Theme: iWiki Log in Register

Diff: Immunosuppressant

Comparing revision #1 (2023-08-18 12:31:15) with revision #2 (2026-06-22 09:00:58).

Old	New
	An '''immunosuppressant''' is a medicine that reduces activity in the immune system. Immunosuppressants are used when the immune system is causing harm, when inflammation needs to be controlled, or when the body might reject a transplanted organ.

An immunosuppressant is a type of medication that suppresses or reduces the immune system's activity. It is commonly used in medical treatments to prevent the immune system from attacking and damaging healthy tissues or to manage conditions where an overactive immune response is harmful. Immunosuppressants are crucial in preventing organ rejection in transplant patients and treating autoimmune diseases.
	These medicines are important in transplant medicine, autoimmune disease, inflammatory bowel disease, dermatology, rheumatology, nephrology, respiratory medicine, and some neurological conditions. They can be highly effective, but they require careful monitoring because reduced immune activity can increase infection risk and affect other organs.

== Mechanism of Action ==
Immunosuppressants work by targeting various components of the immune system to dampen its response. The immune system's primary function is to identify and eliminate foreign substances, such as bacteria, viruses, and other pathogens. However, in certain situations, the immune system can mistakenly attack healthy cells and tissues. Immunosuppressants interfere with these immune responses by:
	== How They Work ==
	The immune system is made of cells, antibodies, and signalling molecules that protect against infection and abnormal cells. Immunosuppressants interfere with selected parts of that response.

# T-cell Inhibition: T-cells are a type of white blood cell that plays a central role in immune responses. Immunosuppressants can inhibit the activation and proliferation of T-cells, reducing their ability to mount an immune response.
# Cytokine Modulation: Immunosuppressants can alter the production and release of cytokines, which are signalling molecules that regulate immune cell communication. This modulation helps reduce inflammation and immune activity.
# Antibody Production Suppression: Some immunosuppressants target B-cells, which produce antibodies. By suppressing B-cell activity, these medications can mitigate autoimmune responses.
	Different medicines act in different ways:

	* Some reduce broad inflammation.
	* Some slow immune-cell growth.
	* Some reduce T-cell activation.
	* Some reduce B-cell activity or antibody production.
	* Some block specific cytokines or inflammatory pathways.
	* Some target immune cells directly through biological antibodies.

	Modern treatment often aims for targeted immune control rather than shutting the entire immune system down.

== Uses ==	== Uses ==
Immunosuppressants are used in various medical scenarios, including:
	Common uses include:

=== Organ Transplantation ===
After organ transplantation, the recipient's immune system may recognize the transplanted organ as foreign and attempt to reject it. Immunosuppressants are administered to prevent organ rejection and maintain the viability of the transplanted organ.
	* Preventing rejection after kidney, liver, heart, lung, or other organ transplantation.
	* Treating autoimmune disorders such as rheumatoid arthritis, lupus, vasculitis, autoimmune kidney disease, and autoimmune bowel disease.
	* Treating inflammatory bowel disease, including Crohn's disease and ulcerative colitis.
	* Treating severe psoriasis, eczema, uveitis, or other inflammatory eye and skin disease.
	* Managing some neurological inflammatory diseases.
	* Preventing or treating graft-versus-host disease after some stem-cell transplants.

=== Autoimmune Diseases ===
In autoimmune diseases, the immune system attacks the body's own tissues. Immunosuppressants help control this inappropriate immune response in conditions such as rheumatoid arthritis, lupus, and multiple sclerosis.
	The choice of medicine depends on the disease, severity, other health conditions, pregnancy plans, infection history, previous treatment response, and monitoring requirements.

=== Inflammatory Bowel Diseases ===
Conditions like Crohn's disease and ulcerative colitis involve chronic inflammation of the digestive tract. Immunosuppressants can help manage symptoms and reduce inflammation in these conditions.
	== Main Classes ==
	Major classes include:

=== Psoriasis ===
Immunosuppressants can be used to treat severe psoriasis, a skin disorder characterized by rapid skin cell turnover and inflammation.
	* '''Corticosteroids''': prednisolone, methylprednisolone, and related medicines. These act quickly and are often used for flares, but long-term use can cause significant side effects.
	* '''Calcineurin inhibitors''': tacrolimus and ciclosporin. These are central in many transplant regimens and some autoimmune conditions.
	* '''Antimetabolites''': azathioprine, methotrexate, mycophenolate mofetil, and similar medicines. These affect immune-cell growth and immune activity.
	* '''mTOR inhibitors''': sirolimus and everolimus, used in some transplant and specialist settings.
	* '''Biological medicines''': monoclonal antibodies or receptor blockers that target specific immune cells or inflammatory signals.
	* '''Janus kinase inhibitors''': targeted small-molecule medicines used in selected inflammatory conditions.

