How do you assess the risk of developing demyelinating disease when initiating TNF inhibitors?

Demyelinating disease (DD) associated with TNF inhibitors is rare. Risk assessment is mostly clinical. TNF should be avoided if there is a personal history of established DD, especially MS. A strong family history in first-degree relatives or concerning neurological symptoms should warrant caution a...

First, a bit of history. In the 1990s, TNFi were studied as potential drugs to treat multiple sclerosis (MS). One product in particular, lenercept a soluble p55 TNF receptor IgG fusion protein, showed promise in animal models of MS. However, in phase II trials studying its role as a treatment for MS...