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Article History

Received: 28 January 2026

Revised: 7 May 2026

Accepted: 12 May 2026

First Online: 23 May 2026

Declarations

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: The authors of this manuscript declare relationships with the following companies: M. Rubin has nothing to disclose. P. Preziosa received speaker honoraria from Roche, Biogen, Novartis, Merck, Bristol Myers Squibb, Genzyme, Horizon and Sanofi; he has received research support from the Italian Ministry of Health and Fondazione Italiana Sclerosi Multipla; E. Pagani has nothing to disclose. M. Margoni reports grants and personal fees from Sanofi Genzyme, Merck Serono, Roche, Biogen, Amgen and Novartis. L. Storelli received speakers’ honoraria from Biogen. E. Pagani has nothing to disclose. P. Valsasina has nothing to disclose. M. Albergoni has nothing to disclose. L. Moiola received speaker honoraria from Roche. M. Filippi is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Neurological Sciences, and Radiology; received compensation for consulting services 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 receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla. M.A. Rocca received consulting fees from Biogen, Bristol Myers Squibb, 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 receives research support from the MS Society of Canada, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla. She is Associate Editor for Multiple Sclerosis and Related Disorders, and Associate Co-Editor for Europe and Africa for Multiple Sclerosis Journal.

: This retrospective cross-sectional study involved human participants and was approved by the local ethics committee on human experimentation of IRCCS Ospedale San Raffaele (protocol no 32–2016). All participants provided informed consent prior to inclusion, in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.