditure plus encouragement of increase physical activity, such as walking 150 minutes per week. In STEP 3 trial, all subjects received a low-calorie diet (1000-1200 kcal/d) provided as meal replacement for the first 8 weeks. Subsequently, they were transitioned to a low-calorie diet (1200-1800 kcal/d) of conventional food. Moreover, they were prescribed 200 min of physical activity/week [7]. The coprimary endpoints of STEP 1 to 3 trials were the percentage change in body weight and weight reduction of at least 5% at week 68 compared with placebo [5-7].
Weight loss in STEP 1-3 trials
Weight loss started in the first few weeks after starting semaglutide and reached a nadir after 52-60 weeks [5-7]. In all STEP trials, semaglutide was significantly superior to placebo in the magnitude of weight loss. Thus, in STEP 1-3, semaglutide-treated subjects lost 6.2 to 10.3 percentage points greater than placebo after 68 weeks [5-7]. In STEP 2 that exclusively included patients with type 2 diabetes, the difference in weight loss vs placebo was relatively small (6.2 percentage point) [6]. The explanation of this finding is unclear but might be related to the coexistence of type 2 diabetes, relatively older patient population (mean age 55 in STEP 2 versus 46 year-old in STEP 1 and 3), or the lower baseline body weight (99.8 kg in STEP 2 versus approximately 105.5 kg in STEP 1 and 3). Across the STEP 1-3 trials, percentage of subjects who achieved ≥ 5% weight loss at 68 weeks was significantly greater with semaglutide than with placebo, 69-86% and 28-48%, respectively (Table 1) [5-7]. A subgroup analysis (n=140) in STEP 1 trial using dual-energy x ray absorptiometry (DXA) has shown that semaglutide administration was associated with reduction in total fat and regional visceral fat mass and to a lesser extent reduction in lean body mass [5].
Glycemic effects of OW semaglutide in STEP trials
In STEP 2 trial, mean HbA1c reductions were -1.6%, -1.5%, and -0.4% in the OW semaglutide 2.4 mg, OW semaglutide 1.0 mg, and placebo groups, respectively [6]. HbA1c levels were also reduced by approximately 0.2 to 0.3 percentage points in patients without diabetes in STEP 1 and 3 trials [5, 7]. Moreover, in STEP 1, 84.1 % of participants who had prediabetes at baseline reverted to normoglycemia at 68 weeks. Corresponding proportion was 47.8% in the placebo group [5].
Effects of OW semaglutide on cardiovascular risk factors in STEP trials
Significant reduction in systolic blood pressure (SBP) was recorded in subjects randomized to semaglutide in STEP1-3 trials, approximately 4-5 mmHg lower than in individuals randomized to placebo [5-7]. Likewise, a significant reduction in DBP of approximately 2 mmHg was observed in STEP 1 and 3 trials [5, 7]. Changes in lipid panel were generally mild. Thus, reduction in plasma triglycerides of 14-17% compared to placebo was the most consistent change in lipid panel. Minor reductions in concentrations of low-density lipoprotein-cholesterol (LDL-C) (by ≤7% vs placebo) and increase in high-density lipoprotein-cholesterol (HDL-C) levels (by <5% vs placebo) were also observed. In addition, there was significant reduction in the inflammatory marker C-reactive protein (CRP) levels in semaglutide-treated subjects vs placebo [5-7]. The above favorable changes in blood pressure, lipids and CRP are likely attributed to weight loss per se and are unlikely to be direct effects of semaglutide.
Effects of semaglutide on physical functioning and quality of life
Greater improvements in physical functioning scores and quality of life were seen with semaglutide than with placebo [5, 6].
Safety of once weekly semaglutide 2.4 mg
Overall, OW semaglutide 2.4 mg was fairly tolerated. This conclusion is based on the proportions of subjects who discontinued trial drug prematurely due to adverse effects, 5.9-7% in semaglutide groups versus 2.9-3.5% in the placebo groups across STEP 1 to 3 trials [5-7]. It was somewhat reassuring that over 68 weeks of semaglutide therapy, no signals of increased incidence of cancer or pancreatitis were observed.
Gastrointestinal adverse effects
In STEP 1-3, GI adverse effects were the most common events reported by approximately 63-83% and 34-63% in subjects randomized to OW semaglutide and placebo, respectively [5-7]. Among the GI adverse effects, nausea was the most frequent, followed by diarrhea, vomiting and constipation. The frequency of GI symptoms increased early in the first few weeks during drug titration. They were generally described as mild to moderate and transient. However, they were severe in a minority of patients> in fact GI adverse effects were the most frequent cause of premature drug withdrawal. Thus, drug discontinuation due to GI adverse effects occurred in 3.4-4.5% and 0-1.0% in patients randomized to OW semaglutide and placebo, respectively [5-7].
