What are the 10 best immunosuppressants?
We will describe what are the 10 best immunosuppressants. Actually there are not really ‘best’ ones, just the most commonly used. That is the focus of this article.
Who needs immunosuppressants?
You may need immunosuppressants if you have a:
- Autoimmune disease
- Solid organ transplant (e.g. kidney for kidney, liver, heart or lung transplant)
- Stem cell or bone marrow transplant
- Cancer.
So. What are the 10 most common immunosuppressants?
You may receive the following immunosuppressants as a tablet, or an IV infusion or injection.
Corticosteroids
1. Prednisolone – and methylprednisolone, dexamethasone or hydrocortisone
Purine analogues
2. Mycophenolate – and azathioprine or mercaptopurine
Calcineurin inhibitors
3. Tacrolimus – and ciclosporin
mTOR inhibitor
4. Sirolimus
Polyclonal antibodies
5. Antilymphocyte (ALG) – and antithymocyte antigens (ATG)
Monoclonal antibodies (e.g. IL-2 receptor antibodies)
6. Basiliximab
Alkylating agent
7. Cyclophosphamide
Anti-TNF biological agents (TNF inhibitors)
8. Rituximab – and adalimumab or infliximab
Folic acid analogue
9. Methotrexate
Janus kinase inhibitors
10. Tofacitinib.
Other immunosuppressants
These include anti-IL-1 and anti-IL-6 biological agents, complement protein C5 binder (eculizumab), interferon (used for multiple sclerosis), sulfasalazine, leflunomide and hydroxychloroquine.
There are now many immunosuppressants (usually called immunotherapy) for cancer. These are beyond the scope of this article.
What are the side effects of immunosuppressants?
Immunosuppressants can have powerful effects on the body. Your doctors will order regular blood tests to make sure medication levels do not get too high. High doses can cause serious side effects.
Side effects vary depending on the type of immunosuppressant; generally speaking the stronger the drugs, the worse the side effects. These drugs can cause:
- Acne and stretch marks
- Diabetes (if following a transplant, can be called NODAT = ‘new onset diabetes after transplantation’). This can occur in up to 30% of patients after a transplant. Prednisolone, tacrolimus and ciclosporin can all cause diabetes
- Weakness
- Hair loss or gain
- Headaches. Trouble concentrating or remembering
- High blood pressure (hypertension)
- Gum swelling or mouth sores
- Thin bones (osteoporosis)
- Tremor
- Weight gain
- Stomach upset and nausea and vomiting
- Cancer – especially skin cancer and lymphoma (when after a transplant, it is called post-transplant lymphoproliferative disorder, PTLD).
Immunosuppression and pregnancy
Some immunosuppressants, such as methotrexate and leflunomide, can be harmful to a developing foetus; and should not be taken during pregnancy or breastfeeding.
So it is important to discuss your medication with a doctor, if you are pregnant, planning to become pregnant, or are breastfeeding.
Summary
We have described what are the 10 best immunosuppressants. We hope it has been helpful.
Other resources
This is doctors article about immunosuppressant drugs.
Last Reviewed on 13 June 2024