TNF and Cowden disease: Vedolizumab is a gut-focused antilymphocyte trafficking α4β7-integrin inhibitor,13,14 which was approved for the treatment of moderate to severe CD based on the results of the phase 3 GEMINI 2 and GEMINI 3 trials in anti-TNF-naïve or anti-TNF-experienced patients.15 Ustekinumab is an interleukin-12/23 p40 inhibitor,16 which was approved based on the efficacy and safety results of its phase 3 clinical trials in patients with moderate to severe CD, with significantly higher rates of clinical response and clinical remission versus placebo.16,17