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We read with interest the study by Sokol et al in Gut , emphasising the need for co-treatment with immunomodulators in patients receiving infliximab maintenance therapy. Concomitant use of immunosuppressives was associated with reduced disease activity and infliximab dose escalation, presumably through a lowered frequency of antibody formation.1 Although adalimumab is a 100% human anti-tumour necrosis factor monoclonal antibody, it is not devoid of immunogenicity. Antibodies against adalimumab have been reported in 2.6–38% of patients treated for Crohn's disease or rheumatoid arthritis.2 However, the long-term efficacy of the combination of adalimumab plus immunosuppressives in this setting is not known. One observational study from Karmiris et al performed at …