Page 39 - Binder2

Too Profitable to Change—For Now

Finally, let’s speak plainly: tolerization is profitable. Not
in a malicious, conspiratorial way—but in a quiet,
structural way that has gone unchallenged for far too long.
In today’s biologic drug market, patients who fail one
therapy and cycle to another don’t disrupt the business
model—they fuel it.

Many of the highest-grossing biologics are part of the
same mechanistic families, often made by the same
manufacturers or licensed partners. A patient who starts on
Drug A, develops anti-drug antibodies, and is moved to
Drug B may still remain within the same corporate
portfolio. From the manufacturer’s perspective, the therapy
has not failed—it has merely transitioned to its next
monetizable phase.

And because biologics are front-loaded in price, with the
majority of revenue captured in the first 12 to 18 months of
treatment, even partial use is lucrative. If a drug is
discontinued due to tolerization after one year, it has
already delivered its economic return. Whether it sustains
the patient’s remission long-term is not directly tied to the
company’s financial outcome. This misalignment between
clinical durability and commercial success is the core
reason tolerization remains an open secret: it’s bad
medicine, but good business—at least for now.

There’s also no regulatory or payer pressure—yet—to build
biologics for long-term immune compatibility. Clinical
trials are designed to show short-term safety and efficacy,
not immune sustainability over years. Reimbursement
systems pay for treatment, not tolerance. And the cycle of
dose escalation, therapeutic switching, and add-on

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