This is how I do it. Cost being an overriding constraint, I limit biologic treatment at recommended dosing intervals for the first 3 months as induction of remission. Thereafter, assuming good remission, I increase the dosing interval gradually over the next 3-9 months (depending on individual patient's financial prowess and continuing clinical remission) to eventual twice or 3 times the initial dosing interval, before considering stopping the biologic altogether. If initial response is inadequate, I add NSAID and Sulfasalazine (even if pure axial disease). I will also screen for TB with IGRA, and silent ileiitis with stool calprotectin.
Objective To compare the effectiveness, safety and costs of standard versus individually tailored reduced doses of anti-tumour necrosis factor (TNF) drugs in patients with ankylosing spondylitis (AS) after achieving low-disease activity.