11.03.2 Drugs that Modify the Cytokine Pathways

Anakinra is a recombinant IL-1 receptor antagonist. It is a recombinant form of the endogenous IL-1 antagonist, which supresses inflammatory cascades. It is used to treat severe rheumatoid arthritis.

The interferons bind to receptors on cell infected by viruses and are used to treat viral infections like hepatitis. They also have additional anti-tumour activity and are used to treat leukaemia and lymphoma (IFNα).

The colony stimulating factors are recombinant stem cell factors used to stimulate growth of blood cell precursors. They are used to treat chemotherapy induced neutropenia and in bone marrow transplants (e.g. filgrastim).

Monoclonal antibodies to TNFα bind to TNFα and inhibit its activity. They are used in autoimmune diseases such as rheumatoid arthritis and Crohn’s disease. (e.g. etanercept, infliximab).

Drugs that modify the cytokines and/or lymphocytes (white cells) are used as immunosuppressants in organ transplant. These include a few different targets; monoclonal antibody against IL-2 (e.g. basiliximab), monoclonal antibody against the T lymphocyte CD3 (e.g. muromonab CD3) and anti-thymocyte globulins that remove leukocytes from the circulation (anti-thymocyte globulins) are all used to prevent renal transplant rejection.

Drugs that modify the cytokines and/or lymphocytes are used in treating multiple sclerosis. These drugs include glatiramer which blocks T lymphocyte recognition of myelin as an antigen, interferon β, which reduces cytokine release, while also augmenting suppressor T-cell function and natalizumab which is thought to inhibit leukocyte migration from blood to CNS, reducing the inflammation and demyelination of nerves.