Biologic Safety — SCE Dermatology MCQ
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Correct answer: C — Stop the TNF inhibitor permanently; demyelinating disease is a contraindication to anti-TNF therapy
TNF-alpha inhibitors are associated with new-onset or exacerbation of demyelinating disease (multiple sclerosis, optic neuritis, transverse myelitis, Guillain-Barré syndrome). This is a class effect and an absolute contraindication to ALL TNF-alpha inhibitors. BAD guidelines mandate permanent discontinuation of the anti-TNF agent and immediate neurological referral. A personal or family history of demyelinating disease is a contraindication to starting anti-TNF therapy. Alternative biologic classes (IL-17 inhibitors, IL-23 inhibitors, IL-12/23 inhibitors) do not carry this risk and can be used for ongoing psoriasis management. Pre-treatment screening should include asking about neurological symptoms and family history of MS.
Reference: BAD 2020 Biologic Psoriasis Guidelines; BNF Anti-TNF Warnings