About 33% of RD patients, 20% of IBD patients, and 12% of psoriasis patients switched a second time; some patients to a third TNFα inhibitor (36.5% for RD and 37.0% for IBD), some to an interleukin inhibitor (41.3% for RD and 8.1% for IBD) and some to a selective immunosuppressant (19.0% for RD and 51.9% for IBD), except for psoriasis, these patients switched all to a TNFα inhibitor. The gene discussed is TNF; the disease is inflammatory bowel disease.