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2.5 Quality assessment and risk of bias In line with PRISMA guidelines, the assessment of methodological quality was conducted to evaluate the strength of evidence, recognising that methodological limitations may introduce bias

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Despite the development of new medications and therapeutic approaches, such as phosphodiesterase inhibitors and sphingosine receptor modulators, only approximately 40% of patients achieve clinical remission after one year, highlighting the need for new treatment modalities [320322]