Side Effects of Glucocorticoids

Glucocorticoids

• Patients should expect common early adverse effects, such as sweatiness, hoarse voice, loss of appetite, and stimulation.
• Rarely, more serious acute psychiatric disturbances can occur, including agitation, aggression, or psychosis.
• Long-term and less reversible adverse effects include Cushingoid appearance, proximal myopathy, hypertension, hyperlipidaemia, diabetes, cataract formation, peptic ulceration, osteopenia, and aseptic necrosis of bone.

Cytostatics

• Cytostatics inhibit cell division and are used in immunotherapy in smaller doses than in the treatment of malignant diseases.
• They affect the proliferation of both T cells and B cells.
• Examples of cytostatics include alkylating agents (e.g., cyclophosphamide), antimetabolites (e.g., folic acid analogues, purine analogues), and cytotoxic antibiotics (e.g., dactinomycin, anthracyclines, mitomycin C, bleomycin, mithramycin).

Antibodies

• Antibodies are used for quick and potent immunosuppression to prevent acute rejection reactions.
• There are two types of antibodies: polyclonal antibodies and monoclonal antibodies.
• Polyclonal antibodies inhibit T lymphocytes, cause their lysis, and affect all lymphocytes, leading to general immunosuppression and possibly post-transplant lymphoproliferative disorders or serious infections.
• Monoclonal antibodies are directed towards exactly defined antigens and cause fewer side effects.

Immunosuppressive Drugs

• Immunosuppressive drugs reduce the activation or efficacy of the immune system.
• They are used to control severe manifestations of allergic, autoimmune, and organ transplant-related diseases.
• Examples of immunosuppressive drugs include glucocorticoids, cytostatics, and antibodies.

Classification of Immunosuppressive Drugs

• Immunosuppressive drugs can be classified into three major groups: glucocorticoids, cytostatics, and antibodies.

Glucocorticoids

• Glucocorticoids act by inhibiting genes that code for cytokines IL-1, IL-2, IL-3, IL-4, IL-5, IL-6, IL-8, and TNF-γ.
• Examples of glucocorticoids include prednisolone, azathioprine, mycophenolate, and methotrexate.

Monoclonal Antibodies (mAb)

• Monoclonal antibodies are directed towards exactly defined antigens and cause fewer side effects.
• Examples of monoclonal antibodies include muromonab-CD3, Basiliximab, daclizumab, rituximab, and alemtuzumab.

Production of Monoclonal Antibodies

• Monoclonal antibodies are produced in multiple myeloma where only one clone secretes a particular type of antibody.
• In the laboratory, monoclonal antibodies can be generated by hybridoma technology.
• The process of hybridoma technology involves injecting an antigen into mice, fusing spleen cells from immunized mice with mice myeloma cells, and using polyethylene glycol as a fusion agent.