Immunosuppressors and immunomodulators in Neurology - Part I: a guide for management of patients underimmunotherapy

Abstract

For patients with autoimmune diseases, the risks and benefits of immunosuppressive or immunomodulatory treatment are a matter of continual concern. Knowledge of the follow-up routine for each drug is crucial, in order to attain better outcomes and avoid new disease activity or occurrence of adverse effects. To achieve control of autoimmune diseases, immunosuppressive and immunomodulatory drugs act on different pathways of the immune response. Knowledge of the mechanisms of action of these drugs and their recommended doses, adverse reactions and risks of infection and malignancy is essential for safe treatment. Each drug has a specific safety profile, and management should be adapted for different circumstances during the treatment. Primary prophylaxis for opportunistic infections and vaccination are indispensable steps during the treatment plan, given that these prevent potential severe infectious complications. General neurologists frequently prescribe immunosuppressive and immunomodulatory drugs, and awareness of the characteristics of each drug is crucial for treatment success. Implementation of a routine before, during and after use of these drugs avoids treatment-related complications and enables superior disease control.

Screening for severe drug-drug interactions in patients with multiple sclerosis: A comparison of three drug interaction databases

“…However, concurrent use of immunomodulatory or immunosuppressive therapies can have additive effects on the immune system, thereby increasing infectious risks. Therefore, corticosteroid treatment for relapses should be limited (3-5 days) in MS patients receiving DMDs, and a decision for prolonged or repeated high-dose corticosteroid use should be made on an individual basis after careful consideration (Arvin et al, 2015;Abrantes et al, 2021). The pDDI resulting from the combination of citalopram with fingolimod was classified as severe due to the risk of ventricular arrhythmias, but clinical studies revealed no additional risk of abnormal electrocardiogram findings in patients who received fingolimod and SSRIs compared with patients receiving fingolimod therapy alone (Bermel et al, 2015;Bayas et al, 2016).…”