Would you consider using a TNFi in a patient with a family history of demyelinating disease, in the absence of a personal history?

No contraindication based on family history of MS that I am aware of. One could consider MRI head to rule out radiologically isolated syndrome, as a biomarker of risk.

The FDA database has identified several cases of new onset multiple sclerosis following TNF-inhibitor therapy [1]. There is still uncertainty whether TNF-inhibitors actually cause de novo cases versus triggering an exacerbation in those with underlying demyelinating disease.

Given that we have many o...