Immunomodulators

What are immunomodulators?

Immunomodulators are drug treatments that change your body’s immune response. Your immune system is a vast network of organs, white blood cells, proteins and other chemicals that protect you from threats. Germs and diseased cells, like cancer cells, cause a healthy immune system to spring into action to fight.

Several conditions can prevent your immune system from working to protect you. When this happens, you may need an immunomodulator to help your immune system work more effectively.

How do immunomodulators work?

Immunomodulators fall into two general categories based on how they work. Immunomodulators may:

• Increase your immune response. For example, immunomodulators treat cancer by helping your immune system destroy cancer cells.
• Decrease your immune response. These immunomodulators are called immunosuppressants. Your provider may prescribe an immunosuppressant if you have an autoimmune disease. With an autoimmune disease, your immune system attacks healthy cells. Immunosuppressants can prevent or slow the attack. Immunosuppressants can also prevent your immune system from attacking donated tissue following a procedure like an organ transplant or an allogeneic stem cell transplant.

Which conditions do immunomodulators treat?

Immunomodulators treat many conditions, including:

• Ankylosing spondylitis.
• Crohn’s disease.
• Graft vs. host disease (GvHD).
• Inflammatory bowel disease.
• Juvenile idiopathic arthritis.
• Lupus.
• Myositis.
• Multiple sclerosis.
• Pericarditis.
• Plaque psoriasis.
• Psoriasis.
• Psoriatic arthritis.
• Rheumatoid arthritis.
• Rheumatoid vasculitis.
• Sjögren’s syndrome.
• Ulcerative colitis.
• Uveitis.
• Some cancers, allergies and infections.

What are the types of immunomodulators?

Immunomodulators include many drug classes and drug types that treat many conditions. They work in various ways to increase or suppress your immune response.

Immunotherapy for cancer

Immunotherapy trains your immune system so it’s better at finding cancer cells and killing them. Cancer cells are good at bypassing your immune system’s typical defenses. Immunotherapy boosts your immune response, making it harder for cancer cells to thrive.

Types include:

• Checkpoint inhibitors: Cancer cells hide from your immune system by turning off the signals that tell cancer-fighting cells (T-cells) to attack. Checkpoint inhibitors keep the signals turned on.
• Adoptive cell therapy (T-cell transfer therapy): This treatment removes T-cells from your body and changes them in a lab so they’re better at fighting cancer cells.
• Monoclonal antibody therapy: Antibodies are proteins in your body that fight threats. Monoclonal antibody therapy uses lab-made copies of your body’s antibodies to fight cancer.
• Cancer vaccines: Cancer vaccines train your immune system to recognize cancer cells. If a cancer cell forms, your immune system can identify and attack it.
• Immune system modulators: This treatment interferes with the processes cancer cells use to make more cancer cells. Types include cytokines, Bacillus Calmette-Guerin (BCG) and biologic response modifiers. Biologic response modifiers include Thalidomide (Thalomid®), Lenalidomide (Revlimid®), Pomalidomide (Pomalyst®) and Imiquimod (Aldara®, Zyclara®).

Corticosteroids

Corticosteroids lessen your immune response and reduce inflammation in your body. They’re some of the most commonly prescribed immunosuppressants. Corticosteroids treat autoimmune conditions, allergies and some cancers.

Examples include:

• Prednisone.
• Prednisolone.
• Dexamethasone.

Traditional DMARDs

Disease-modifying antirheumatic drugs (DMARDs) include many medicines that lessen your immune response. A decreased response reduces pain and inflammation. DMARDs are a common treatment for rheumatoid arthritis. Some forms also treat other autoimmune conditions, allergies, skin conditions and some cancers. Some traditional DMARDs may also prevent your body from rejecting an organ following a transplant.

Examples include:

• Azathioprine (Imuran®).
• Cyclosporine (Gengraf® and Neoral®).
• Hydroxychloroquine (Plaquenil®).
• Leflunomide (Arava®).
• Methotrexate (Rheumatrex®, Trexall®).
• Sulfasalazine (Azulfidine®).

Biologics

Biologics are a newer form of DMARDs. They consist of proteins engineered in a lab. Biologics target specific cells and pathways that cause inflammation. They’re stronger than traditional DMARDs.

Types include:

• Tumor necrosis factor (TNF) inhibitors: These drugs limit the effects of TNF, a substance that causes inflammation in your body. TNF inhibitors include adalimumab (Humira®), certolizumab pegol (Cimzia®), etanercept (Enbrel®), golimumab (Simponi®) and infliximab (Remicade®).
• Interleukin-1 (IL-1) inhibitors: These drugs block the effects of IL-1, a protein that causes inflammation. Examples include anakinra (Kineret®), canakinumab (Ilaris®) and rilonacept (Arcalyst®).
• Interleukin-6 (IL-6) inhibitors: These drugs block the effects of IL-6, another protein that causes inflammation. Examples include tocilizumab (Actermra®) and sarilumab (Kevzara®).
• T-cell inhibitor: These drugs prevent your body’s T-cells from killing healthy cells. An example of a T-cell inhibitor is abatacept (Orencia®).
• B-cell inhibitor: These drugs prevent your body’s B-cells from releasing antibodies that attack your body’s healthy cells. An example of a B-cell inhibitor is rituximab (Rituxan®).

Janus kinase inhibitors

Janus kinase inhibitors are DMARDs that are like biologics. They’re sometimes called biosimilars. These drugs reduce inflammation by limiting the activity of certain enzymes (Janus kinases).

Examples include:

• Baricitinib (Olumiant®).
• Tofacitinib (Xeljanz®).
• Upadacitinib (Rinvoq®).

How are immunomodulators administered?

Your prescription will include instructions about how you’ll receive your medicine. Ask your healthcare provider if you have any questions about how you should take them.

You may receive an immunomodulator:

• By IV:The drug travels through a plastic catheter that connects to your vein. From there, the medicine travels through your bloodstream.
• By injection:You receive a shot into the fatty tissue underneath your skin.
• Orally:You take a pill or tablet.
• Topically (cream):You apply the medicine onto your skin as a cream. For example, imiquimod is a cream that fights some forms of skin cancer. Also, many forms of corticosteroids go directly onto your skin.

What are the side effects of immunomodulator treatment?

Potential side effects differ depending on the specific treatment you’re receiving.

Some of the more common side effects include:

• Fatigue.
• Drowsiness.
• Diarrhea.
• Nausea and vomiting.
• Loss of appetite.
• Rash.

Discuss all potential side effects with your healthcare provider before starting an immunomodulator.

What are the risks of immunomodulators?

Your immune system is an important regulatory system in your body. Changing your immune system can interrupt processes that protect you from germs and diseases. For example, suppressing your immune system can increase your risk of infections.

Immunomodulators that stimulate your immune system can cause autoimmune reactions. This means your immune system attacks your own tissues. This most commonly leads to issues with:

• Hormone levels.
• Skin rash.
• Diarrhea.
• Difficulty breathing.

Your healthcare provider can discuss these risks with you. Depending on the medicine you’re taking, you may need regular appointments to ensure the medicine is helping without putting you at risk.

How effective are immunomodulators?

Effectiveness depends on your condition and your specific treatments. Immunomodulators can help manage symptoms or prevent your condition from worsening.

A note from Cleveland Clinic

Immunomodulators are medicines that change your immune system so it works more effectively. Ask your healthcare provider what to expect if you’re on an immunomodulator. Uses of immunomodulators are as varied as the conditions they treat. Your provider can explain the benefits and potential risks of any new treatments, including immunomodulators.