Pharmacology
Immunomodulators
These medicines change how the immune system behaves rather than treating an organism or a receptor. They share a common trade-off that organises the whole section: the benefit is suppression of a damaging immune response, and the cost is reduced defence against infection and, for some, against malignancy.
5 classes across 2 mechanism families.
1. Disease-modifying antirheumatic agents
These medicines alter the course of inflammatory rheumatic disease rather than only relieving its symptoms, and share a requirement for infection screening and ongoing monitoring.
- Conventional DMARDs — Methotrexate and relatives; monitoring for marrow, hepatic and pulmonary toxicity is mandatory.
- Biologic DMARDs — Monoclonal antibodies and fusion proteins; tuberculosis screening precedes treatment.
- JAK inhibitors — Small-molecule intracellular signalling inhibitors carrying cardiovascular and malignancy warnings.
2. Immunosuppressant agents
These medicines suppress lymphocyte activation or proliferation, principally in transplantation and severe autoimmune disease, at the cost of infection and malignancy risk.
- Calcineurin inhibitors — Ciclosporin and tacrolimus; nephrotoxicity and narrow therapeutic index govern their use.
- Antimetabolite immunosuppressants — Azathioprine and mycophenolate; TPMT status and teratogenicity are the key points.
Studying this the efficient way
Learn the mechanism family first, then the classes inside it. Almost every exam question about spectrum, adverse effects or resistance is really a question about which mechanism a drug belongs to. Each class page ends with a 60-second revision block and the traps students most often fall for.