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Article History

Received: 3 September 2025

Accepted: 20 October 2025

First Online: 5 November 2025

Declarations

:

: Raed Alroughani received consulting fees for scientific advisory boards from Roche, Novartis, Sanofi, Biogen, AstraZeneca, and the healthcare business of Merck KGaA, Darmstadt, Germany; speaker honoraria from Roche, Novartis, Sanofi, AstraZeneca, the healthcare business of Merck KGaA, Darmstadt, Germany, and Lilly; and support for attending scientific meetings from Roche, the healthcare business of Merck KGaA, Darmstadt, Germany, Biogen, and AstraZeneca (no payment). Elisabeth G. Celius received lectures fees from the healthcare business of Merck KGaA, Darmstadt, Germany, Biogen, Sanofi, Novartis, Teva, Janssen-Cilag; and received consulting fees for advisory boards from the healthcare business of Merck KGaA, Darmstadt, Germany and Sanofi. Helen Gray is an employee of Merck Serono (Ireland) Ltd., Dublin, Ireland, an affiliate of Merck KGaA, Darmstadt, Germany. Elisabeth Kasilingam’s institution (European Multiple Sclerosis Platform) received consulting fees from Roche, the healthcare business of Merck KGaA, Darmstadt, Germany, and Sanofi; she is Vice President of the European Patients’ Forum ( ). Paola Kruger received fees for participation as a patient advisor from the healthcare business of Merck KGaA, Darmstadt, Germany; and received fees for attending MS21 steering committee meetings from the healthcare business of Merck KGaA, Darmstadt, Germany. Amanda Montague’s institution (Multiple Sclerosis Association of America) received grants and honorarium from Biogen, EMD Serono, Boston, MA, Sanofi, Genentech, TG Therapeutics, Bristol Myers Squibb, Mallinckrodt, and Novartis. Celia Oreja-Guevara received fees for speaking, consulting, and serving on advisory boards from Alexion, Amgen, Biogen IDEC, Bristol Myers Squibb, Horizon, Janssen, the healthcare business of Merck KGaA, Darmstadt, Germany, Novartis, Roche, Sanofi Genzyme, Sandoz, Viatris, Neuraxpharm, and Teva. Amber Plant is an employee of Shift.ms. Maija Pontaga holds a role in the Latvian Multiple Sclerosis Association. Peter Rieckmann received fees for lectures from the healthcare business of Merck KGaA, Darmstadt, Germany and Sanofi. Leslie Ritter is a member of the American Brain Coalition Board and is the Vice President of the National MS Society, Healthcare Access. Marja-Liisa Sumelahti received consulting fees and honoraria from the healthcare business of Merck KGaA, Darmstadt, Germany, Organon, Teva, AbbVie, Gedeon Richter, Lundbeck, and Pfizer; support for meetings from the healthcare business of Merck KGaA, Darmstadt, Germany, Organon, Teva, AbbVie, Lundbeck, and Pfizer; and has participated in advisory boards for Teva, AbbVie, Lundbeck, and Pfizer.

: This study was reviewed by an independent institutional review board, WCG, and determined to be exempt from full review. All voting was conducted anonymously. The manuscript does not contain clinical studies or patient data.