TNF and Cowden disease: In CD, NMAs have generally focused on the comparative efficacy of advanced therapies including anti-TNF, anti-interleukin, anti-integrin agents, and Janus Kinase inhibitors,2, 3, 4 but there is paucity of data on how these therapies compare with conventional immunosuppressants such as thiopurines and methotrexate, particularly in moderate-to-severe CD.