Steroid-sparing therapy (SST), including immunomodulators and anti–tumor necrosis factor α (anti-TNFα) medications, improves many CD outcomes, but it remains to be determined whether PFCs are preventable and, if so, which medical therapies are most efficacious.21,22,23 We hypothesized that SST use would be associated with prevention of PFCs among patients who were free from such complications at CD diagnosis. This evidence concerns the gene TNF and Cowden disease.