=== Allergic Reactions ===
In cases of severe allergic reactions or anaphylaxis, immunosuppressants can help dampen the immune response and prevent further complications.
	Some medicines are used at different doses for different diseases. A medicine used after a transplant may have a different risk profile from the same medicine used for a milder inflammatory condition.

== Types of Immunosuppressants ==
Several classes of immunosuppressants are available, including:
	== Monitoring ==
	Monitoring is a major part of immunosuppressant treatment. Depending on the medicine, clinicians may check:

* Corticosteroids: These anti-inflammatory medications, such as prednisone and dexamethasone, suppress immune responses by modulating gene expression.
* Calcineurin Inhibitors: Drugs like cyclosporine and tacrolimus target T-cell activation by inhibiting calcineurin, a protein involved in immune cell signalling.
* Antimetabolites: Medications like azathioprine and mycophenolate mofetil interfere with DNA and RNA synthesis in rapidly dividing immune cells.
* Biological Therapies: Monoclonal antibodies, such as infliximab and adalimumab, target specific immune cells or proteins involved in autoimmune responses.
	* Full blood count.
	* Kidney and liver function.
	* Drug levels in the blood.
	* Blood pressure.
	* Blood sugar.
	* Infection screening, such as tuberculosis or hepatitis testing.
	* Vaccination status.
	* Pregnancy risks and contraception where relevant.
	* Skin checks or cancer risk in long-term treatment.

== Risks and Side Effects ==
While immunosuppressants are valuable therapeutic tools, they can carry risks, including:
	NHS Blood and Transplant notes that kidney transplant recipients usually need immunosuppressant medicines to reduce the risk of rejection, and that some will be needed for the lifetime of the transplant.

* Increased Infection Risk: A weakened immune system is less effective at fighting infections, making individuals more susceptible to bacterial, viral, and fungal infections.
* Kidney and Liver Dysfunction: Prolonged use of certain immunosuppressants can lead to kidney or liver problems.
* Blood Disorders: Some immunosuppressants can affect blood cell counts, leading to anaemia, thrombocytopenia, or leukopenia.
	== Side Effects and Risks ==
	Risks differ by medicine, dose, and patient. Common concerns include:

== Ongoing Research ==
Research into immunosuppressant therapy continues, aiming to develop more targeted and effective medications with fewer side effects. The field also explores ways to tailor treatment to individual patients, optimizing therapeutic outcomes.
	* Increased risk of infection.
	* Slower recovery from some infections.
	* Low white blood cell counts or other blood-count changes.
	* Liver or kidney effects.
	* High blood pressure.
	* Raised blood sugar.
	* Stomach irritation, nausea, or diarrhoea.
	* Tremor with some transplant medicines.
	* Bone thinning, weight gain, mood change, or skin thinning with longer-term corticosteroids.
	* Increased risk of some cancers with long-term or intensive immune suppression.

== See Also ==
	The risk is not the same for every person. Some people use low-dose treatment for years with stable monitoring, while others need intensive combinations after transplantation or during severe disease.

	== Infection and Vaccination ==
	Because immunosuppressants reduce immune activity, infection prevention is often part of care. Patients may be advised about vaccinations, avoiding live vaccines during some treatments, early reporting of fever or infection symptoms, and temporary medicine changes during serious infection.

	Vaccination planning is usually done before treatment starts where possible. The exact advice depends on the medicine and the person's condition.

	== Stopping or Changing Treatment ==
	Stopping an immunosuppressant suddenly can be dangerous in some circumstances. It may trigger transplant rejection, a severe disease flare, adrenal problems after long-term steroid use, or loss of disease control.

	Changes are usually made by reducing dose, switching medicine, or adding another medicine under specialist supervision.

	== See Also ==
	* [[Autoimmune Disorders]]
	* [[Coeliac Disease]]
* [[Transplantation]]	* [[Transplantation]]
* [[Autoimmune Diseases]]
* [[Inflammatory Bowel Diseases]]	* [[Inflammatory Bowel Diseases]]

	== References ==
	* [https://www.nhsbt.nhs.uk/organ-transplantation/kidney/living-with-a-kidney-transplant/kidney-transplant-medicines/ NHS Blood and Transplant: Kidney transplant medicines]
	* [https://kidneycareuk.org/kidney-disease-information/treatments/transplantation/patient-info-medicines-commonly-taken-by-people-after-transplant-or-with-an-autoimmune-disease/ Kidney Care UK: Medicines after transplant or with autoimmune disease]
	* [https://my.clevelandclinic.org/health/treatments/10418-immunosuppressants Cleveland Clinic: Immunosuppressants]

	[[Category:Medicine]]
	[[Category:Immunology]]
	[[Category:Pharmacology]]