Moreover, patients who initially respond to the regimen are still at risk of loss of response.7 Anti-TNF treatment is also associated with adverse events that contribute to treatment discontinuation.8,9 Ustekinumab (UST) and vedolizumab (VDZ) have emerged as promising biologic therapies for CD patients with refractory disease.10 UST is a monoclonal antibody targeting the p40 subunit of interleukin-12 (IL-12) and interleukin-23 (IL-23) that are implicated in the pathogenesis of CD. Here, TNF is linked to Cowden disease.