TNF-a inhibition should not be initiated in patients with a history of demyelinating disorders such as multiple sclerosis (MS). Post-marketing surveillance has reported rare incidences of demyelinating disorders or exacerbations of pre-existing multiple sclerosis in patients receiving etanercept. In addition, early studies examining the use of a TNF- inhibitor, lenercept, in the treatment of multiple sclerosis found increased numbers of MS exacerbations compared to placebo as well as MS exacerbations that occurred earlier compared to placebo. Physicians should be wary of new-onset neurological symptoms in patients receiving eta-nercept treatment, and a good neurological history should be obtained before commencing therapy.
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