How do you select patients for ustekinumab optimization instead of switching therapy after secondary loss of response in Crohn's disease?

I subscribe to the principle that we should not switch to a new therapy until we are certain that we have achieved the maximal benefit of the old therapy. Dose optimization by shortening the intervals for ustekinumab is a viable strategy (Ollech et al., PMID 32109634; Hupé et al., PMID 40484747).

Optimizing a therapy before switching is likely a good idea because of the time that it takes for a prior authorization for another therapy. Drug levels for ustekinumab are available, so optimizing is possible. Having said that, the targeted anti-interleukins appear to be superior. So if a patient l...