Immunomodulatorie

Immunomodulatorie (immunomodulatory agents) are substances or therapies that modify the immune response, enhancing or suppressing its activity. They include biologics, small molecules, and cytokines that affect innate or adaptive immunity, influencing processes such as cytokine production, cell activation, antigen presentation, or immune tolerance. Immunomodulation can be subdivided into immunostimulation, aiming to boost host defense, and immunosuppression, reducing harmful inflammation or autoimmunity. Many agents have context-dependent effects and may act at multiple levels of the immune system.

Immunostimulants include certain cytokines and Toll-like receptor agonists, and some topical agents such as imiquimod. Immunosuppressants encompass corticosteroids, calcineurin inhibitors (cyclosporine, tacrolimus), and antimetabolites (azathioprine, methotrexate), which dampen T cell function to prevent organ rejection or treat autoimmune disease. Targeted immunomodulatory therapies comprise monoclonal antibodies (rituximab, adalimumab, pembrolizumab) and small molecules (tofacitinib) that interfere with specific immune pathways such as B cell signaling, TNF, or the JAK-STAT and CTLA-4/PD-1 axes. Immunomodulatory drugs (IMiDs) such as thalidomide, lenalidomide, and pomalidomide influence cytokines, immune cell activity, and the tumor microenvironment.

Applications span autoimmune diseases (for example rheumatoid arthritis, inflammatory bowel disease), transplant medicine, and cancer immunotherapy. In oncology, checkpoint inhibitors and adoptive cell therapies seek to enhance anti-tumor immunity. Safety considerations include increased infection risk, thromboembolism, cytopenias, and immune-related adverse events, with regulatory status varying by indication and product class.