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Letter: impact of concomitant autoimmune diseases on the outcome of primary sclerosing cholangitis

SIRS, We thank Savarino et al. for taking the time to read our paper, and for their comments. We agree that antitumour necrosis factor-a drugs are effective in Crohn’s disease, but it is important to remember that these drugs may have serious side effects. 5 In addition, as we stated in our paper, although the studies we included were not randomised, using these data to calculate a number needed to treat (NNT) suggested that only seven people with Crohn’s disease would need to stop smoking to prevent one flare of disease activity, and 10 would need to stop smoking to prevent one person undergoing a second operation. These NNTs compare favourably with many of the available medical therapies. 6–9 Finally, even if the other beneficial effects on health of stopping smoking are ignored, anti-TNF drugs are expensive. There are ever increasing financial constraints on most healthcare systems. In the future, therefore, healthcare providers may refuse to reimburse for the continued use of expensive therapies among patients with Crohn’s disease who fail to stop smoking, or even implement surveillance for continued tobacco use, as a means of restricting access to such drugs.