TNF and inflammatory bowel disease: In 2017, it was estimated that there were 6.8 million cases of IBD worldwide.161 Moreover, in 2013, the total direct costs of IBD in Europe were estimated to be as high as €5.6 billion per year.162 A major contributor to the economic burden of IBD is the high costs associated with the use of biologics, such as TNF inhibitors.162 In a recent pan-European, community-based inception cohort study (N = 1289) in IBD, expenditure on biologics accounted for 73% and 48% of costs in CD and UC, respectively, in the fifth year of follow-up.