Only a few years elapsed from the first clinical trial of infliximab in Crohn’s disease (CD) in 1997 [1] to its widespread use in clinical practice [2]. This is a short interval given the novelty of the drug and its shockingly high cost. The rapid acceptance of the anti-TNF therapies despite the lack of long-term data could be easily understood in light of the striking unmet need for effective salvage therapies that was present prior to the anti-TNF era, when only one-third of patients had mild disease, judged longitudinally [3]. Indeed, anti-TNF medications brought rapid change to the management of IBD and improved the quality of life of countless patients. Accompanied by massive industry-driven aggressive marketing, more antiTNF drugs have been introduced including adalimumab, certolizumab pegol and golimumab, contributing further to the increasing use of biologics in IBD. Although clinical trials are essential for evaluating the effectiveness of emerging therapies, standard trial design cannot be considered sufficient in view of its inherent limitations. Only approximately one-third of potentially eligible patients are enrolled into trials, imposing a significant selection bias which is further enhanced by the typical conduct of clinical trials in large referral centers. The meticulous follow-up during the trial, not routinely employed in clinical practice, imposes measurement bias; furthermore, the length of follow-up does not usually exceed 1–1.5 years. Given these limitations, the postmarketing, real-life evaluation of drugs, as performed by Seminerio et al. in this issue [4] is of utmost importance. Seminerio et al. elegantly reported their long-term experience of patients treated with infliximab with a median follow-up of 6.4 years, the longest to date [4]. The medical records of 492 unselected patients (or 464 with outcome data, used here as the denominator to calculate rates) treated with infliximab at the Mayo Clinic (1998–2002) were systematically reviewed. The study showed an 86 % initial response rate (or 80 % calculated on an ITT basis), similar to the 82–89 % reported in most other publications such as the pediatric REACH trial [5], the Edmonton cohort [6], the large Leuven cohort [7], the Leeds cohort [8], and the Targan initial RCT [1] but higher than the short-term response rate achieved in the ACCENT trial (65 %) [2]. This figure (82–89 %) also includes those with partial response, variably defined in the different studies. In the current study, the complete response rate was 65 %, but it should be emphasized that the vast majority had only one or two induction doses rather than the current standard of a three-dose protocol. The long-term outcome of the current study is shown in Fig. 1, benchmarked by some other long-term real-life reports, most notably the Leuven cohort, which reviewed the outcome of 614 patients [7] and the safety of 734 patients [9]. Direct comparison between the studies is challenging in view of the different follow-up periods and definitions of response as well as the variable inclusion of patients with episodic treatment and fistulizing disease. Nonetheless, some overall conclusions can be extrapolated along with estimation of long-term outcomes. The longterm failure rate (i.e., the need to discontinue infliximab for low effectiveness or unbearable adverse events) is high at *40 %. The comparable rates between the cohorts despite the differing follow-up periods (2–6.4 years) could be D. Turner (&) R. Lev-Tzion Pediatric Gastroenterology and Nutrition Unit, Shaare Zedek Medical Center, P.O. Box 3235, 91031 Jerusalem, Israel e-mail: turnerd@szmc.org.il