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Switching is not a reset. It’s a roll of the dice, often made
out of necessity, not strategy.

Combination Therapy: Complexity Without
Durability

In some cases, physicians will try to keep a failing biologic
on board by combining it with another agent—perhaps
another monoclonal antibody, or a kinase inhibitor, or a
corticosteroid. These combinations may achieve short-term
gains, but they introduce polypharmacy risk, compliance
challenges, and unpredictable immune responses.

These regimens are harder to monitor, harder to optimize,
and harder for payers to justify—especially when outcomes
remain inconsistent. It's both a lazy and insufficient fix to a
larger problem.

What These Approaches Have in Common

All of these coping strategies—dose escalation,
immunosuppression, switching, combination therapy—
share three characteristics:

1. They treat the symptom, not the cause.
None of them address the immune system’s core
intolerance to the biologic itself.
2. They are expensive and inefficient.
Every escalation and every switch increases both
direct and indirect costs, often with diminishing
returns.

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