Which condition is listed as a contraindication to TNF inhibitors?

• A. CHF Class III-IV
• B. Live vaccines
• C. Pregnancy
• D. Diabetes mellitus

Answer: (A)

Blocking TNF-α with these agents can worsen cardiac function, so significant congestive heart failure (advanced NYHA class III–IV) is a contraindication. In patients with severe heart failure, TNF inhibitors have been associated with increased morbidity and mortality, making their use inappropriate.

Live vaccines are not conditions a patient has; they’re vaccination considerations because immunosuppression from TNF inhibitors raises infection risk, so live vaccines are generally avoided during therapy—this is a precaution, not a disease-based contraindication. Pregnancy is not an absolute contraindication for all TNF inhibitors, as some agents are used during pregnancy with guidance. Diabetes mellitus does not by itself preclude TNF inhibitor therapy.

Therefore, the condition that correctly contraindicates TNF inhibitors is advanced congestive heart failure.