Immunosuppressive agents glucocorticoids

Amongst the —> immunosuppressive agents besides the —> glucocorticoids the modern nontoxic drugs have become drugs of choice including ciclosporin, tacrolimus or ascomycin. 

Glucocorticoids Immunosuppressive Agents Bronchial Asthma Allergy... 

Glucocorticoids belong to the oldest immunosuppressive agents given to transplant recipients and are... 

In the pathogenesis of many chronic inflammatory diseases (e.g., rheumatoid arthritis, glomerulonephritis, colitis ulcerosa, Morbus Crohn, atopic dermatitis, psoriasis) autoimmune processes play an important role, too. Although first of all nonsteroidal antiinflammatory agents or glucocorticoids should be applied, immunosuppressive agents may also be indicated. 

Treatment of IBD centers on agents used to relieve the inflammatory process. Salicylates, glucocorticoids, antimicrobials, and immunosuppressive agents are commonly used to treat active disease and, for some agents, to lengthen the time of disease remission. 

The major types of drug therapy used in IBD include aminosalicylates, glucocorticoids, immunosuppressive agents (azathioprine, mercaptopu-rine, cyclosporine, and methotrexate), antimicrobials (metronidazole and ciprofloxacin), and agents to inhibit tumor necrosis factor-a (TNF-a) (anti-TNF-a antibodies). 

The major classes of immunosuppressive drugs employed in clinical practice to avoid tissue rejection include calcineurin inhibitors, target of rapamycin (TOR) inhibitors, sphingosine-1 -phosphate receptor (S1P-R) modulators, cytotoxic agents, glucocorticoids and monoclonal antibodies. These drugs need to be used on a lifelong basis and have major undesirable side effects. 

Note The glucocorticoids possess a plethora of physiological actions, including a role in differentiation and development. They are vital in die treatment of adrenal insufficiency and are used extensively in large pharmacological doses as anti-inflammatory and immunosuppressive agents. 

Leflunomide has been used as an immunosuppressive agent in kidney and liver transplant recipients to spare cal-cineurin inhibitors and glucocorticoids and to slow progression of chronic kidney graft dysfunction (28,37) (Table 1). 

Islet cell and whole pancreas transplantation are occasionally used in patients, nsually renal transplants, who reqnire immunosnp-pressive therapy for other reasons. There has been considerable interest in islet cell transplantation since investigators in Edmonton reported snccess without using glucocorticoids as immunosuppressive agents. Some of these patients are able to come off insnlin altogether. 

Natural or synthetic steroids with cortisol-like effects are called glucocorticoids. Such compiiunds can act as anti-inllainmatory or immunosuppressive agents. Synthetic glucocorticoids have found therapeutic applications in a wide range of clinical situations, c.g. asthma and connective tissue disorders. 

Glucocorticoid chemistry, pharmacokitietics, and drug interactions are described in Chapter 59. Prednisone, prednisolone, and other glucocorticoids are used alone and in combination with other immunosuppressive agents for treatment of transplant rejection and autoimmune disorders. 

Glucocorticoids are often used in conjunction with other immunosuppressive agents such as cyclophosphamide arid methotrexate, which offer better long-term control than steroids alone. 

In organ transplantation, most patients are kept on a regimen that includes glucocorticoids in conjunction with other immunosuppressive agents (see Chapter 52). 

Immunosuppressive effects Glucocorticoids inhibit some of the mechanisms involved in cell-mediated immunologic functions, especially those dependent on lymphocytes. These agents are actively lymphotoxic and are important in the treatment of hematologic cancers. The drugs do not interfere with the development of normal acquired immunity but delay rejection reactions in patients with organ transplants. 

Oral corticosteroids have many properties which may be beneficial in acute and chronic pain relief. They are principally anti-inflammatory or immunosuppressant agents that are derived from adrenal steroids and have primarily glucocorticoid activity with limited or no mineralocorticoid activity. 

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