How Do Immunomodulators Work?

Immunomodulators are drugs that can support the immune function by modifying, in a beneficial way, the immune system’s response to a threat. They are used to treat conditions such as multiple sclerosis (wherein the nerves do not function properly), hereditary angioedema (HAE-an immune disease passed down through families), rheumatoid arthritis (a condition in which the body attacks its own joints causing pain, swelling, and loss of function), and Cryopyrin-associated periodic syndromes (CAPS). Although they do not cure multiple sclerosis and HAE, they may reduce the episodes of symptoms in patients with relapsing-remitting multiple sclerosis (course of disease where symptoms flare up from time to time) and slow down the progression of the disease.

The immune system is a complex network of cells, tissues, and organs. Together, they help the body fight infections and diseases. When the immune system recognizes an antigen (a substance that the body identifies as harmful or foreign) which can be germs such as bacteria and viruses, chemicals or toxins, and cells that are damaged from cancer or sunburn, it produces antibodies (proteins that work to attack, weaken, and destroy antigens).

The three different types of immunity:

• Innate immunity: it is the body's first line of defense. It includes barriers such as the skin and mucous membranes.
• Active immunity (also known as adaptive immunity): It develops after an infection or vaccination against a foreign substance, usually lasts for a lifetime.
• Passive immunity: when antibodies to disease are received through blood products, lasting a few weeks or months.
• Immunomodulators are prescription-only medicines and are administered via oral and intravenous (through a vein), and subcutaneous (under the skin) routes.

Immunomodulators work in the following ways:

• They work by decreasing inflammation and preventing nerve damage that may cause symptoms of multiple sclerosis.
• They prevent the immune system from attacking the nerves in the brain and the spinal cord.
• They block a natural substance produced by the body “kallikrein” which acts to increase another natural substance “bradykinin.” Bradykinin is thought to cause the symptoms of an HAE attack.
• They help to slow down or stop the growth of the cancer cells.
• They block the activity of interleukin, a substance in the body that causes inflammation.
• In addition, they block a natural protein in the body “interleukin-1” that may worsen the symptoms of CAPS.

Immunomodulators are used in conditions such as:

• Multiple sclerosis (a disease in which the nerves do not function properly, characterized by weakness, numbness, loss of muscle coordination, and problems with vision, speech, and bladder control)
• HAE (a condition caused by the shortage of a protein called C1 esterase inhibitor can lead to repeated attacks of swelling, pain in the abdomen, and difficulty breathing)
• Acute lymphatic leukemia (a type of cancer that begins in the white blood cells)
• Rheumatoid arthritis (an autoimmune and inflammatory disease marked by symptoms of inflammation and pain in the joints)
• Crohn’s disease (a chronic, or long-term, condition that causes inflammation of the digestive tract)
• Ulcerative colitis (an inflammatory bowel disease that affects your large intestine, causing irritation, inflammation, and ulcers in the colon)
• Condylomata acuminata (genital warts caused by the human papillomavirus)
• Cryopyrin-associated periodic syndromes (a group of illnesses related to defects in the protein cryopyrin that causes recurrent episodes of fever, a hive-like rash, joint pain and swelling, red eyes, and headache)
• Deficiency of interleukin-1 receptor antagonist (a disorder in which the body attacks its own tissues causing inflammation and damages bones, nervous system, skin, lungs, liver, and joints) 
• Pericarditis (swelling and irritation of the thin, saclike tissue surrounding the heart)
• Still’s disease (a rare illness that causes high fevers, rash, and joint pain)
• Bronchiolitis obliterans (a type of obstructive lung disease of the small airways)
• Kidney transplant rejection
• Capillary leakage syndrome (a rare disorder characterized by repeated flares of massive leakage of plasma from blood vessels into neighboring body cavities and muscles)
• Friedreich's ataxia (a rare genetic disease that causes difficulty in walking, a loss of sensation in the arms and legs, and impaired speech)
• Amyotrophic lateral sclerosis (a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord)
• Hemophagocytic lymphohistiocytosis (a rare disease that usually occurs in infants and young children)
• Demyelinating polyneuropathy (a neurological disorder characterized by progressive weakness and impaired sensory function in the arms and legs)
• Multicentric Castleman disease (an abnormal overgrowth of lymph cells in more than one part of the body that may cause symptoms and increase the risk of developing a serious infection or cancer)
• Familial cold auto-inflammatory syndrome (symptoms include rash, fever, and joint pain triggered by exposure to cold temperatures)
• Muckle wells syndrome (a disorder characterized by periodic episodes of skin rash, fever, and joint pain)
• Neonatal-onset multisystem inflammatory disease (a disorder that causes inflammation and damages the nervous system, skin, and joints)

Common side effects include:

• Abdominal pain
• Asthenia (physical weakness or lack of energy)
• Chills
• Diarrhea
• Constipation
• Dyspnea (shortness of breath)
• Fever
• Headache 
• Malaise (a feeling of weakness, overall discomfort, and illness)
• Nausea
• Vomiting
• Flushing
• Muscle cramps
• Back/joint pain 
• Drowsiness
• Pain, redness, swelling, itching, or lump at the injection site

Other rare side effects include:

• Leukopenia (reduced number of white blood cells)
• Peripheral edema (swelling of lower legs or hands)
• Tachycardia (a fast heart rate—more than 100 beats per minute)
• Thrombocytopenia (low blood platelet count)
• Dizziness (feeling faint, weak, or unsteady)
• Increased sweating
• Alopecia (a condition that causes hair to fall out in small patches)
• Urinary tract infection
• Mental/mood changes (depression, thoughts of suicide)
• Rapid and shallow breathing
• Chest pain/heaviness
• Swelling of the ankles, feet, and hands
• Elevated liver function test
• Trouble sleeping
• Hallucinations (involves hearing, seeing, feeling, smelling, or even tasting things that are not real)
• Hives (itchy, raised welts that are found on the skin)
• Wheezing (a high-pitched whistling sound made while breathing) 
• Skin rash on arms or cheeks 
• Unusual weight gain
• Liver problems such as:
  • Nausea/vomiting that does not stop
  • Loss of appetite
  • Stomach/abdominal pain
  • Yellowing eyes/skin
• Signs of kidney problems:
  • Change in the amount of urine
  • Pink/bloody/frothy urine

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of immunomodulators include:

• 6Mercaptopurine
• 6MP
• Alferon N
• Anakinra
• Arcalyst
• Avonex
• Bafiertam
• Berinert
• Betaseron
• BG-12
• C1 esterase inhibitor recombinant
• C1 inhibitor human
• Cinryze
• Copaxone
• Dimethyl fumarate
• Diroximel fumarate
• Ecallantide
• Emapalumab
• Emapalumab-lzsg
• Extavia
• Fingolimod
• Firazyr
• Gamifant
• Gilenya
• Glatiramer
• Glatopa
• Haegarda
• Icatibant
• Infergen
• Interferon alfa n3
• Interferon alfacon 1
• Interferon beta 1a
• Interferon beta 1b
• Kalbitor
• Kineret
• Mercaptopurine
• Monomethyl fumarate
• Peginterferon beta-1a
• Plegridy
• Purinethol
• Purixan
• Rebif
• Rebif rebidose
• Remestemcel-L
• Rilonacept
• Ropeginterferon alfa 2b
• Ruconest
• Ryoncil
• Siltuximab
• Sutimlimab
• Sylvant
• Tecfidera
• Vumerity