Would you re-challenge patients who have had a TNF-associated paradoxical adverse event (such as inflammatory bowel disease) with a different TNF inhibitor?

I honestly have not heard of IBD as a paradoxical event with TNF inhibitors (unless possibly in a patient with underlying IBD that was not being treated adequately with etanercept rather than a monoclonal anti-TNF antibody). On the other hand, I have seen paradoxical psoriasis with TNF inhibitor use, and my experience has been that sometimes a switch to another TNF inhibitor is successful. So, in a patient who develops psoriasis after starting on a TNF inhibitor, I would definitely consider trying another TNF inhibitor, especially if he/she had otherwise had a good clinical response to the first rather than immediately looking to switch to another mechanism of action.

This paper may be helpful for this issue: Li SJ, Perez-Chada LM, Merola JF...