Immune system suppressors

[monroe]

immune system suppressors

Ok, so went to my doctor yesterday, first time ive seen him since ive been diagnosed, which was about 3 weeks ago. Showed me pictures of my colon and intestines (yummy!). Said I have ulcerations (ithink?) everywhere within my intestines. He asked about my medication(entocort), and we figured out it isn't working, hasn't put me into remission yet and i still have all of the same symptoms as i did before the hospital (cant eat, weight loss, etc:voodoo: ). Hes going to put me on a immune system suppressor, have no clue what its called because the name was extremely long. But I have to take a bone density test first, and from those results he'll be able to see if I'm good to go onto this new medication and he wants it done asap. Has anyone had experience with immune system suppressors? Or actually know the name of 1? Lol, any advice on the drug would be great.

 

[My Butt Hurts]

There are 3 immunosuppressors that are also known as biologics. These are Remicade (infliximab), Humira (adalimumab) and Cimzia (certolizumab). These are known as the strongest medications for Crohn's and are injected with a shot or IV.
Methotrexate is another one that is strong, but pill form I think.
Imuran (azathioprine) and 6-mp (mercaptopurine) are also immunosuppressors, but they can be taken in pill form. Prednisone is an immunosuppressor too, I think.
Those all have long names, do any of those sound familiar?? I am on 3 of those all at the same time, and I haven't noticed any compromised immune system yet. (fingers croseed)
So anyways, welcome to the forum - I hope you get your treatment started soon, and get to feeling better!

 

[monroe]

Im pretty sure its a pill he said, but theres one or two that sound familiar. I wont have to get it injected if the pill works but we'll have to wait and see. thanks a bunch.

 

[Agent X20]

I've been on azathioprine (pill form) for about 18 months and I have had an improvement in symptoms. I don't really go in for a lot of research on these things. I hate taking any sorts of drugs, but you have to keep the symptoms under control and maintain a quality of life on a day by day basis (that's my theory, anyway)

 

[drew_wymore]

There are 3 immunosuppressors that are also known as biologics. These are Remicade (infliximab), Humira (adalimumab) and Cimzia (certolizumab). These are known as the strongest medications for Crohn's and are injected with a shot or IV.
Methotrexate is another one that is strong, but pill form I think.
Imuran (azathioprine) and 6-mp (mercaptopurine) are also immunosuppressors, but they can be taken in pill form. Prednisone is an immunosuppressor too, I think.
Those all have long names, do any of those sound familiar?? I am on 3 of those all at the same time, and I haven't noticed any compromised immune system yet. (fingers croseed)
So anyways, welcome to the forum - I hope you get your treatment started soon, and get to feeling better!

Tsk tsk MBH.

Biologics are classified as Immuno-Modifiers!

Methotrexate, Azathioprine and 6-MP are immunosuppressants

Prednisone is an anti-inflammatory (amongst other things I'm sure) that suppresses the immune system due to it inhibiting the inflammatory response.

 

[My Butt Hurts]

Oopsies!! I never said I was smart, just cute.
(But I swear to GOD Humira is an immunospressant!! Help me BWS! He knows everything!)

 

[drew_wymore]

Oopsies!! I never said I was smart, just cute.
(But I swear to GOD Humira is an immunospressant!! Help me BWS! He knows everything!)

My understanding and please someone chime in and correct me if I'm wrong.

Immune suppression is wholesale suppression without regard to the type of cells being suppressed.

Immune Modulation is suppression of a specific protein atleast for Crohn's patients. TNF-a which is what is affected by Remicade, Humira, Cimzia et al.

So I guess one could say by modulating the immune system, you are suppressing it as well?

 

[Creepy Lurker]

Actually, these days they refer to Azathioprine as a modulator as well. It's a PR thing. Sounds less hard-core.

I've been on azathioprine for years now with few problems. You'll need regular blood tests to make sure your bone marrow isn't being depleted though. It'll be once a week for a month, then probably monthly for a while, then 6 monthly when it looks like you're stable.

 

[Agent X20]

Pleased to hear what you're saying about Azathioprine, Creepy. It rather freaked me out when I first had to go on it. I'm on 3 monthly blood tests now and the last one was normal. I suppose if it's not working or you're having side effects you just have to try something else.

 

[BWS1982]

Over time I gathered mostly what Drew said, actually, that immunomodulators modulate or modify the immune system's "protocol" and ways of attack, whilst immunosuppressants tend to suppress on a larger scale with little regard to specific features. They cross over a good bit though, because I've seen them almost used interchangably....but at the same time, they seem to have a purpose in their usage, if you look at this article, and read the whole thing (or skim it looking for the two terms), both terms come up a few times, and it's hard to decipher from their context why one was chosen over the other. They had to have had a reasoning though, which still has me convinced there is supposed to be a difference, and the way Drew said it makes some sense, that is what I thought. If you suppress something, you push it back or down....if you modulate something, you are modifying or changing it...both sound similar if you think about TNF inhibitors.

In the article, the way they use them can be taken both ways...

Infliximab remains effective for long-term maintenance therapy, and concomitant immunomodulators may not be necessary long-term to maintain response.

