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Article History

Received: 27 March 2026

Accepted: 29 July 2026

First Online: 28 August 2026

Declarations

Conflict of Interest: Kazuo Fujihara has received funding and medical writing support from Tanabe Pharma Corporation; consulting fees from Tanabe Pharma Corporation, Chugai/Roche, Argenyx, and UCB; Payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing and educational events from Tanabe Pharma Corporation, Eisai, Biogen, Novartis, Chugai/Roche, Alexion, Sanofi, Teijin, Asahi Kasei Medical, and UCB; support for attending meetings and/or travel from Roche/Chugai, Novartis, and Asahi Kasei Medical; participation in a Data Safety Monitoring Board or Advisory Board for Tanabe Pharma Corporation, Biogen, Novartis, Chugai/Roche, Alexion, Sanofi, UCB, and Amgen; Paid or unpaid leadership or fiduciary role in board, society, committee or advocacy group including President Emeritus (unpaid) of the Pan-Asian Committee for Treatment and Research In Multiple Sclerosis (PACTRIMS), board member (unpaid) for Japan Multiple Sclerosis Society and European Charcot Foundation, and committee and board member (unpaid) on the executive committee of the International Medical and Scientific Board. Kazuo Fujihara is an Editorial Board member of Neurology and Therapy . Kazuo Fujihara was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Shinya Hirota, Hideaki Hida, Kyoko Kato, Muneyoshi Kudo, Satoshi Yuki, and Takashi Narisawa are employees of Tanabe Pharma Corporation.

Ethical Approval: This PMS has been mandated by the Ministry of Health, Labour and Welfare of Japan and is being conducted in compliance with the Good Post-marketing Study Practice (GPSP) ordinance and the principles of the Declaration of Helsinki (1964) and its later amendments. The study protocol was approved through pre-consultation with the Pharmaceuticals and Medical Devices Agency (PMDA), in accordance with the GPSP. Prior to enrolment, all patients were informed of the purpose and scope of the PMS by the physicians, and written consent for publication of de-identified data has been obtained.