Previous trials in type 2 diabetes using OW 1.0 mg semaglutide have shown that GI adverse effects tend to be more common with semaglutide compared with other GLP-1 agonits [15]. Meanwhile, post-hoc analysis by Lingway et al [15] suggest that GI adverse effects contribute minimally (less than 0.1 kg) to the superior weight loss effects of semaglutide vs other GLP-1RA agonists. Incidence of cholelithiasis and cholecystitis was slightly higher in STEP 1 and 3 trials (2.5-2.6% with semaglutide versus 0-1.2% with placebo) [5, 7]. These events are attributed in part due to weight loss, but other mechanisms could be involved such as inhibition of gallbladder contraction and biliary motility [16].
Diabetic retinal disorders
Worsening diabetic retinopathy was observed previously in association with use of OW semaglutide 0.5-1.0 mg [11]. In STEP 2, there was a trend towards increase in incidence of retinal disorder events in the 2 semaglutide arms compared with the placebo arm [6]. Thus, these events occurred in 6.9%, 6.2%, and 4.2% in patients randomized to OW semaglutide 2.4 mg, OW semaglutiude 1.0 mg, and placebo, respectively (statistical significance level was not reported). No doubt, this safety issue requires further studies.
Hypoglycemia
In STEP 2 trial, severe or blood-glucose confirmed symptomatic hypoglycemia occurred in 5.7% and 3.0% of patients receiving OW semaglutide 2.4 mg and placebo, respectively [6]. Interestingly, in patients without diabetes, frequency of hypoglycemia with OW semaglutide was low (0.5-0.6%) and similar to placebo (0-0.8%) [5-7].
Advantages and limitations of semaglutide
OW semaglutide 2.4 mg offers several advantages as potential drug for treatment of obesity. First, its short-term efficacy and safety are supported by 3 well-designed randomized trials [5-7]. Second, being an anti-diabetic drug, it may be particularly useful in obesity-related type 2 diabetes by causing reduction of both weight and hyperglycemia [6]. Third, the OW administration of semaglutide may enhance prolonged drug adherence. Meanwhile, OW semaglutide has several limitations. First, the common occurrence of GI adverse effects represents one of the most important limitations of OW semaglutide. Second, the duration of therapy in clinical trials was short (68 weeks) [5-7]. Thus, the durability of its weight loss effect is still unknown. In fact, in the full-analysis set of STEP1-3 trials, the maximum weight loss was achieved after 52 weeks followed by a slight rebound [5-7]. Therefore, it is unclear to what extent weight regain may occur after stopping the drug. Indeed, in the STEP1-3 trials, follow-up extended for 7 weeks after trial end to evaluate short-term safety. Unfortunately, the investigators did not report any weight data at this time period after the end of drug admnistration. Nevertheless, the ongoing STEP 4 will address this issue as it includes a group of subjects who switch from semaglutide to placebo [4]. Third, long-term safety of OW semaglutide for several years is unknown. The ongoing STEP 5 may in part clarify this problem as it extends over a 2-year period [4]. Fourth, drug cost is virtually another limitation. Advantages and limitations of OW semaglutide are summarized in table 1.
Overall, once weekly semaglutide 2.4 mg added to healthy life-style changes represents a promising new drug for treatment of obesity given its acceptable short-term efficacy and safety. Longer term trials are underway to evaluate the durability of its weight loss action and long-term safety. The incidence of cancer and possible worsening of diabetic retinopathy should be carefully examined during the studies underway. In addition, the impact of OW semaglutide on CV events and mortality is unknown, In this regard, the SELECT study is an ongoing, double-blind placebo-controlled trial specifically designed to examine the effect of OW semaglutide 2.4 mg on CV outcomes in overweight and obese persons with established CV disease who do not have diabetes [. This SELECT study started in November 2018 and is expected to recruit 17,500 participants, and last for approximately a total of 59 months. Data derived from this large trial should further clarify the safety profile of OW semaglutide.
The author does not have any conflict of interest to declare.
Abbreviations
W: women, BMI: body mass index, S: semaglutide, OW: once weekly, PL: placebo, HbA1c: hemoglobin A1c, CI, confidence intervals
Table 1: Advantages and limitations of once weekly 2.4 mg semaglutide for treatment of obesity
Advantages
Acceptable weight loss efficacy
Amelioration of HbA1c levels in patients with type 2 diabetes
Easy administration once weekly
Limitations
Common occurrence of gastrointestinal adverse effects
Lack of long-term efficacy and safety data
Expected high cost
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!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. 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.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
