As the number of patients with pediatric-onset inflammatory bowel diseases (PIBD), including Crohn disease (CD), ulcerative colitis (UC), and inflammatory bowel disease unclassified (IBD-U), has increased remarkably, more real-life data on therapies used off-label in children are needed especially for patients who do not respond or lose their response to anti-tumor necrosis factor (TNFα) [1–5]. This evidence concerns the gene TNF and inflammatory bowel disease.