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Article History

Received: 2 July 2025

Revised: 25 November 2025

Accepted: 2 December 2025

First Online: 6 January 2026

Declarations

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: The authors have no competing interests to declare that are relevant to the content of this article. RR reports funding by Novartis unrelated to this project. SA has received speaker’s honoraria from Amgen, Alexion, Roche Pharma AG, and Bayer AG. She has received research grants from Novartis, Roche, Berlin Institute of Health and Charité Universitätsmedizin Berlin. PS received speaker’s honoraria by Roche, received speaker’s honoraria and travel support by UCB, and received speaker’s honoraria and served on an advisory board by Alexion. CC has received research support from Novartis and Alexion, AstraZeneca Rare Disease, is a Standing Committee on Science Member for the Canadian Institutes of Health Research and is a part of a consortium funded by the U.S. Department of Defense; unrelated to this study. SR reported grants from the German Ministry of Education and Research. CF reports no conflicts of interests. FCO reports current research grants by the Hertie foundation, German ME/CFS foundation, Novartis and UCB—not related to this project. Past fellowship support by the American Academy of Neurology and the National MS Society (until 2023). Past research grant by the DGN (Germany Neurology Association) and DFG-TWAS program. Speaker honoraria by UCB and Novartis. Travel support by Guthy Jackson Charitable Foundation, European Committee for Research and Treatment in Multiple Sclerosis and American Academy of Neurology. Academic editor at DGNeurologie and Neurological Research & Practice. Board member at the IMSVISUAL consortium. KR received research support from Novartis, Merck Serono, German Ministry of Education and Research, European Union (821283-2), Stiftung Charité, Guthy-Jackson Charitable Foundation, and Arthur Arnstein Foundation; received speaker’s honoraria from Virion Serion and Novartis. SJ reports no conflicts of interest. BW reported grants from the Deutsche Forschungsgemeinschaft (DFG), German Ministry of Education and Research, Baden-Württemberg Ministry for Science, Research and Art, Dietmar Hopp Foundation, Klaus Tschira Foundation, grants and personal fees from Merck, Novartis, and personal fees from Alexion, INSTAND, Roche; none related to this study. MR reports no conflict of interests. KS reports no conflict of interests. VC reports no conflicts of interests. TSH received research support by Celgene/bms and speaker’s honoraria by Bayer. FP received research support from Neurosciences Clinical Research Center, German Ministry for Education and Research (BMBF), Deutsche Forschungsgemeinschaft (DFG), Einstein Foundation, Guthy Jackson Charitable Foundation, EU FP7 Framework Program, Biogen, Genzyme, Merck Serono, Novartis, Bayer, Roche, Parexel and Almirall; honoraria for lectures, presentations and speaker honoraria from Guthy Jackson Foundation, Bayer, Biogen, Merck Serono, Sanofi Genzyme, Novartis, Viela Bio, Roche, UCB, Mitsubishi Tanabe and Celgene; received compensation for serving on a scientific advisory board of Celgene, Roche, UCB and Merck; and is an Academic Editor of PLos One and Associate Editor of Neurology® Neuroimmunology & Neuroinflammation; all unrelated to the presented work. PSS reports no conflicts of interests.

: All participants gave written informed consent prior to participation in the NMO cohort study. The cohort was approved by the local ethics committee (EA1/041/14) and was conducted in line with guidelines framed by the declaration of Helsinki.