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Article History

Received: 12 February 2026

Revised: 10 April 2026

Accepted: 13 April 2026

First Online: 4 May 2026

Declarations

:

: Massimo Filippi received research grants from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla (funds paid to the institution); consulting fees from Almirall, Biogen, Bristol-Myers Squibb, Eli Lilly, Merck, Novartis, Roche, Sanofi; speaking activities from Amgen, Bayer, Biogen, Bristol-Myers Squibb, Celgene, Chiesi Italia SpA, Eisai, Eli Lilly, Fujirebio, Genzyme, Janssen, Merck, Neopharmed Gentili, Neuraxpharm, Novartis, Novo Nordisk, Roche, Sanofi, Takeda; participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Eli Lilly, GE Healthcare Ltd, Merck, Neuraxpharm, Novartis, Roche, Sandoz, Sanofi, Takeda; scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi-Genzyme; he is Editor-in-Chief of the Journal of Neurology and Associate Editor of Human Brain Mapping, Neurological Sciences, and Radiology. Vincenzo Brescia Morra received grants to his institution (AOU Federico II) and honoraria from Novartis, Roche, Biogen, Teva, Almirall, Sanofi-Genzyme, Merck, Bayer, Mylan, and Bristol-Myers Squibb. Massimiliano Mirabella received speaking fees from Novartis, Roche, Sanofi-Genzyme, Janssen, Viatris, Alexion, and Amgen. Antonella Conte received honoraria for speaking or consultation fees from Almirall, Biogen Idec, Bristol-Myers Squibb, Merck Serono, Novartis, Sanofi-Genzyme, Roche, Alexion, and Neuraxpharma. Valentina Tomassini received consulting fees, honoraria or lecture fees, and support for attending meetings or travel from Roche, Novartis, Sanofi, Merck, Viatris, Almirall, Amgen, Alexion, Horizon, Bristol-Myers Squibb, Janssen, Biogen, Juvisè, and Lundbeck. Cinzia Masini, Valeria Perosino, and Paola Tortorella are employed by Roche SpA and may own stock or stock options. Maria Assunta Rocca received research grants from the MS Society of Canada, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla; consulting fees from Biogen, Bristol-Myers Squibb, and Roche; and speaker honoraria from Alexion, Biogen, Bristol-Myers Squibb, Celgene, Horizon Therapeutics Italy, Merck Serono SpA, Mitsubishi-Tanabe Pharma, Neuraxpharm, Novartis, Roche, Sandoz, and Sanofi; she is Associate Editor of Multiple Sclerosis and Related Disorders and Associate Co-Editor for Europe and Africa of Multiple Sclerosis Journal. Emanuele D’Amico, Chiara Zanetta, Aurora Zanghì, Paola Sofia Di Filippo, Elena Longobardi, and Elena Colombo declare no conflicts of interest.

: This study was conducted in compliance with the Declaration of Helsinki, GCP standards, International Council for Harmonisation (ICH) guidelines, and national regulations. Ethics approval (protocol ID: ML44477) was granted on 31 May 2023 from the Territorial Ethics Committee – South West Veneto (Comitato Etico Territoriale Area Sud Ovest Veneto). All participants provided informed consent.