How Do Immunomodulators (DMARDs) Work?

Reviewed on 11/22/2021

How do immunomodulators (DMARDs) work?

Immunomodulators (DMARDs) belong to a class of medications known as disease-modifying anti-rheumatic drugs (DMARDs), which modify and slow down or halt the course of disease in many autoimmune and other inflammatory diseases and cancers.

Immunomodulators include synthetic compounds that are toxic to cancer cells, biologic monoclonal antibodies against specific antigens, and small molecule drugs that are capable of penetrating cells and altering their functions. Immunomodulators work in diverse ways to modify immune cell functions to control inflammation and tumor growth.

Some of how immunomodulator DMARDs suppress the immune system and prevent abnormal cell growth include the following:

  • Inhibit the activation of T-lymphocytes, immune cells that attack specific antigens they perceive as foreign to the body.
  • Block the activity of pro-inflammatory proteins released by immune cells, including:
  • Inhibit the division of cells by interfering with DNA and RNA synthesis.
  • Prevent malignant cell growth by cross-linking DNA in tumor cells.
  • Prevent T-cell proliferation and activation by inhibiting calcineurin, a key signaling enzyme.
  • Prevent cell division and proliferation by inhibiting enzymes essential for nucleotide (DNA and RNA building blocks) synthesis.
  • Inhibit enzymes known as Janus kinases (JAK) which transmit signals from the cell membrane within the cell, stimulating an immune response and blood cell formation.

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How are immunomodulators (DMARDs) used?

Immunomodulators (DMARDs) may be administered through the following routes:

Immunomodulators (DMARDs) are used in the treatment of conditions that include the following:

FDA-approved:

Off-label:

  • Crohn’s disease, an inflammatory bowel disease
  • Chronic refractory thrombocytopenic purpura, an autoimmune disorder that suppresses platelet production and destroys them
  • Kidney transplantation, to prevent transplant rejection in children
  • Solid-organ transplant including liver, heart, and kidney, to prevent transplant rejection in children
  • Lupus nephritis, kidney inflammation caused by lupus
  • Juvenile idiopathic arthritis/vasculitis in adults
  • Systemic sclerosis, an autoimmune disease that hardens and tightens skin and connective tissue
  • Ectopic pregnancy

Orphan:

Emergency use authorization (EUA):

  • COVID-19

What are side effects of immunomodulators (DMARDs)?

Some of the most common side effects of immunomodulators (DMARDs) may include the following:

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

What are names of some immunomodulators (DMARDs)?

Generic and brand names of immunomodulators (DMARDs) include:

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References
https://reference.medscape.com/drugs/dmards-immunomodulators

https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/103950s5189lbl.pdf

https://www.cancer.gov/publications/dictionaries/cancer-terms/def/interleukin-1

https://go.drugbank.com/drugs/DB00563

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