Modulating Drugs Flashcards
Anti-CTLA4
Iplimumab
Advanced melanoma
Increase T cell response
Anti-PD1
Pembrolizumab
Nivolumab
Advanced Melanoma
Increase T cell response
Alkylates gunaine base of DNA
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
Blocks de novo purine (eg adenine, guanine) synthesis
Azathioprine
Indications
Transplantation
Auto-immune disease
Auto-inflammatory diseases, eg Crohn’s, ulcerative colitis
Blocks de novo nucleotide synthesis
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
Side effect of Progressive multifocal leukoencephalopathy (JC virus)
Mycophenolate Mofetil
Indications for plasmapheresis
Severe antibody-mediated disease
Goodpastures syndrome
Severe acute myasthenia gravis
Severe vascular rejection
Calcineurin inhibitors
Cyclosporin
Tacrolimus
Prevents IL-2 upregulation
Use post-transplant
Dysmorphism
Cyclosporin
JAK inhibitor antibody
Tofacitinib (inhibits cell signalling)
Rheumatoid Arthritis
PDEF 4 inhibitor antibody
Apremilast (inhibits cell signalling)
Psoriasis
Psoriatic arthritis
Neutropenia particularly if TPMT low
Azathioprine
Infertility
Cyclophosphamide
Inhibits T cell migration but may only be used in highly active remitting/relapsing MS
Natalizumab (Anti-a4 integrin
Inhibits T cell activation and is effective in rheumatoid arthritis
Abatacept (CTLA4-Ig fusion protein)