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Article History

Received: 19 March 2026

Revised: 19 June 2026

Accepted: 22 June 2026

First Online: 10 July 2026

Declarations

Conflict of interest: MF: 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 Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi; speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA; participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, 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; LMEG: has received funding for travel to attend scientific events or speaker honoraria from Merck, Biogen Idec, Sanofi-Aventis, Teva Pharmaceutical Industries Ltd., Roche, Novartis, Bayer Schering Pharma, Alexion and Neuraxpharm; VBM: disclosed travel/meeting expenses from Novartis, Janssen, Roche and Merck and speaking honoraria from Merk, BMS, Biogen, Novartis, Roche and Almirall; AC: has served on advisory boards and/or received honoraria for speaking or consultation fees from Biogen, Merck-Serono, Novartis, Roche, Sanofi-Genzyme, BMS, Amgen, Almirall, Alexion; CC: in the last two years I received personal compensation for advisory board, speaking and travel grants from Biogen, Novartis, Merck Serono, BMS, Roche; RT: has served on advisory boards and/or received honoraria for speaking or consultation fees from Alexion, Almirall, Biogen, CSL behring, Janssen-Cilag, Merck-Serono, Novartis, Roche, Sanofi-Genzyme; GL: received research grants and honoraria as a speaker and member of advisory boards by: Alexion, Bristol, Bayer, Biogen Idec, Merck Serono, Novartis, Sanofi Genzyme, Almirall, Allergan, Merz, Ipsen, Roche; AR: received a grant for the organization of a scientific congress or speaker honoraria from Biogen Idec, Sanofi, Merck Serono, Bristol, and Roche; FM: received compensation for speaking activities, travel grant, and participation in advisory board from Biogen, Bristol-Myers Squibb, Novartis, Roche, Sanofi-Genzyme, and Merck-Serono; PV: has received speaker's honoraria and consulting fee, honoraria for advisory boards from Biogen Idec, Novartis, Merck Serono, Sanofi Genzyme, and TEVA; PP: has received speaker honoraria and consulting fees from Biogen, Merck Serono, Novartis, Roche, Sanofi Genzyme, and TEVA; GM: is an Advisory Board member of Biogen Idec, Sanofi Genzyme, Merck-Serono, Novartis, and TEVA, and received honoraria for speaking or consultation fees from Almirall, Bayer Schering, Biogen Idec, Merck Serono, Novartis, Sanofi-Genzyme, and TEVA. She is the principal investigator in clinical trials for Actelion, Biogen Idec, Merck Serono, Mitsubishi, Novartis, Roche, Sanofi-Genzyme, and TEVA; MV: Biogen, Sanofi, TEVA, Merck, Roche; SM: Consultation and speaking fees from Sanofi-Genzyme, Biogen-Idec, Merck Serono, Novartis, Celgene-Bristol-Myers Squibb Company, Teva; CZ: received compensation for speaking activities, and/or consulting services, from Alexion, Astrazeneca, Biogen, Bristol-Myers Squibb, Janssen, Merck, Novartis, Roche, Sanofi; LP: is the co‐owner and an employee of AdRes, which has received project funding from Biogen; DP, LS: are employees of and may hold stock in Biogen.

Ethical approval: The ethics committee of all the participating center approved the study (CET 144–2023 from the Comitato Etico Territoriale Lombardia 1). The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Informed consent: All participating patients gave their informed consent to participate in the study.