Modulating Drugs

Question 1

Anti-CTLA4

Answer 1

Iplimumab

Advanced melanoma

Increase T cell response

Question 2

Anti-PD1

Answer 2

Pembrolizumab
Nivolumab

Advanced Melanoma

Increase T cell response

Question 3

Alkylates guanine base of DNA

Answer 3

Cyclophosphamide

Affects B cells > T cells

Indications
Multisystem connective tissue disease or vasculitis with severe end-organ involvement
eg GPA (Wegener’s granulomatosis), SLE
Anti-cancer agent
HAEMORRHAGIC CYSTITIS

Question 4

Blocks de novo purine (eg adenine, guanine) synthesis

Answer 4

Azathioprine

Indications
Transplantation
Auto-immune disease
Auto-inflammatory diseases, eg Crohn’s, ulcerative colitis
CHECK TPMT LEVELS PRIOR

Question 5

Blocks de novo nucleotide synthesis

Answer 5

Mycophenolate mofetil

Prevents T>B cell proliferation

Major Indications
Widely used in transplantation as alternative to azathioprine
Also used in auto-immune diseases and vasculitis as alternative to cyclophosphamide

Question 6

Side effect of Progressive multifocal leukoencephalopathy (JC virus)

Answer 6

Mycophenolate Mofetil
Natalizumab
Rituximab

Question 7

Indications for plasmapheresis

Answer 7

Severe antibody-mediated disease

Goodpastures syndrome

Severe acute myasthenia gravis

Severe vascular rejection

Question 8

Calcineurin inhibitors

Answer 8

Cyclosporin

Tacrolimus

Prevents IL-2 upregulation

Use post-transplant

Question 9

Dysmorphism

Answer 9

Cyclosporin

Question 10

JAK inhibitor antibody

Answer 10

Tofacitinib (inhibits cell signalling)

Rheumatoid Arthritis

Question 11

PDEF 4 inhibitor antibody

Answer 11

Apremilast (inhibits cell signalling)

Psoriasis

Psoriatic arthritis

Question 12

Neutropenia particularly if TPMT low

Answer 12

Azathioprine

Question 13

Infertility

Answer 13

Cyclophosphamide

Question 14

Inhibits T cell migration but may only be used in highly active remitting/relapsing MS

Answer 14

Natalizumab (Anti-a4 integrin

Question 15

Inhibits T cell activation and is effective in rheumatoid arthritis

Answer 15

Abatacept (CTLA4-Ig fusion protein)

Question 16

Depletes B cells and is effective in treatment of B cell lymphomas and rheumatoid arthritis

Answer 16

Rituximab (Anti-CD20)

Question 17

Inhibits function of lymphoid and myeloid cells and used in management of rheumatoid arthritis

Answer 17

Tocilizumab (Anti-IL6 receptor)

Question 18

Antibody specific for CD25 which inhibits T cell activation and is used to prevent rejection

Answer 18

Basiliximab (Anti-IL2 receptor)

Question 19

Anti-Thymocyte globulin

Answer 19

Anti-CD3
Removes T cells
Allograft rejection
Daily IV infusion
Infusion reaction, leucopaenia

Question 20

Anti-CD25

Answer 20

Basiliximab

Inhibits T cell proliferation

Prophylaxis in organ transplant

IV pre and post surgery

Question 21

CTLA4-Ig fusion

Answer 21

Abatacept

Prevents T cell activation

Rheumatoid arthritis

IV 4 weekly
Subcut weekly

Question 22

Anti-CD20

Answer 22

Rituximab

Removes mature B cells

Lymphoma
SLE
Rheumatoid arthritis

2 doses every 6 months IV

Question 23

Anti-alpha4 integrin

Answer 23

Natalizumab

Reduce T cell migration

Highly active relapsing MS
Crohn’s
IV every 4 weeks

Question 24

Anti-CD11a

Answer 24

Efalizumab

Inhibits T cell migration

Psoriasis

causes PML, now withdrawn

Question 25

Anti-IL-6R

Answer 25

Tocilizumab ``` Reduces activation of: Macrophages T cells B cells Neutrophils ``` Castleman's Rheumatoid arthritis

Question 26

Anti-TNFa Antibodies

Answer 26

Infliximab Adalimumab Certolizumab Golimumab Indications and dosing - Rheumatoid arthritis - Ankylosing spondylitis - Psoriasis and psoriatic arthritis - Inflammatory bowel disease Subcutaneous or intravenous

Question 27

TNFa antagonist = TNF receptor p75-IgG fusion protein

Answer 27

Etanercept Indications and dosing - Rheumatoid arthritis - Ankylosing spondylitis - Psoriasis and psoriatic arthritis - Subcutaneous weekly Action - Inhibits TNFa and TNFb

Question 28

Antibody to p40 subunit of IL-12 and IL-23

Answer 28

Ustekinumab Indications and dosing - Psoriasis, psoriatic arthritis - Subcutaneous every 12 weeks Action Inhibits IL-12 and IL-23

Question 29

Antibody to IL17 A

Answer 29

Secukinumab Indications and dosing Psoriasis and psoriatic arthritis Ankylosing spondylitis SC load and then monthly Action Inhibits IL-17A

Question 30

Antibody directed at RANK ligand

Answer 30

Denosumab Indications and dosing Osteoporosis Subcutaneous every 6 months Action Inhibits RANK mediated osteoclast differentiation and function Toxicity Infection - Avascular necrosis of jaw

Question 31

Treatment options include inhibition of IL6, TNF alpha and depletion B cells

Answer 31

Rheumatoid arthritis

Question 32

Treatment options include inhibition of IL12/23, TNF alpha and IL17A

Answer 32

Psoriasis

Question 33

Treatment options include inhibition of RANK ligand

Answer 33

Osteoporosis