TNF and Cowden disease: VDZ is a gut-selective anti-lymphocyte trafficking integrin antibody with an attractive safety profile that is recommended for inducing response and remission in patients with moderately to severely active CD who have an inadequate response to conventional therapy and/or to anti–tumor necrosis factor (TNF) agents, or for maintaining clinical remission in patients who have achieved clinical remission with VDZ [3, 7–9].