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immunosuppressive agent
Function:
- immunosuppression
- inhibition of autoimmunity
Laboratory:
- liver function tests
- complete blood count every 3 months
- screening for tuberculosis, hepatitis B, hepatitis C & HIV1 infection prior to initiation of aggressive immunosuppressive therapy [1]*
- screening for viral infection & before or during immunosuppressive therapy [1,3]
- hepatitis A serology
- hepatitis B serology
- hepatitis C serology
- HIV1 serology
- Epstein-Barr virus serology
- cytomegalovirus serology
- varicella-zoster virus serology
- measles virus serology
- papillomavirus DNA in urine
- screening for tuberculosis
- surveillance for opportunistic infections
* antibiotic therapy must be started prior to initiation of immunosuppressive agent
* also see ARUP consult [2]
Management:
- vaccines
- avoid live virus vaccines with immunosuppressive therapy
- delay live virus vaccination 1-6 months after discontinuation of immunosuppressive therapy
- Shingrix vaccine recommended
- infectious diseases
- may need to hold doses of immunosuppressive agents during infections that require antimicrobial therapy [1]
- discontinue immunosuppressive therapy if disseminated CMV infection [3]
- chemoprophylaxis after Pneumocystis jirovecii infection [3]
Interactions
drug interactions
drug adverse effects of immunosuppressive agents
monitor with immunosuppressive agents
Specific
alefacept (Amevive)
anti-thymocyte globulin (ATG)
azathioprine (Azanin, Imuran, Imurel)
basiliximab (Simulect)
belatacept (Nulojix)
belumosudil (Rezurock)
biologic immunosuppressive agent (biologic agent, biologic immune modulator)
cyclophosphamide (Cytoxan, Neosar, Procytox {Canadian}) [CPM, CTX, CYT, NSC 26271]
cyclosporin A (Sandimmune, Neoral [CsA])
daclizumab (Zinbryta)
efalizumab (Raptiva)
glucocorticoid
mTOR inhibitor; target of rapamycin inhibitor
mycophenolate (Cellcept, Myfortic)
natalizumab (Tysabri)
rhuMAB-E25
risankizumab (Skyrizi)
tacrolimus; FK506; fujimycin (Prograf, Advagraf, Envarsus XR)
vedolizumab (Entyvio)
voclosporin (Lupkynistm)
General
biological response modifier; immune factor; immunomodulator; biomodulator
References
- Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18.
American College of Physicians, Philadelphia 2012, 2015, 2018
- ARUP Consult: Immunosuppressive Drug Optimization and Monitoring -
Organ Transplantation Drugs
The Physician's Guide to Laboratory Test Selection & Interpretation
https://www.arupconsult.com/content/organ-transplantation
- European Crohn's and Colitis Organisation
Infections in Inflammatory Bowel Disease Clinical Practice Guidelines (ECCO, 2021).
Medscape. August 10, 2021
https://reference.medscape.com/viewarticle/956233