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Article History

Received: 24 February 2026

Accepted: 13 May 2026

First Online: 12 June 2026

Declarations

:

: This study was approved by the Ethics Committee of the Medical Faculty, Düsseldorf and Westfalen-Lippe (No.: 2023-2402, 2025-639-b-S). The informed consent form was reviewed by the ethics committee for approval of the study, and all trial activities were in accordance with the Declaration of Helsinki. All participants provided written informed consent prior to study participation.

: Not applicable.

: NMW reports no conflicts of interests. MS received honoraria for lecturing and travel expenses for attending meetings from Biogen, Hexal, Janssen Cilag, Juvise, Merck Healthcare Germany, Neuraxpharm, Novartis, Roche, Sanofi, Teva and Viatris all outside the scope of this work. Her research is funded by the by the German Multiple Sclerosis Foundation (DMSG), Neuraxpharm and Novartis. RH, JV and BD report no conflicts of interests. PK received honoraria for lectures, consultancy and travel sssupport for attending meetings from German Society of Neurology (DGN), Hexal, Roche, Sanofi, Merck, Neuraxpharm and Viatris. MH received honoraria for lecturing and travel expenses for attending meetings from Bayer Health Care, Biogen, Hexal, Merck Serono, Neuraxpharm, Novartis, Roche, Sanofi-Aventis, Teva, all outside the scope of this work. TZ reports membership of the scientific advisory board and/or consulting for Biogen, Roche, Novartis, BMS, Sanofi, and Merck; compensation for serving on speakers’ bureaus for Roche, Neuraxpharm, Novartis, Merck, Novo Nordisk, Sanofi, BMS, Viatris, Sandoz, TEVA, and Biogen; and research support from Novartis, TEVA, Neuraxparm, Roche and Sanofi. UKZ has received speaking fees, travel support and/or financial support for research activities from Alexion, Almirall, Bayer, Biogen, Bristol Myers Squibb, Janssen, Merck Serono, Novartis, Octapharm, Roche, Sanofi Genzyme, Teva as well as EU, BMBF, BMWi and DFG. None resulted in a conflict of interest. SGM reports Honoraria/travel support from Academy2, Argenx, AstraZeneca, Bayer, Biontech, Celgene, Datamed, Desitin, Diaplan, DIU, Dpmed, Gen Medicine & Healthcare, IGES, Impulze GmbH, KW Medipoint, MedDay, Medmile, MICE, Mylan, Neuraxpharm, Neurapharm, Oxford PharmaGenesis, QuintilesIMS, Sanofi, Springer, STADA, Chugai, UCB, Viatris, Wings for Life int, and Xcenda. Research support from BMBF, BfR, DFG, EKFS, G-BA, Hertie Fdn, IZKF, DGN, Ministry of Culture & Science NRW, Daimler & Benz Fdn, dmsg, Peek & Cloppenburg Fdn, Hempel Fdn, German Alzheimer Society, Bayer, BMS, Demecan, Diamed, Genzyme, Hexal, Janssen, MerckSerono, Novartis, NovoNordisk, ONO Pharma, Roche, and Teva. MP received honoraria for lecturing and travel expenses for attending meetings from Alexion, ArgenX, Bayer Health Care, Biogen, Hexal, Merck Serono, Novartis, Roche, Sanofi-Aventis, Takeda and Teva. His research is funded by ArgenX, Biogen, Demecan, Hexal, Horizon Merck Serono, Novartis, Roche, Viatris, Takeda and Teva, all outside the scope of this work. His research is funded by the by the German Multiple Sclerosis Foundation (DMSG), the B. Braun Foundation and the German Alzheimer Society LM reports no conflicts of interest related to this study. He reports honoraria for lecturing, consulting and travel expenses for attending meetings from Biogen, Merck, argenX, Bial, Roche, Hexal, Neuraxpharm, Sanorfi, Alexion and Novartis, all outside the scope of this work. His research is funded by the by the German Multiple Sclerosis Foundation (DMSG), the B.Braun Foundation and the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) – 493659010.