Definition and Overview

Immunosuppressive therapy is a medical procedure that uses drugs to suppress or reduce immune activity to (1) transplant patients so the new organ will not be rejected by the recipient’s body and (2) patients with autoimmune disease and myelodysplastic syndrome.

The immune system is the body’s natural defense. Its main goal is to fight pathogens, such as viruses and worms, to ward off sickness and infection. It is composed of the following:

  • White blood cells, which are produced by the bone marrow, which are soft tissues found in the vertebrae of the arms and legs, as well as the pelvic region. They are responsible for attacking pathogens such as bacteria and viruses.

  • Antibodies, which are produced by the tonsils and thymus. They increase the body’s immunity by creating specific “soldiers” to fight off recurrent infections or pathogens.

  • Lymph system, which filters lymphatic fluid that helps trap these pathogens

  • Spleen, which helps boost the function of the immune system and eliminates damaged red blood cells

The immune system is designed to not only spot pathogens but also to distinguish them from healthy body tissues. However, some problems or conditions occur that cause the immune system to go into overdrive.

To control the activity of the immune system, drugs are administered to the patient. Depending on the illness, the drug may have to be taken over a certain period or throughout the patient’s lifetime.

Although the drugs are necessary, they also have major risks and complications. It’s essential that health providers discuss these properly with the patient, and the patient is encouraged to follow through regular monitoring.

Who Should Undergo and Expected Results

Immunosuppressive therapy is often recommended to:

  • Transplant patients – These are patients who have received a newly transplanted organ, such as the heart, kidney, and liver. Transplants are necessary to increase a patient’s survival after his original organ has already shut down or failed completely. Kidney transplants, for example, can extend the life of at least 90% of patients by five years or more. However, a newly transplanted organ can be viewed by the immune system as a possible threat, attacking it in the process. Immunosuppressive therapy is then prescribed to avoid the rejection of the organ.

  • Autoimmune disease – An autoimmune disease is a general term for medical conditions that are caused by an overactive immune system. The actual cause remains unknown, although various factors have been confirmed to increase the risk. These include chronic inflammation and family history. When a person has an autoimmune disease, it means that the immune system, for some reason, recognizes a healthy tissue as a foreign threat and begins to attack and destroy it. Many sufferers are able to live long lives despite their autoimmune condition, but the drugs can keep the overactivity at bay and reduce the possibility of flare-ups. Some of the most common autoimmune diseases are lupus, psoriasis, alopecia areata, multiple sclerosis, and rheumatoid arthritis.

  • Myelodysplastic syndrome (MDS) – MDS is a term used for a condition wherein normal blood cells are damaged at the bone marrow level. The drugs are provided to prevent the immune system from attacking the bone marrow. Immune-suppressing drugs work by preventing certain functions of the DNA, which is found in cells that make up the immune system. With this disruption, immune cells die and are therefore controlled.

How Does the Procedure Work?

Immunosuppressive therapy requires close coordination and relationship between the doctor and the patient. The therapy is typically not the first line of defense for various autoimmune condition, and before it is recommended, the doctor carries out tests and procedures to determine the best course of treatment.

In the case of transplant patients, these drugs are often provided to protect vital organs such as the lungs, kidneys, brain, and heart. Before the drugs are recommended, these organs have to undergo strict tests.

The doctor then creates a customized treatment plan, which has to be strictly followed by the patient. This means the patient cannot skip intake, downgrade or upgrade doses, change medication, or stop the treatment without the approval and guidance of the doctor. Otherwise, serious complications can arise.

The doctor will continue to monitor the well-being of the patient once the treatment is initiated. The specifics may be changed—for example, the dosage may be reduced—but in the majority of cases, transplant patients maintain one kind of immune-suppressing agent for the rest of their lives.

The medication—which is available in different forms like capsules, injections, and liquids—can also be an adjuvant, which means it is prescribed alongside other drugs, such as steroids. This is done to reduce the serious side effects of the latter, which include the thinning of bones.

Possible Risks and Complications

One of the major risks of immunosuppressive therapy is a poor or weakened immune system. Although this doesn’t mean the patient no longer has immunity, it can be suppressed that the patient loses the ability to completely fight off infections. Conditions that are typically manageable for a healthy person can easily turn out to be life-threatening for those under the therapy.

For this reason, patients are required to constantly monitor their vital signs and temperature. Any increase of temperature warrants a visit to the ER, particularly if the patient is still new to the therapy.

Patients are also advised to exercise great care and caution to reduce inflammation and sickness. These include staying away from sick individuals, washing hands frequently, and avoiding getting injured, among others.

Taking immunosuppressant drugs doesn’t guarantee 100% protection for the transplanted organ. Among kidney transplants, for example, at least 7% of the organs are rejected and 17% of the patients live for only about three years.

Some studies have also associated immunosuppressive therapy with decreased muscle function including poor coordination. This can be addressed by engaging in certain exercises such as weight-bearing regimen.

Reference:

  • United Network for Organ Sharing's "Transplant Living" website. U.S. Department of Health and Human Services, "Partnering with Your Transplant Team: The Patient's Guide to Transplantation, 2004."
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