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Article History

First Online: 9 January 2020

Compliance with Ethical Standards

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: Natalie Schwehr, Karen Kuntz, Eva Enns, Nathan Shippee, Elaine Kingwell, Helen Tremlett, Adam Carpenter, and Mary Butler have no conflicts of interest that are directly relevant to the contents of this article. Eva Enns has received consulting fees from ViiV Healthcare for work unrelated to this manuscript. Helen Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis. Current research support was received from the National Multiple Sclerosis Society, the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada, and the Multiple Sclerosis Scientific Research Foundation. In addition, in the last 5 years, she has received research support from the Multiple Sclerosis Society of Canada (Don Paty Career Development Award); the Michael Smith Foundation for Health Research (Scholar Award), and the UK MS Trust; speaker honoraria and/or travel expenses to attend continuing medical education (CME) conferences from the Consortium of MS Centers (2013, 2018), the National MS Society (2014, 2016, 2018), European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) (2013, 2014, 2015, 2016, 2017, 2018, 2019), Biogen Idec (2014), and American Academy of Neurology (2013, 2014, 2015, 2016, 2019). All speaker honoraria are either declined or donated to an MS charity or to an unrestricted grant for use by Helen Tremlett’s research group. Adam Carpenter has received research funding for participation in clinical trials involving medications (interferon-β, natalizumab) discussed in this manuscript.

: Natalie Schwehr received funding that partially supported this project, i.e. a Thesis Research Travel Grant from the University of Minnesota and 3 months of support as an Advanced Research Program Scholar under the University of Minnesota’s NIH Clinical and Translational Science Award (UL1TR002494). The funding sources played no role in the design, methods, data, or interpretation of the results of the study.

: Ethical approval was gained from the University of Minnesota Institutional Review Board and the UBC Clinical Research Ethics Board.

: Simulation model parameters were derived from analyses of a patient cohort (access to these data are restricted to on-site in Vancouver, BC, Canada) and published literature. The resulting parameters are presented in the Methods section and in the accompanying tables.