HOW DO IMMUNOSUPPRESSANTS WORK?
Immunosuppressants are a class of drugs used to treat and prevent certain medical conditions, including autoimmune diseases (disorders that cause abnormally low activity or overactivity of the immune system) such as psoriasis (an immune-mediated disease that causes raised, scaly patches on the skin because of systemic inflammation), rheumatoid arthritis (a condition in which the body attacks its own joints causing pain, swelling, and loss of function), lupus, leukemia (cancer that begins in the white blood cells), and organ transplantations. These drugs inhibit or prevent the activity of the immune system. A few drugs belonging to this class are used to prevent the rejection of a transplanted organ, such as the liver, heart, or kidney; these drugs are called antirejection drugs.
The immune system is a complex network of cells, tissues, and organs. Together, they help the body fight infections and diseases. In conditions such as an autoimmune disease or organ transplantation, the immune system mistakenly considers healthy tissues and cells to be foreign invaders (virus, bacteria, parasites, chemicals, and toxins) and mounts an attack when there is no invader or does not stop an attack after the invader has been killed. These activities result in autoimmune diseases, allergic reactions, and organ transplant rejection.
Immunosuppressants are prescription-only medicines and are administered as a powder to be mixed with sterile water to be given intravenously (into a vein) and as a solution (liquid) in a prefilled syringe or an autoinjector to be given subcutaneously (under the skin).
Immunosuppressants work in the following ways:
- They suppress or inhibit the immune system’s activity and prevent it from attacking the transplanted organ, as it attacks any foreign cells, which could otherwise lead to severe damage to the organ.
- They stop the immune system from damaging healthy cells and tissues.
- They work by blocking the activity of T-cells (a type of white blood cell) that directly attacks and eliminates foreign molecules from the body.
- These drugs target intracellular signaling pathways induced by the activation of T lymphocytes or T-cells.
- They inhibit calcineurin (an enzyme that activates T-cells of the immune system) and thus inhibit the function of T-cells.
- In addition, they reduce the immune system’s ability to attack the body tissues in some cases of autoimmune diseases (a condition in which the immune system mistakenly attacks the healthy cells in the body).
HOW ARE IMMUNOSUPPRESSANTS USED?
Immunosuppressants are used in conditions such as:
- Aplastic anemia (a condition that damages stem cells in the bone marrow)
- Rheumatoid arthritis (a condition in which the body attacks its own joints, causing pain, swelling, and loss of function)
- Psoriatic arthritis (a condition that causes joint pain and swelling and scales on the skin)
- Giant cell arteritis (an inflammation of the lining of the arteries)
- Plaque psoriasis (characterized by raised red patches covered with a whitish buildup of dead skin cells called scales)
- Ankylosing spondylitis (a condition in which the body attacks the joints of the spine and other areas causing pain and joint damage)
- Chronic refractory thrombocytopenic purpura (a blood disorder characterized by a decrease in the blood platelet count that can lead to easy or excessive bruising and bleeding)
- Acute lymphoblastic leukemia (a type of cancer of the blood and bone marrow)
- Lupus nephritis (inflammation of the kidney that is caused by systemic lupus erythematosus)
- Crohn’s disease (a chronic, or long-term, condition that causes inflammation of the digestive tract)
- Ulcerative colitis (an inflammatory bowel disease that affects your large intestine, causing irritation, inflammation, and ulcers in the colon)
- Multiple sclerosis (a disease in which the nerves do not function properly characterized by weakness, numbness, loss of muscle coordination, and problems with vision, speech, and bladder control)
- Idiopathic pulmonary fibrosis (a chronic, progressive lung disease)
- Spondyloarthritis (a group of inflammatory diseases that cause arthritis)
- Diabetes mellitus type-1 (a condition in which the immune system destroys insulin-making cells in the pancreas)
- Juvenile idiopathic arthritis (a type of childhood arthritis that affects five or more joints during the first six months of the condition, causing pain, swelling, and loss of function in children two years of age or older)
- Myelodysplastic syndrome (a condition that can occur when the blood-forming cells in the bone marrow become abnormal)
- Graft versus host disease (a life-threatening complication that can occur after certain stem cell or bone marrow transplants)
- Acute renal graft rejection (when the immune system identifies a grafted organ as foreign and attacks it)
- Lupus (a chronic autoimmune condition that can cause inflammation throughout the body)
- Solid organ transplant rejection (attack on the transplanted organ by the immune system of the person receiving the organ)
- Systemic lupus erythematosus (a chronic autoimmune disease that can cause severe fatigue and joint pain)
- Lymphangioleiomyomatosis (a rare lung disease that tends to affect women of childbearing age)
- Porphyria cutanea tarda (a rare blood disorder characterized by painful, blistering skin lesions that develop on sun-exposed skin)
- Bronchiolitis obliterans (a type of obstructive lung disease of the small airways)
- Meningeal leukemia (cancer cells spread from the original [primary] tumor to the meninges [thin layers of tissue that cover and protect the brain and spinal cord])
- Non-Hodgkin lymphoma (a type of cancer that begins in your lymphatic system, which is part of the body's germ-fighting immune system)
- Squamous cell carcinoma of the head and neck
- Breast cancer
- Osteosarcoma (also called osteogenic sarcoma is the most common type of cancer that starts in the bones)
- Gestational trophoblastic neoplasia (a group of rare tumors that develop during the early stages of pregnancy)
- Prophylaxis and treatment in organ transplantation:
- Bone marrow
WHAT ARE SIDE EFFECTS OF IMMUNOSUPPRESSANTS?
Common side effects include:
- Abdominal pain
- Asthenia (physical weakness or lack of energy)
- Dyspnea (shortness of breath)
- Malaise (a feeling of weakness, overall discomfort, and illness)
- Muscle cramps
- Back/joint pain
- Cold symptoms such as stuffy head/nose
- Pain/tenderness at the injection site
- Other rare side effects include:
- Leukopenia (reduced number of white blood cells)
- Peripheral edema (swelling of lower legs or hands)
- Tachycardia (a fast heart rate—more than 100 beats per minute)
- Thrombocytopenia (low blood platelet count)
- Dizziness (feeling faint, weak, or unsteady)
- Increased sweating
- Hyperuricemia (high blood uric acid levels)
- Alopecia (a condition that causes hair to fall out in small patches)
- Trouble sleeping
- Urinary tract infection
- Hives (itchy, raised welts that are found on the skin)
- Hypotension (low blood pressure)
- Rapid and shallow breathing
- Chest pain/heaviness
- Swelling of the ankles, feet, and hands
- Signs of kidney problems
- Change in the amount of urine
- Pink/bloody/frothy urine
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 IMMUNOSUPPRESSANTS?
Generic and brand names of immunosuppressants include:
- Antithymocyte globulin equine
- Antithymocyte globulin rabbit
- Astagraf XL
- ATG equine
- ATG rabbit
- Certolizumab pegol
- Envarsus XR
- Hydroxychloroquine sulfate
- Muromonab CD3
- Orencia ClickJect
- Orthoclone OKT3
- Sirolimus intravitreal
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