Immunosuppressants

Overview

What are immunosuppressants?

Immunosuppressants are drugs that keep your immune system in check.

The body’s immune system helps fight off infections that cause illness. But sometimes, the immune system mistakenly attacks healthy cells and tissues. Immunosuppressants can slow or stop this response.

Who needs immunosuppressants?

Your healthcare provider may recommend immunosuppressants if you have:

• Autoimmune disease.
• Organ transplant.
• Stem cell or bone marrow transplant.

What’s the role of immunosuppressants in autoimmune diseases?

When you have an autoimmune disease, the immune system mistakes healthy tissue and cells for foreign invaders (like germs). The immune system essentially turns against the body and attacks it. Depending on which part of the body is under attack, this response can lead to different types of autoimmune diseases.

Immunosuppressants hold back the immune system, helping to prevent cell damage and inflammation. These drugs minimize symptoms. They can even put an autoimmune disease into remission (you have no signs of the disease).

You may need immunosuppressants if you have one of these autoimmune diseases:

• Alopecia areata.
• Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis.
• Lupus.
• Multiple sclerosis.
• Psoriasis or psoriatic arthritis.
• Rheumatoid arthritis.

What’s the role of immunosuppressants in organ transplants?

For people who get organ transplants, immunosuppressants help prevent organ rejection. Your immune system knows the new organ isn’t part of your original body. It perceives the new organ as a threat and will try to destroy it. Immunosuppressants control this response, protecting the new organ.

You will receive strong doses of immunosuppressants (induction agents) at the time of the organ transplantation. This helps ensure transplant success. To prevent organ rejection, you’ll need to take immunosuppressants (maintenance drugs) every day for life.

The medication dosage may decrease over time as your immune system adjusts to the new organ. Healthcare providers commonly prescribe prednisone for organ transplantation.

What’s the role of immunosuppressants in stem cell (bone marrow) transplants?

Stem cell transplants can treat many conditions, including:

• Blood cancers like leukemia, lymphoma and multiple myeloma.
• Blood disorders like sickle cell disease and thalassemia.
• Bone marrow problems like aplastic anemia.

Some stem cell transplants use your own cells (autologous transplant). People who have an autologous transplant don’t need immunosuppressant medications.

Allogeneic stem cell transplants replace diseased cells in your body with healthy ones from a donor (called a graft). After a transplant, donor cells begin to build a new immune system in your body (the host).

Sometimes, this new immune system views your body as foreign. The immune system may attack healthy tissues and organs. This leads to graft-versus-host disease (GVHD).

Immunosuppressants lower the chances of GVHD. You receive different intravenous (IV) or oral immunosuppressants for several weeks to months during and after a stem cell transplant. You may need to take immunosuppressants for years until the new immune system settles down.

What are the types of immunosuppressants?

Corticosteroids, such as prednisone, are among the most common immunosuppressants that healthcare providers prescribe. But there are many types of immunosuppressants. Your provider will select a medicine (or a combination of immunosuppressants) based on your specific condition and symptoms.

You may receive immunosuppressants as a pill or liquid, IV or injection (shot). Types of immunosuppressants include:

• Biologics such as adalimumab (Humira®) and infliximab (Remicade®).
• Calcineurin inhibitors such as tacrolimus (Envarsus XR® or Protopic) and cyclosporine (Gengraf®, Neoral® or Sandimmune®).
• Corticosteroids (prednisone).
• Inosine monophosphate dehydrogenase (IMDH) inhibitors such as mycophenolate mofetil (CellCept®).
• Janus kinase inhibitors such as tofacitinib (Xeljanz®).
• Mechanistic target of rapamycin (mTOR) inhibitors such as sirolimus (Rapamune®).
• Monoclonal antibodies such as basiliximab (Simulect®).