That way seems to speak of Aza and 6 MP, because you wouldn't take Remicade AND a biologic like Humira, taking both sounds crazy, I've never heard of that myself...they basically say "taking Remicade as well as concurrent immunomodulators..." and you kind of have to assume they're speaking on things like Imuran and 6MP, because that's what's left. So, it sounds like they're calling those immunomodulators, not suppressants.

Here, the conclusion uses both Immunosuppression AND Immunomodulation, and it's hard to tell how they differ:

However, these benefits from advances in therapy must be weighed against the potential risks of immunomodulation. Patients should be vigilantly monitored for the development of infection, dysplasia, and lymphoma. The potential benefit to maintaining response to biologic therapy has to be weighed against the risk of combined immunosuppression for infection and malignancy. Strategies to reduce overall immunosuppression, such as stopping azathioprine/6-mercaptopurine in patients on maintenance infliximab after 6 months, will need to be seriously considered. We look forward to future studies and registry data that will help guide management of these complex patients.

Here: http://www.medscape.com/viewarticle/536293

They seem to almost be synnonyms, yet, why use one over another in each incident?

 

[My Butt Hurts]

Benson -
I think you left out your last sentence by accident. I think it said

"So, young Drew - MBH isn't as wrong as you thought she was, since the terms seem to be able to be used interchangably. Thankfully, she's not as dumb as she looks. You now owe her 3 juicy PMs, and a nice candlelight dinner."

I don't know how that got deleted, but somehow it must have.

 

[jed]

/\lolz/\

 

[drew_wymore]

When you suppress the immune system you don't suppress just one function, you suppress the creation of white cells and other functions related to the immune response and try to limit it's response to infection, that's why we have to be careful. One of the byproducts of an immune response is inflammation.

When you are modulating the immune response, yes, you are suppressing it but in the case of TNF-a you're specifically targeting the inflammatory response. Other portions of the immune system are supposed to remain intact as far as I know.

Anyways I guess the 2 can be used interchangeably. It's a matter of the specific mechanism under which they work.

 

[BWS1982]

Drew, what you said above is pretty much what I believe, all of it. I guess I just get quite disturbed by the fact that they're (seemingly) used in place of each other so often, and the link I provided was just one example I quickly searched for, not the basis for my opinion. All my reading seems to continue to "state" my Cimzia/Remicade has been modulating and/or suppressing, and as I said, I'm confused because there has to be a reason to use one over the other, hence I've surmised there is a difference, and the only one I can come up with is to apply what I know about the terms as basic words, like you just described. This is why I just spent the last 10 months trying to use Sythroid to suppress my thyroid instead of opting for surgery, because I've been on what they keep calling suppressants AND modulators....I have a weakened immune system and higher risk for infection in an area far from my colon, and I am said to be more apt to get sick this winter as well...But like I said, why use one over the other, there has to be reasoning for that?...

I have to wonder if it's a PR/psychological thing like Creepy says, so patients don't freak as much.....There is a difference, like you pointed out, but over time they've "melted" the difference in connotation?? There's a distinct difference, but it seems they continue to be flip-flopped in usage in even medical circles....I'll ask my GI what he thinks at my next appointment...unless saidinstouch comes around. The fact that he's actually studying the damned medicines in extended education should provide some insight...haven't seen him around for a while...

Drew was mostly right IMO, but this is the new age, MBH should owe Drew a dinner, you women pushed for equal pay and complete equality for so long, now open your purses as we open our wallets. *hides behind a vast distance in which the plotted wrath of physical retribution is impractical for female members of the forum*

 

[drew_wymore]

I agree Benson. No idea why they would use them interchangeably. I think they use them in order of cost and toxicity for the most part and it's PR in terms of what they call them I think. It's easier on the mind to say suppressant then it is to modulate, because people start wondering, well what in the hell are you exactly modulating? It's sort of like "DSL and Cable Modems" .. A modem by definition modulates and demodulates an analog signal whereas DSL and Cable are digital signals all the way through and there is no modulation or demodulation going on yet it's still used as a sales tactic.



Prednisone is known very well for it's effectiveness but the side effects suck but it's cheap and works right?

Metho and Aza (suppressant supposedly) hold most of the known same sides as modulators but are cheaper and also have a longer term track record of study so most doctors know what they can expect.

Remi/Humira are much more expensive and nobody can really predict the long term effects of what these drugs might do to somebody.

 

[My Butt Hurts]

...MBH should owe Drew a dinner, you women pushed for equal pay and complete equality for so long...

Well, I'm pretty good at keeping thinks equal, but since Drew had a huge opportunity to flirt on this thread, and completely ignored the chance, AND since jed laughed when I was trying to be funny, I might take jed to dinner instead. Schnitzel and candles it is.
I know we need to talk about serious things too on the forum, but that was a good opportunity, that's all...

 

[drew_wymore]

I love being an object of opportunity.

Well, I'm pretty good at keeping thinks equal, but since Drew had a huge opportunity to flirt on this thread, and completely ignored the chance, AND since jed laughed when I was trying to be funny, I might take jed to dinner instead. Schnitzel and candles it is.
I know we need to talk about serious things too on the forum, but that was a good opportunity, that's all...

 

[My Butt Hurts]

*sigh...*