Immune modulating drugs Flashcards
(26 cards)
MOA: alkylates guanine bases in DNA
B cells > T cells
Indications: Burkitt’s lymphoma
SE: loss of hair, bone marrow suppression, teratogen, haemorrhagic cystitis
Cyclophosphamide
Anti-proliferative
Inhibits phospholipase A2»_space; reduces prostaglandin
- inhibits phagocyte trafficking
- promotes apoptosis
SE: transient neutrophilia, diabetes, cushingoid syndrome, osteoporosis
Corticosteroids
MOA: inhibits IM PDH, prevents guanine synthesis
Tcells >Bcells
Indications: transplantation
SE: bone marrow suppression, infection (herpes reactivation, progressive multifocal leukoncephalopathy), teratogen, malignancy
Mycophenolate mofetil
Anti-proliferative
MOA: metabolised to 6-mercaptopurine. Blocks de novo purine synthesis.
Preferentially T cells
Indications: transplantation
SE: bone marrow suppression, infection, malignancy, teratogen.
NB. some people have TPMT polymorphism and therefore are at increased risk of SE.
Azathioprine
Anti-proliferative
MOA: inhibits dihydrofolate reductase
Indications: RA, Crohn’s, chemo, abortifactant
SE: bone marrow suppression, infection, malignancy, pneumonitis, pulmonary fibrosis, hepatotoxicity, folate deficiency
Methotrexate
Anti-proliferative
Calcineurin inhibitor - inhibits cell signalling, decreases IL-2»_space; inhibits Tcell proliferation
Indications: transplant rejection prophylaxis
SE: nephrotoxic, hypertension, neurotoxic, diabetogenic
Tacrolimus
Calcineurin inhibitor - inhibits cell signalling, decreases IL-2» inhibits Tcell proliferation
Indications: transplant rejection prophylaxis
SE: nephrotoxic, hypertension, neurotoxic, diabetogenic
Cyclosporin
Blocks Tcell proliferation
Less nephrotoxic
Sirolimus
anti-CD25 (alpha chain of Il-2 receptor)
Inhibits T cell proliferation
Indications: allograft rejection
SE: infusion reactions, infection, malignancy, GI disturbance
Basiliximab
anti-CTLA4-Ig
reduces T cell proliferation
Indications: rheumatoid arthritis
SE: infusion reactions, infection (TB, HBV, HCV), malignancy, cough
Abatacept
anti-CD20
depletes mature B cells
Indications: lymphoma, RA, SLE
SE: infusion reactions, infection (PML), malignancy
Rituximab
anti-alpha4 integrin - binds to VCAM1 and MadCAM1
mediates rolling arrest of leukocytes, inhibits T cell migration
Indicatins: MS, Crohn’s
SE: infusion reactions, infection (PML), malignancy, hepatotoxic
Natalizumab
anti-IL6 receptor
reduces macrophage, Bcell, Tcell, neutrophil activation
Indications: Castleman’s disease, RA
SE: infusion reactions, infection, hepatotoxic, hyperlipidaemia, malignancy
Tocilizumab
Blocks CD3 on Tcells
mouse
Indications: active allograft transplant rejection
SE: infusion reactions, leukopenia, infection, malignancy
Muromonab-CD3
IL-2 receptor ab, targets CD25
Indications: organ transplant rejection prophylaxis
Daclizumab
Anti-CD11a
Inhibits migration of Tcells
Efalizumab
Lymphocyte depletion
Indications: allograft rejection
SE:
Anti-thymocyte globulin
Binds to CD52
Lymphocyte depletion
Indications: CLL, MS
SE: CMV infection
Alemtuzumab
Anti-TNFalpha
Indications: RA, Ankylosing spondylitis, psoriasis, psoriatic arthritis, IBD
SE: infusion site reactions, infection, lupus like conditions, demyelination, malignancy (lymphoma)
Adalimumab
Anti-TNFalpha
SE: infusion site reactions, infection, lupus like conditions, demyelination, malignancy (lymphoma)
Infliximab
TNFalpha/TNF beta receptor p75-IgG fusion protein
Indications: RA, Ankylosing spondylitis, psoriasis, psoriatic arthritis
SE: infusion site reactions, infection, lupus like conditions, demyelination, malignancy (lymphoma)
Etanercept
anti-IL12, anti-IL23
Indications: psoriasis, psoriatic arthritis
SE: injection site reactions, infection (TB), malignancy, cough
Ustekinumab
anti-IL17a
indications: psoriasis, psoriatic arthritis, ankylosing spondylitis
SE: infection (TB)
Secukinumab
anti-RANK ligand ab
Indications: osteoporosis, MM, bone mets
SE: infection, avascular necrosis of the jaw
Denosumab
