Immune modulating drugs

Question 1

MOA: alkylates guanine bases in DNA
B cells > T cells
Indications: Burkitt’s lymphoma
SE: loss of hair, bone marrow suppression, teratogen, haemorrhagic cystitis

Answer 1

Cyclophosphamide

Anti-proliferative

Question 2

Inhibits phospholipase A2&raquo_space; reduces prostaglandin
- inhibits phagocyte trafficking
- promotes apoptosis
SE: transient neutrophilia, diabetes, cushingoid syndrome, osteoporosis

Answer 2

Corticosteroids

Question 3

MOA: inhibits IM PDH, prevents guanine synthesis
Tcells >Bcells
Indications: transplantation
SE: bone marrow suppression, infection (herpes reactivation, progressive multifocal leukoncephalopathy), teratogen, malignancy

Answer 3

Mycophenolate mofetil

Anti-proliferative

Question 4

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.

Answer 4

Azathioprine

Anti-proliferative

Question 5

MOA: inhibits dihydrofolate reductase
Indications: RA, Crohn’s, chemo, abortifactant
SE: bone marrow suppression, infection, malignancy, pneumonitis, pulmonary fibrosis, hepatotoxicity, folate deficiency

Answer 5

Methotrexate

Anti-proliferative

Question 6

Calcineurin inhibitor - inhibits cell signalling, decreases IL-2&raquo_space; inhibits Tcell proliferation
Indications: transplant rejection prophylaxis
SE: nephrotoxic, hypertension, neurotoxic, diabetogenic

Answer 6

Tacrolimus

Question 7

Calcineurin inhibitor - inhibits cell signalling, decreases IL-2» inhibits Tcell proliferation
Indications: transplant rejection prophylaxis
SE: nephrotoxic, hypertension, neurotoxic, diabetogenic

Answer 7

Cyclosporin

Question 8

Blocks Tcell proliferation

Less nephrotoxic

Answer 8

Sirolimus

Question 9

anti-CD25 (alpha chain of Il-2 receptor)
Inhibits T cell proliferation
Indications: allograft rejection
SE: infusion reactions, infection, malignancy, GI disturbance

Answer 9

Basiliximab

Question 10

anti-CTLA4-Ig
reduces T cell proliferation
Indications: rheumatoid arthritis
SE: infusion reactions, infection (TB, HBV, HCV), malignancy, cough

Answer 10

Abatacept

Question 11

anti-CD20
depletes mature B cells
Indications: lymphoma, RA, SLE
SE: infusion reactions, infection (PML), malignancy

Answer 11

Rituximab

Question 12

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

Answer 12

Natalizumab

Question 13

anti-IL6 receptor
reduces macrophage, Bcell, Tcell, neutrophil activation
Indications: Castleman’s disease, RA
SE: infusion reactions, infection, hepatotoxic, hyperlipidaemia, malignancy

Answer 13

Tocilizumab

Question 14

Blocks CD3 on Tcells
mouse
Indications: active allograft transplant rejection
SE: infusion reactions, leukopenia, infection, malignancy

Answer 14

Muromonab-CD3

Question 15

IL-2 receptor ab, targets CD25

Indications: organ transplant rejection prophylaxis

Answer 15

Daclizumab

Question 16

Anti-CD11a

Inhibits migration of Tcells

Answer 16

Efalizumab

Question 17

Lymphocyte depletion
Indications: allograft rejection
SE:

Answer 17

Anti-thymocyte globulin

Question 18

Binds to CD52
Lymphocyte depletion
Indications: CLL, MS
SE: CMV infection

Answer 18

Alemtuzumab

Question 19

Anti-TNFalpha
Indications: RA, Ankylosing spondylitis, psoriasis, psoriatic arthritis, IBD
SE: infusion site reactions, infection, lupus like conditions, demyelination, malignancy (lymphoma)

Answer 19

Adalimumab

Question 20

Anti-TNFalpha

SE: infusion site reactions, infection, lupus like conditions, demyelination, malignancy (lymphoma)

Answer 20

Infliximab

Question 21

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)

Answer 21

Etanercept

Question 22

anti-IL12, anti-IL23
Indications: psoriasis, psoriatic arthritis
SE: injection site reactions, infection (TB), malignancy, cough

Answer 22

Ustekinumab

Question 23

anti-IL17a
indications: psoriasis, psoriatic arthritis, ankylosing spondylitis
SE: infection (TB)

Answer 23

Secukinumab

Question 24

anti-RANK ligand ab
Indications: osteoporosis, MM, bone mets
SE: infection, avascular necrosis of the jaw

Answer 24

Denosumab

Question 25

JAK inhibitor

Indications: RA

Answer 25

Tofactinib

Question 26

PDE4 inhibitor

Indications: psoriasis

Answer 26

Apremilast