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Article History

Received: 23 March 2026

Revised: 5 June 2026

Accepted: 27 June 2026

First Online: 10 July 2026

Declarations

Conflicts of interest: Hernan Inojosa received speaker honoraria from Roche and Novartis, and financial support for research activities from Merck, Neuraxpharm, Novartis, Teva, Biogen, and Alexion. Lars Masanneck reports no conflicts of interest related to this study. He has received honoraria for lecturing, consulting, and travel expenses for attending meetings from Biogen, Merck, Sanofi, argenX, Neuraxpharm, Bial, Roche, Alexion, and Novartis, all outside the scope of this work. His research is funded by the German Multiple Sclerosis Foundation (DMSG), the B.Braun Foundation and the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)—493659010. Katja Akgün received personal compensation from Novartis, Biogen Idec, Teva, Sanofi, and Roche for consulting services. LW and RH have nothing to declare. Ramona Hagler reports no disclosures. Sven G. Meuth reports Honoraria/travel support from Academy2, Argenx, AstraZeneca, Bayer, Biontech, Celgene, Datamed, Desitin, Diaplan, DIU, Dpmed, Gen Medicine & Healthcare, IGES, Impulze GmbH, KW Medipoint, MedDay, Medmile, MICE, Mylan, Neuraxpharm, Neurapharm, Oxford PharmaGenesis, QuintilesIMS, Sanofi, Springer, STADA, Chugai, UCB, Viatris, Wings for Life int, and Xcenda. Research support from BMBF, BfR, DFG, EKFS, G-BA, Hertie Fdn, IZKF, DGN, Ministry of Culture & Science NRW, Daimler & Benz Fdn, dmsg, Peek & Cloppenburg Fdn, Hempel Fdn, German Alzheimer Society, Bayer, BMS, Demecan, Diamed, Genzyme, Hexal, Janssen, MerckSerono, Novartis, NovoNordisk, ONO Pharma, Roche, and Teva. Carolin Otto is the Principal Investigator of the CRC NeuroMac funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) – Project-ID 259373024 – TRR 167. Patrick Schindler received speaker’s honoraria, travel support and/or served on advisory boards by Alexion, Roche, and UCB. Karin Schulze-Bosse no disclosures. Jens Kuhle received speaker fees, research support, travel support, and/or served on advisory boards by Swiss MS Society, Swiss National Research Foundation (320030_212534/1), University of Basel, Progressive MS Alliance, Alnylam, Argenx, Bayer, Biogen, Bristol Myers Squibb, Celgene, Immunic, Merck, Neurogenesis, Novartis, Octave Bioscience, Quanterix, Roche, Sanofi, Stata DX. Pascal Benkert: no disclosures. Klemens Ruprecht has received research support from the European Union (821283-2), Stiftung Charité, Guthy-Jackson Charitable Foundation, and Arthur Arnstein Foundation; and received speaker’s honoraria from Virion Serion and Novartis. Marc Pawlitzki received honoraria for lecturing and travel expenses for attending meetings from Alexion, ArgenX, Bayer Health Care, Biogen, Hexal, Merck Serono, Novartis, Roche, Sanofi-Aventis, Takeda and Teva. His research is funded by ArgenX, Biogen, Demecan, Hexal, Horizon Merck Serono, Novartis, Roche, Viatris, Takeda and Teva, all outside the scope of this work. His research is funded by the German Multiple Sclerosis Foundation (DMSG), the B. Braun Foundation and the German Alzheimer Society. Tjalf Ziemssen reports personal fees from Biogen, BMS, Merck, Neuraxpharm, Novartis, Novo Nordisk, Roche, Sanofi, Sandoz, Teva, and Viatris; and research support from Genzyme, Neuraxpharm, Novartis, Roche, Sanofi, and Teva.

Ethics statement: Participants were drawn from three independent cohorts: the Düsseldorf cohort, the Dresden cohort, and the CONTACT study cohort. All cohorts received ethical approval from the respective ethics committees (University Hospital Duesseldorf (2021-1475, 5951R, and 2024-2817) and Review Board of the University Hospital of Dresden (EK331112009, EK3480920149) in accordance with the ethical principles set forth in the Helsinki Declaration of 1975, as revised in 1983, and the guidelines on good pharmacovigilance practices.