Which class of biologic medications should be avoided in patients with multiple sclerosis?

• A. Tumor necrosis factor inhibitors
• B. Interferon beta agents
• C. Natalizumab
• D. Ocrelizumab

Answer: (A)

Tumor necrosis factor inhibitors should be avoided in multiple sclerosis because blocking TNF-alpha can worsen demyelinating disease. TNF signaling in the CNS has complex roles: while it drives inflammation, it also participates in repair and remyelination processes. Inhibiting TNF can disrupt these repair pathways and has been associated with new-onset MS and relapses in people who already have MS. That paradoxical effect makes TNF inhibitors contraindicated for MS management. By contrast, therapies like interferon beta, natalizumab, and ocrelizumab are used to treat MS because they modulate the immune response in a way that helps reduce relapses and progression.