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TNF inhibitor contraindications — SCE Rheumatology MCQ

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HardRheumatological pharmacologyTNF inhibitor contraindicationsSCE Rheumatology

A 68-year-old man with RA and severe heart failure with ejection fraction 28% remains active despite methotrexate. He also has previous optic neuritis. Which biologic class should be avoided if possible?

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Correct answer: B — TNF inhibitors

TNF inhibitors are relatively contraindicated or used with great caution in severe heart failure and demyelinating disease. Prior optic neuritis also raises concern for demyelination. Alternative mechanisms should be considered according to disease phenotype and prior treatment history.

Reference: BSR biologic DMARD safety guideline; BNF