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Article History

Received: 15 January 2026

Revised: 2 March 2026

Accepted: 4 March 2026

First Online: 23 March 2026

Declarations

:

: WZY was supported by an ECTRIMS Research Fellowship and the Robert and Elizabeth Albert Travel Grant from the RACP Foundation, Mr Robert O. Albert AO and Mrs Elizabeth Albert; is currently supported by an MS Australia Postdoctoral Fellowship; and has received travel support from Biogen, UCB and the Guthy-Jackson Charitable Foundation outside of the submitted work. AF received a travel grant from Alexion in 2023. HB’s institution (Monash University) received compensation for consulting, talks, and advisory/steering board activities from Alfred Health, Biogen, Genzyme, Merck, Novartis; research support from Biogen, Merck, Multiple Sclerosis Australia, National Health and Medical Research (Australia), Novartis, the Oxford Health Policy Forum, the Pennycook Foundation, Roche. RG has received support for scientific meetings and courses and honoraria for advisory work from Bayer, Biogen, Merck, Novartis, Jasen, MIAC, and UCB. MIL is funded by the NHS (Myasthenia and Related Disorders Service and National Specialised Commissioning Group for Neuromyelitis Optica, UK) and by the University of Oxford, UK. She has been awarded research grants from UK associations for patients with myasthenia and with muscular disorders (Myaware and Muscular Dystrophy UK, respectively) and the University of Oxford. She has received speaker honoraria or travel grants from Biogen, Novartis, UCB Pharma and the Guthy-Jackson Charitable Foundation. She serves on scientific or educational advisory boards for Argenx, UCB Pharma and Viela Bio/Horizon Therapeutics/Amgen. JP has received support for scientific meetings and honorariums for advisory work From Merck Serono, Novartis, Chugai, Alexion, Roche, Medimmune, Amgen, Vitaccess, UCB, Mitsubishi, Amplo, Janssen; Grants from Alexion, Argenx, Clene, Roche, Medimmune, Amplo biotechnology; Patent ref P37347WO and license agreement Numares multimarker MS diagnostics Shares in AstraZenica. She acknowledges partial funding to the trust by highly specialized services NHS England.

: This study was approved by the Oxford C Research Ethics Committee, reference 21/SC/0353, in accordance with local guidelines and regulations. Written informed consent was obtained from included participants.

: Informed consent was obtained from all individual participants included in the study.