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• First-line drugs are front-loaded in value, generating
the bulk of revenue within the first 12–18 months—
before many cases of immune rejection peak.
• And with few durable competitors, switching
remains within the bounds of branded
reimbursement.

This creates a system where impermanence is monetized.
Not because it’s malicious, but because there has been no
viable, scalable alternative.

Until now.

A Fragile House of Cards

Tolerization matters because it exposes a flaw too big to
ignore: We are building a biologic-based future on
unstable immunologic ground.

For patients, that means disappointment. For payers, it
means waste. For pharma, it means risk.

For medicine as a whole, it means vulnerability—one that
grows with every new biologic added to the pipeline.

If we want to preserve the promise of biologics—not just as
blockbuster drugs, but as pillars of 21st-century medicine—
we must confront their deepest vulnerability. Not with
workarounds, not with silence, and not with acceptance of
inefficiency as inevitable. We must solve the tolerization
problem at its root: immunologically, technologically, and
structurally.

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