Immunosuppressants

Mechanisms by class

Immunosuppressant drug classes act through distinct mechanisms - calcineurin inhibitors (blocking T-cell activation signalling), antiproliferative agents (blocking lymphocyte DNA synthesis), corticosteroids (broad anti-inflammatory/immunosuppressive genomic effects), and biologics (targeted cytokine or cell-surface receptor blockade) - mechanism determines both therapeutic use and characteristic infection/malignancy risk profile
Calcineurin inhibitors (ciclosporin, tacrolimus) block calcineurin-mediated IL-2 gene transcription, preventing T-cell activation and proliferation - narrow therapeutic index requiring therapeutic drug monitoring, with characteristic nephrotoxicity from direct renal vasoconstrictive effect
Corticosteroids exert broad genomic anti-inflammatory effects across multiple immune cell types, explaining both their broad efficacy and their extensive, well-characterised adverse effect profile (metabolic, bone, infection risk) with prolonged use

Used across transplant medicine (preventing rejection) and autoimmune/inflammatory disease management, with agent selection and combination matched to the specific clinical indication and required intensity of immunosuppression

All significant immunosuppression carries elevated infection risk (opportunistic and conventional pathogens) and, with prolonged use, elevated malignancy risk (particularly skin cancer and lymphoproliferative disease) - requiring proactive screening (see ) and vaccination planning (see ) before and during treatment

Therapeutic drug monitoring for calcineurin inhibitors given narrow therapeutic index and nephrotoxicity risk at supratherapeutic levels
Pre-treatment screening (latent TB, hepatitis B/C, and vaccination status review) before starting significant immunosuppression, particularly biologic therapy

Calcineurin inhibitor nephrotoxicity and therapeutic drug monitoring, elevated skin cancer risk with prolonged immunosuppression (see ), pre-treatment infection screening, biologic therapy-specific risks (e.g. reactivation of latent infections)

Pre-treatment screening for latent infections (tuberculosis, hepatitis B) and vaccination status review is an essential step before starting significant immunosuppression, not an optional consideration - starting immunosuppression in a patient with unrecognised latent TB or hepatitis B risks serious reactivation disease that is preventable with appropriate pre-treatment assessment and prophylaxis

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