Immunosuppressant Drugs

Overview :

Immunosuppressant drugs can be classified according to their specific molecular mode of action. The three main immunosuppressant drugs currently used in organ transplantations are the following:

• Cyclosporins (Neoral, Sandimmune, SangCya). These drugs act by inhibiting T-cell activation, thus preventing T-cells from attacking the transplanted organ.
• Azathioprines (Imuran). These drugs disrupt the synthesis of DNA and RNA and cell division.
• Corticosteroids such as prednisolone (Deltasone, Orasone). These drugs suppress the inflammation associated with transplant rejection.

Most patients are prescribed a combination of drugs after their transplant, one from each of the above main groups; for example cyclosporin, azathioprine and prednisolone. Over a period of time, the doses of each drug and the number of drugs taken may be reduced as the risks of rejection decrease. However, most patients need to take at least one immunosuppressive for the rest of their lives.

Immunosuppressants can also be classified depending on the specific transplant:

• basiliximab (Simulect) is also used in combination with such other drugs as cyclosporin and corticosteroids, in kidney transplants
• daclizumab (Zenapax) is also used in combination with such other drugs as cyclosporin and corticosteroids, in kidney transplants
• muromonab CD3 (Orthoclone OKT3) is used, along with cyclosporin, in kidney, liver and heart transplants
• tacrolimus (Prograf) is used in liver transplants and is under study for kidney, bone marrow, heart, pancreas, pancreatic island cell, and small bowel transplantation

Some immunosuppressants are also used to treat a variety of autoimmune diseases:

• Azathioprine (Imuran) is used not only to prevent organ rejection in kidney transplants, but also in treatment of rheumatoid arthritis. It has been used to treat chronic ulcerative colitis, but it has been of limited value for this use.
• Cyclosporin (Sandimmune, Neoral) is used in heart, liver, kidney, pancreas, bone marrow and heart/lung transplantation. The Neoral form has been used to treat psoriasis and rheumatoid arthritis. The drug has also been used for many other conditions including multiple sclerosis, diabetes and myesthenia gravis.
• Glatiramer acetate (Copaxone) is used in treatment of relapsing-remitting multiple sclerosis. In one study, glatiramer reduced the frequency of multiple sclerosis attacks by 75% over a two-year period.
• Mycopehnolate (CellCept) is used along with cyclosporin in kidney, liver and heart transplants. It has also been used to prevent the kidney problems associated with lupus erythematosus.
• Sirolimus (Rapamune) is used in combination with other drugs including cyclosporin and corticosteroids, in kidney transplants. The drug is also used for the treatment of psoriasis.
  
  

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