We thank Drs. Goren and Yanai for their astute comments on our paper.1 Our results indicate that patients are at the highest risk of loss of response to anti-TNFα, both with and without anti-drug antibodies, within the first 2 years of treatment.2 After this initial phase, a rapid decline in the risk of adverse treatment outcomes was observed. Unfortunately, we could not identify clinically useful predictors that enable the selection of patients with a better prognosis, prior to starting anti-TNF.

Over the recent years it has become evident that concomitant treatment with immunomodulators drastically reduces the risk of loss of response to anti-TNF treatment due to anti-drug antibodies,3, 4 but other modifiable factors, apart from smoking in Crohn's disease,5 have not been identified.

Our results provide new insights regarding anti-TNF treatment and reinforce some common notions. However, they also highlight a large unmet need: a better understanding of which patients will have a long-term treatment benefit. We hope that our findings help patients and their physicians make better informed decisions.

The authors' declarations of personal and financial interests are unchanged from those in the original article.2