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Article History

Received: 8 September 2025

Revised: 16 January 2026

Accepted: 21 January 2026

First Online: 9 February 2026

Declarations

:

: Dr. Freedman has received a speaker honorarium from Novartis. Dr. Oh has received grants from Biogen-Idec, Roche, and EMD-Serono; consulting fees from Biogen-Idec, EMD-Serono, BMS, Novartis, Eli-Lilly, Sanofi, and Roche; payment or honoraria from EMD-Serono, Biogen-Idec, Novartis, Roche, and Sanofi; participation on a Data Safety Monitoring or Advisory Board for Biogen-Idec, EMD-Serono, Roche, Novartis, and Sanofi; and leadership or fiduciary role as Chair of the Medical Advisory Committee for the MS Society of Canada during the conduct of this study. Dr. Feinstein has received grants from MS Canada, CIHR, and Bristol Myers Squibb; royalties from Johns Hopkins University Press and Cambridge University Press; and honoraria from Novartis, Roche, and Merck.

: This retrospective chart review study involving human participants was performed in line with the principles of the Declaration of Helsinki. The study was approved by the Research Ethics Board at Sunnybrook Health Sciences Centre, affiliated to the University of Toronto (Date: December 30, 2021/No. 5263).

: Data were collected as part of a retrospective chart review, and a waiver of consent was obtained as part of the research ethics board approval process.