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Article History

Received: 16 December 2025

Accepted: 24 April 2026

First Online: 30 May 2026

Declarations

:

: Enrique Alvarez has received compensation for activities such as advisory boards, lectures, and consultancy from Alexion, Biogen, Celgene/Bristol Myers Squibb, Cionic, EMD Serono/Merck, Genentech, Inc./F. Hoffmann-La Roche Ltd, Horizon, Novartis, Sanofi, and TG Therapeutics and research support from Biogen, Genentech, Inc./F. Hoffmann-La Roche Ltd, Novartis, National Institutes of Health, National Multiple Sclerosis Society, Patient-Centered Outcomes Research Institute, Rocky Mountain MS Center, and TG Therapeutics. Le H. Hua has received personal compensation for speaking, consulting, and/or advisory board activities from Alexion, Bristol Myers Squibb, EMD Serono, Genentech, Inc., Genzyme, Horizon, Novartis, and TG Therapeutics, and has received research support paid to their institution from Genentech, Inc. Robert T. Naismith has consulted for Alexion, Biogen, Bristol Myers Squibb, Celltrion, EMD Serono, Genentech, Inc., Genzyme, Horizon, Novartis, and TG Therapeutics. Elmor D. Pineda is an employee of Genentech, Inc., and shareholder of F. Hoffmann-La Roche Ltd. Hela Romdhani, Annie Guérin and Mohira Lévesque-Leroux are employees of Analysis Group, ULC, a consulting company that received funding from Genentech, Inc. Gayatri Marathe was an employee of the Analysis Group, ULC, at the time of the study and is currently an employee of Alexion Pharmaceuticals, Inc. Kunio Nakamura received research support from Biogen, Bristol Myers Squibb, National Multiple Sclerosis Society, Patient-Centered Outcomes Research Institute, Synaptogenix, US Department of Defense, and US National Institutes of Health. Daniel Ontaneda received research support from Bristol Myers Squibb, Genentech, Inc., Genzyme, National Institutes of Health, National Multiple Sclerosis Society, Novartis, Patient-Centered Outcomes Research Institute, and Race to Erase MS Foundation, and consulting fees from Biogen, Bristol Myers Squibb, Genentech, Inc./F. Hoffmann-La Roche Ltd, Genzyme, Novartis, Pipeline Therapeutics, Convelo, and Sanofi.

: Anonymized patient data were collected from participating clinical sites following institutional review board approval at each site and in accordance with the Helsinki Declaration of 1964 and its later amendments. The study was approved by the Cleveland Clinic Institutional Review Board (23-1329), the Colorado Multiple Institutional Review Board (23-0339), and the Washington University in St. Louis Institutional Review Board (202308182). The study was determined to be minimal risk as a result of using secondary data/data collected for routine clinical practice; therefore, informed consent and HIPAA authorization were waived.