Immunosuppressant medications suppress the immune system and decrease the intensity of the body’s immune responses. A healthcare provider may prescribe an immunosuppressive medication to treat autoimmune disease or prevent organ transplant rejection, for example, after you receive a kidney transplant. Please continue reading to learn more about immunosuppressant drugs and their uses.

What is considered an immunosuppressant drug?

Any drug that suppresses the body’s immune system is considered an immunosuppressant drug. There are different types of immunosuppressive medications, and your healthcare providers will choose one or more based on your condition.

Corticosteroids

Examples: Prednisone, dexamethasone, methylprednisolone.

Corticosteroids (commonly called “steroids”) have broad anti-inflammatory properties. The mechanism of corticosteroids is very complex. However, these medications work by interfering with the production of different inflammatory genes, such as cytokines, which cause an inflammatory response, and depleting immune system cells, such as T cells. They are commonly used to treat inflammatory diseases.

Calcineurin inhibitors

Examples: Tacrolimus (Protopic, Prograf, Envarsus XR), cyclosporine (Gengraf, Neoral, Sandimmune), and voclosporin (Lupkynis).

These drugs block the enzyme calcineurin that stimulates T cells, which are the white blood cells helping the body’s immune system fight infection. They are commonly prescribed after organ transplants to prevent rejection such as heart, liver, or kidney transplantation.

mTOR inhibitors

Examples: Sirolimus (Rapamune), everolimus (Afinitor), and temsirolimus (Torisel).

mTOR (mechanistic target of rapamycin) inhibitors block T and B cell activation and stop cells from multiplying.

Inosine monophosphate dehydrogenase inhibitors (IMDH)

Examples: Mycophenolate mofetil (CellCept, Myfortic), azathioprine (Imuran), and leflunomide (Arava).

IMDH inhibitors work by inhibiting the enzyme inosine monophosphate dehydrogenase, leading to the inhibition of T cells and B cells proliferation.

Biologic agents

Examples: Infliximab (Remicade), adalimumab (Humira), trastuzumab (Herceptin), and bevacizumab (Avastin).

These medicines block inflammatory proteins and reduce the body’s immune response.

Janus kinase inhibitors

Examples: Baricitinib (Olumiant), tofacitinib (Xeljanz), filgotinib (Jyseleca), and upadacitinib (Rinvoq).

JAK inhibitors suppress the activity of enzymes called janus kinases and prevent the action of inflammatory molecules like cytokines.

Monoclonal antibodies

Examples: Basiliximab (Simulect) and daclizumab (Zenapax).

These drugs are used to prevent the immune system from rejecting organ transplants.

Alkylating agents

Examples: Cyclophosphamide (Cytoxan) and chlorambucil (Leukeran).

These drugs are used against certain types of cancerous cells. They also have immunosuppressive effects by suppressing antibody production.

What is the most commonly used immunosuppressant?

Corticosteroids, such as prednisone, are some of the most commonly prescribed immunosuppressants.

What is the strongest immunosuppressant drug?

Alkylating agents, such as cyclophosphamide and chlorambucil, are some of the potent immunosuppressant drugs that also work as anticancer medication, but they also carry a higher risk of causing serious side effects and toxicity.

What are immunosuppressant common uses?

Autoimmune diseases

Autoimmune disorders are conditions in which the immune system attacks healthy tissue mistakenly instead of protecting it. There are 80 types of autoimmune diseases affecting different body systems and organs. Examples of autoimmune disorders include systemic lupus erythematosus (SLE or lupus), rheumatoid arthritis (RA), multiple sclerosis (MS), psoriatic arthritis (inflammatory arthritis), psoriasis, juvenile idiopathic arthritis, inflammatory bowel disease (Crohn’s disease, ulcerative colitis), and alopecia areata. Immunosuppressive medications are commonly used to treat autoimmune diseases. They suppress the immune response and provide relief from symptoms of autoimmune disorders. Some of the drugs used to treat autoimmune diseases even slow down the disease progression.

Organ transplant

When you receive an organ transplant, your body’s immune system sees the transplanted organ as an intruder and attacks it. This can result in organ transplant rejection. Immunosuppressive drugs, also called antirejection drugs, are used in transplant patients to prevent organ rejection. Sometimes, antirejection medications are initiated prior to the transplant surgery. However, in most cases, these medications are started right after the transplant procedure and are to be continued lifelong.

Stem cell transplant

People with blood cancers (leukemia, lymphoma, multiple myeloma), bone marrow disorders (aplastic anemia), and blood disorders (thalassemia, sickle cell disease) may need to undergo allogeneic stem cell transplants. This treatment involves using donor stem cells to replace unhealthy stem cells and build a new immune system. The new immune system sees the body as an intruder and starts attacking it. This is called graft versus host disease. Immunosuppressant drugs are used after bone marrow transplants to help the new immune systems settle down.

What are the side effects of immunosuppressive drugs?

Immunosuppressant drugs are powerful drugs that can cause a wide range of side effects such as fatigue, upset stomach, abdominal pain, nausea, vomiting, hair loss, acne, mouth sores, headache, tremors, muscle cramps, joint pain, high blood pressure, diabetes, osteoporosis, and weight gain.

What are the risks of taking immunosuppressant medications?

Immune cells help the body fight infections. Immunosuppressive drugs suppress immune cells and, therefore, lower the body’s ability to fight infections. Taking these medications can, therefore, lead to an increased risk of infection. This includes serious infections such as bacterial infections (MRSA), fungal infections (thrush, fungal skin infections), respiratory infections (common cold, flu, pneumonia), skin infections (cellulitis), urinary tract infections, digestive tract infections, and even sepsis.

Immunosuppressive drugs reduce the ability of the body’s immune system to find and destroy cancer cells or fight certain infections that can lead to cancer. Transplant patients are at increased risk of many different cancers, some of which are caused by infectious organisms. Cancers that are more common among transplant recipients compared to the general population include kidney, liver, and lung cancers and non-Hodgkin lymphoma.

What precautions should I take while on an immunosuppressant drug?

It is important to take all the doses of an immunosuppressant drug as prescribed. Missing doses can lead to a flare-up of an autoimmune disorder or acute rejection of transplanted organs in people who have undergone organ transplantation.

Give your healthcare providers a complete list of your medications, including prescribed medications, over-the-counter medications, dietary supplements, and herbal products, to prevent potentially dangerous drug interactions between your immunosuppressant drug and your other medicines, which can lead to unwanted side effects or reduce the effectiveness of the anti-rejection medications leading to organ rejection.

Keep all your medical and lab appointments while on immunosuppressant drugs. Your healthcare provider will order regular blood tests that are more frequent during the first one to two years after receiving the organ transplant. These lab tests help your doctor to monitor you for side effects and the effectiveness of the medication so they can adjust the dose of your medicine if necessary. Seek immediate medical care if you develop signs and symptoms of active infections.

To lower your risk of infection, follow hygiene measures such as washing hands and avoiding contact with people who are sick.

Additionally, you can support your immune system by eating a healthy diet, getting enough sleep, staying active, and taking all the recommended vaccines.

References:

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