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• Reduced patient quality of life.

You’re not fixing the immune rejection—you’re just
muffling the immune response. It’s the equivalent of
covering a smoke detector instead of putting out the fire.

In a 2010 study evaluating the risk of immunosuppressant
combination therapy in Crohn’s disease patients they found
that despite combination therapy inducing remission at a
higher rate than either drug alone, it came at a heightened
risk of serious infections and hepatosplenic T-cell
lymphoma.

Therapeutic Switching: Playing Musical Chairs
with Mechanisms of Action

Once a biologic fails outright, the patient is moved to
another drug—usually within the same class, occasionally
to a different target. This process, called therapeutic
switching, is common in rheumatology, oncology,
gastroenterology, and rare disease management.

But switching comes with:

• Delays in authorization and onboarding.
• New risks from unknown side effect profiles.
• No guarantee of better efficacy, especially if the
new drug is structurally or functionally similar.

And most concerning, cross-reactivity is real. Patients who
have developed antibodies to one anti-TNF may have
shared epitope sensitivity to others in the same class. In
other words, the immune system remembers—and rejects
in advance.

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