If an IBD patient has only partial clinical response to a new biologic and or small molecule, do you extend the loading phase before transitioning to the maintenance dose/interval? How do you navigate insurance coverage?   

As long as patient is continuing to improve I try to continue “induction dosing” before transitioning to maintenance dosing. This is particularly true for upatacitinib. We register all our patients with Pharma companies patient assistance (bridge) programs to circumvent insurance companies att...

If it is possible to extend the loading phase (typically for small molecules), then this is definitely an option to attempt to obtain full clinical response. Insurance coverage navigation occurs by submitting clinical notes and evidence that patient has not had full response showing disease activit...

Yes, if a person has partial response, in many cases it is worth extending the loading phase. For anti-TNFs, a partial response should be assessed using therapeutic monitoring, and if suboptimal trough levels are noted at 6 or 14 weeks after induction, then dose should be escalated. For JAK inhibito...