Footnotes

• Contributors MM: drafting/revising the manuscript, study concept, and acquisition, analysis and interpretation of the data. UV and LF: drafting/revising the manuscript, analysis and interpretation of the data. SF, MR, MN, SS, MAG, FC, PP and FR: drafting/revising the manuscript and acquisition of the data. AB: drafting/revising the manuscript, acquisition and interpretation of the data and study supervisor. PG: drafting/revising the manuscript, study concept, acquisition and interpretation of the data and study supervisor.

• Funding We thank Biogen for their financial support (no award/grant number).

• Competing interests Monica Margoni reports grants and personal fees from Sanofi Genzyme, Merck Serono, Novartis and Almirall. She was awarded a MAGNIMS-ECTRIMS fellowship in 2020. Umberto Villani, Livio Finos, Silvia Franciotta, Martina Rubin, Margherita Nosadini, Stefano Sartori, Maria Giulia Anglani, Francesco Causin, Alessandra Bertoldo have nothing to disclose. Francesca Rinaldi reports grants and personal fees from Sanofi Genzyme, Merck Serono, Biogen and Novartis. Paola Perini reports grants and personal fees from Merck Serono, Biogen, Sanofi Genzyme, Roche, Bayer Schering Pharma and Novartis. Paolo Gallo reports grants and personal fees from Merck Serono, Biogen, Sanofi Genzyme, Roche, Bayer Schering Pharma, Novartis, University of Padua, Department of Neurosciences DNS, Veneto Region of Italy, Italian Association for Multiple Sclerosis (AISM) and Italian Ministry of Public Health.

• Provenance and peer review Not commissioned; externally peer reviewed.

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