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Article History

Accepted: 7 May 2026

First Online: 31 May 2026

Declarations

:

: Vincenzo Mangialardi, Giuseppe Macchitella, Rita Vitobello, Antonella Teofilo, Nicola Cavalli, Caterina Lapucci, and Elisa Idini declare no competing financial or non-financial interests related to the content of this article. Jessica Frau reports relationships with Biogen, Bristol Myers Squibb, Novartis, Sanofi-Genzyme, Merck, Teva, and Alexion, including advisory board participation, consultancy activities, and speaker honoraria. Pietro Iaffaldano has received honoraria for lecturing, participation in advisory boards, and/or travel expenses for attending congresses and meetings from Almirall, Biogen Idec, Merck Serono, Mylan, Novartis, Roche, Sanofi-Genzyme, and Teva. Paola Cavalla has received honoraria for consultancy or speaking activities from Alexion, Biogen, Bristol Myers Squibb, Merck, Novartis, Sanofi, and Roche. Maria Matilde Inglese has received personal compensation for consulting, serving on scientific advisory boards, or speaking activities from Alexion, Biogen, Bristol Myers Squibb, Janssen, Merck, Novartis, Roche, and Sanofi-Genzyme. Eleonora Cocco has received honoraria for consultancy or speaking activities from Bayer, Biogen, Novartis, Sanofi, Merck, Teva, Roche, Bristol Myers Squibb, Janssen, and Alexion. Damiano Paolicelli has received honoraria for advisory board membership and speaking activities, travel support, research grants, consulting fees, or clinical trial support from Biogen, Bristol Myers Squibb–Celgene, Sanofi-Genzyme, Merck, Novartis, and Roche. All declared interests are unrelated to the conduct and reporting of the present study.

: This retrospective multicenter study was conducted in accordance with the ethical standards of the institutional and national research committees and with the principles of the 1964 Declaration of Helsinki and its later amendments. This study protocol was approved by the Local Ethics Committee of the University of Bari ‘Aldo Moro’ (Comitato Etico Territoriale AOU Consorziale Policlinico di Bari) and by the Ethics Committees of the participating centers. Ethical approval was obtained at each participating center in accordance with national regulations for retrospective studies. This was a retrospective observational study and therefore did not require prospective trial registration.

: Written informed consent to participate in the study was obtained from all individual participants included in the study.

: Not applicable. The manuscript does not contain identifiable individual data.

: The datasets generated and/or analyzed during the current study are not publicly available due to data protection and privacy regulations but are available from the corresponding author on reasonable request.

: Not applicable.

: Damiano Paolicelli contributed to the study concept and design. Vincenzo Mangialardi and Giuseppe Macchitella contributed to the analysis and interpretation of the data and drafted the manuscript. Rita Vitobello, Antonella Teofilo, Nicola Cavalli, Caterina Lapucci, Marco Vercellino, Elisa Idini, Jessica Frau, Pietro Iaffaldano, Paola Cavalla, Maria Matilde Inglese, and Eleonora Cocco contributed to data acquisition and interpretation and critically revised the manuscript for important intellectual content. All authors read and approved the final version of the manuscript and agree to be accountable for all aspects of the work.