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 the 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 the Pharma companies' patient assistance (bridge) programs to circumvent insurance companies...

The answer to this question depends on a variety of factors, including which advanced therapy is being used, the phenotype of the patient’s IBD, the number of previously failed treatments, and the degree of symptoms. I do not expect patients to be in complete clinical remission by the time induction...

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

Yes, if a person has a 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 the dose should be escalated. For JAK in...