B/31. Immunopharmacology III. (Antibodies and fusion proteins)

Question 1

Drugs need to know in this topic

Answer 1

ATG (antithymocyte-globulin) rituximab infliximab adalimumab tocilizumab ustekinumab natalizumab dupilumab abatacept

Question 2

Immunosuppressive antibodies

Answer 2

IVIG (intravenous immunoglobulin) ATG, ALG Rh0(D) immunoglobulin

Question 3

ATG (antithymocyte-globulin)

Answer 3

Selective inhibition of cellular immunity:

Ab’s bind T cells involved in antigen recognition → initiate their destruction by serum complement

1. Immunoglobulin
   preparation prepared in
   horse, sheep, or rabbits
2. IV administration
3. Stem cell transplantation (prevent graft-vs-host disease)
4. Solid organ transplantation
5. Primary aplastic anemia (immune-mediated process)
6. Hypersensitivity reaction (serum sickness, anaphylaxis)
7. Injection-site reaction

Question 4

Rituximab

Answer 4

1. Anti-CD20
2. Reduce B-cell count
3. Chimeric monoclonal Ab
4. Parenteral
5. B-cell lymphoma
6. Autoimmune diseases (RA, vasculitis)
7. Solid-organ transplantation
8. Injection site reaction
9. Infections
   *Complete recovery of B-cell lineage may take up to 6 m’

Question 5

Infliximab

Answer 5

1. Anti-TNF-α
2. Decrease formation of
   interleukin and adhesion molecules
   involved in leukocyte activation
3. Chimeric monoclonal Ab
4. Parenteral
5. Autoimmune diseases (RA, ankylosing spondylitis, psoriasis)
6. IBD
7. Injection site reaction
8. Infections (opportunistic)
9. Reactivation of latent TB
10. Lymphoma

Question 6

Adalimumab

Answer 6

1. Anti-TNF-α
2. Decrease formation of
   interleukin and adhesion molecules
   involved in leukocyte activation
3. Human monoclonal Ab
4. Parenteral
5. Rheumatoid arthritis
6. Injection site reaction
7. Infections (opportunistic)
8. Reactivation of latent TB
9. Lymphoma

Question 7

Tocilizumab

Answer 7

1. Anti-IL-6 receptor
2. Affect both B and T cell function
3. Humanized monoclonal Ab
4. Parenteral
5. Rheumatoid arthritis
6. Juvenile idiopathic arthritis
7. Neutropenia
8. Injection site reaction
9. Infections

Question 8

Ustekinumab

Answer 8

1. Anti-IL-12 and IL-23
2. Inhibit activation of TH1 and TH17 cells
3. Human monoclonal Ab
4. Parenteral
5. Chron’s disease
6. Psoriasis (plaque disease, psoriatic arthritis)
7. Injection site reaction
8. Infections

Question 9

Natalizumab

Answer 9

1. Anti-integrin α4β1
2. Inhibit T cell activity
3. Humanized monoclonal Ab
4. Parenteral
5. Multiple sclerosis
6. Chron’s disease
7. Injection site reaction
8. Infection
9. Reactivation of the JC virus, may develop PML disease
   (progressive multifocal leukoencephalopathy) –
   demyelinating disease affecting CNS white matter

Question 10

Dupilumab

Answer 10

1. Anti-IL-4 receptor α
2. Human monoclonal Ab
3. Parenteral
4. Atopic dermatitis
5. Allergic reaction
6. Conjunctivitis, keratitis

Question 11

Abatacept

Answer 11

1. CTLA-4 fusion protein → binds CD80/86 on APC
2. Inhibit T cell costimulatory signal (CD28 receptors on T- cells)
3. Composed of the Fc region
4. of immunoglobulin IgG1 fused to the extracellular domain of CTLA-4
5. Rheumatoid arthritis
6. Juvenile idiopathic arthritis
7. Psoriasis
8. Infections
9. Production of neutralizing Ab’s