immunosupressante

Immunosuppressant, also written as immunosupressante in some contexts, refers to a substance that reduces the activity of the body's immune system. These drugs are used to prevent rejection of transplanted organs, to treat autoimmune diseases, and to manage graft-versus-host disease in stem cell transplantation.

Immunosuppressants work by limiting the activation and proliferation of immune cells, particularly T lymphocytes. They are grouped by their mechanism of action and include calcineurin inhibitors such as cyclosporine and tacrolimus; mTOR inhibitors such as sirolimus and everolimus; antimetabolites such as azathioprine and mycophenolate mofetil; corticosteroids such as prednisone; and biologic agents like rituximab or abatacept. The choice of drug, dose, and combination depends on the indication, patient factors, and the balance between efficacy and adverse effects.

Common indications include prevention of organ transplant rejection, treatment of autoimmune diseases (for example rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease), and prophylaxis or treatment of graft-versus-host disease. Monitoring is essential and typically includes drug trough levels for certain agents, routine kidney and liver function tests, complete blood counts, and surveillance for infections and metabolic complications. Adverse effects are common and may include increased susceptibility to infections, nephrotoxicity, hepatotoxicity, hypertension, hyperglycemia, dyslipidemia, osteoporosis, and an elevated risk of malignancies.

Safety and effectiveness require careful balancing of immunosuppression with infection and cancer risk, often with combination therapy and gradual tapering when possible. Drug interactions, particularly involving cytochrome P450 enzymes, can affect levels and toxicity. Patients may require vaccination updates and prophylactic measures against opportunistic infections.