Immuno-Modulators – Classification, Uses, Drugs

Introduction

Immunomodulatory drugs modify the response of the immune system by increasing (immunostimulators) or decreasing (immunosuppressives)

Immunostimulators

These are prescribed to enhance the immune response against infectious diseases, tumor, production of serum antibodies.

Immunostimulants, also known as immunostimulators, are substances (drugs and nutrients) that stimulate the immune system by inducing activation or increasing activity of any of its components. One notable example is the granulocyte macrophage colony-stimulating factor.

Immunosuppressor

These are used to reduce the immune response against transplanted organs and to treat autoimmune diseases such as pemphigus, lupus, or allergies .

Classification of drugs

1. Calcineurin inhibitors :-(Specific T-cell inhibitors) Cyclosporine (Ciclosporin), Tacrolimus
2. m-TOR inhibitors -Sirolimus, Everolimus
3. Antiproliferative drugs -(Cytotoxic drugs) Azathioprine, Methotrexate, Cyclophosphamide, Chlorambucil, Mycophenolate mofetil (MMF)
4. Glucocorticoids – Prednisolone and others
5. Biological agents
   1. TNF alpha inhibitors: Etanercept, Infliximab, Adalimumab
   2. IL-1 receptor antagonist: Anakinra
   3. IL-2 receptor antagonists: Daclizumab, (anti CD-25 antibody) Basiliximab
   4. Anti CD3 antibody: Muromonab CD3
   5. Polyclonal antibodies: Antithymocyte antibody (ATG), Rho (D) immune globulin.

Drugs in detail

Cyclosporine is used to prevent organ rejection in people who have received a liver, kidney, or heart transplant. It is usually taken along with other medications to allow your new organ to function normally.

Tacrolimus, sold under the brand names PROTOPIC and PROGRAF .

It is used after allogeneic organ transplant to lower the risk of organ rejection, and also as a topical medication in the treatment of T-cell-mediated diseases such as eczema and psoriasis.

Sirolimus, also known as rapamycin, is a macrolide compound that is used to coat coronary stents, prevent organ transplant rejection and treat a rare lung disease called lymphangioleiomyomatosis.

It has immunosuppressant functions in humans and is especially useful in preventing the rejection of kidney transplants.

Everolimus is a medication used to prevent rejection of organ transplants and in the treatment of renal cell cancer and other tumours.

Azathioprine (AZA) sold under the brand name IMURAN among others, is an immunosuppressive medication. It is used in rheumatoid arthritis, granulomatosis with polyangiitis, Crohn’s disease, ulcerative colitis, systemic lupus erythematosus, and in kidney transplants to prevent rejection.

Methotrexate, formerly known as amethopterin, is a chemotherapy agent and immune system suppressant. It is used to treat cancer, autoimmune diseases, ectopic pregnancy, and for medical abortion.

Cyclophosphamide (CP), also known as cytophosphane among other names, is a medication used as chemotherapy and suppress the immune system.

As chemotherapy it is used to treat lymphoma, multiple myeloma, leukemia, ovarian cancer, breast cancer, small cell lung cancer, neuroblastoma, and sarcoma.

Cholrambucil It can be used for treating some types of non-Hodgkin lymphoma, Waldenström macroglobulinemia, polycythemia vera, trophoblastic neoplasms, and ovarian carcinoma. autoimmune and inflammatory conditions, such as nephrotic syndrome.

Mycophenolic acid is an immunosuppressant medication used to prevent rejection following organ transplantation and to treat Crohn’s disease.

Specifically it is used following kidney, heart, and liver transplantation. It can be given by mouth or by injection into a vein.

Prednisone is a glucocorticoid medication mostly used to suppress the immune system and decrease inflammation in conditions such as asthma, COPD, and rheumatologic diseases. It is also used to treat high blood calcium due to cancer and adrenal insufficiency along with other steroids. It is taken by mouth.

Etanercept, sold under the brand name ENBREL among others, is a biopharmaceutical that treats autoimmune diseases by interfering with tumor necrosis factor (TNF, a soluble inflammatory cytokine) by acting as a TNF inhibitor.

Infliximab, a chimeric monoclonal antibody, sold under the brand name REMICADE among others, is a medication used to treat a number of autoimmune diseases. This includes Crohn’s disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, and Behçet’s disease.

Adalimumab, sold under the brand name HUMIRA among others, is a medication used to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, psoriasis, hidradenitis suppurativa, uveitis, and juvenile idiopathic arthritis.

Daclizumab is a therapeutic humanized monoclonal antibody which was used for the treatment of adults with relapsing forms of multiple sclerosis. Daclizumab works by binding to CD25, the alpha subunit of the IL-2 receptor of T-cells.

Basiliximab is a chimeric mouse-human monoclonal antibody to the a chain of the IL-2 receptor of T cells. It is used to prevent rejection in organ transplantation, especially in kidney transplants.

Muromonab-CD3 is an immunosuppressant drug used to reduce the natural immunity of patients who receive organ transplants such as liver transplants.