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INTRODUCTION

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This chapter will be most useful after having a basic understanding of the material in Chapter 35, Immunosuppressants, Tolerogens, and Immunostimulants in Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition. In addition to the material presented here, the 12th Edition contains:

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  • Figure 35-3 Generation of monoclonal antibodies that illustrates the method used to generate monoclonal antibodies

  • The molecular structures of immunotherapeutic drugs

  • A Case Study: Immunotherapy for Multiple Sclerosis that includes Table 35-3 Pharmacotherapy of Multiple Sclerosis listing specific pharmacotherapies for treating multiple sclerosis (MS)

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LEARNING OBJECTIVES

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  • Understand the mechanisms of action of drugs used to suppress the immune response in organ transplantation and autoimmune diseases.

  • Understand the mechanisms of action of drugs used to stimulate the immune system.

  • Know the untoward effects of immunotherapeutic drugs.

  • Know the drugs used at each step in organ transplantation.

  • Know the drugs used in treating different autoimmune disorders.

  • Know which immunotherapeutic drugs are used in combination with other drugs.

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DRUGS INCLUDED IN THIS CHAPTER

  • Abatacept (ORENCIA)

  • Adalimumab (HUMIRA)

  • Aldesleukin (PROLEUKIN)

  • Alefacept (AMEVIVE)

  • Alemtuzumab (CAMPATH)

  • Anakinra (KINERET)

  • Azathioprine (IMURAN, others)

  • Bacillus Calmette–Guerin (BCG; TICE BCG, THERACYS)

  • Basiliximab (SIMULECT)

  • Belatacept (NULOJIX)

  • Canakinumab (ILARIS)

  • Cyclosporine (NEORAL, SANDIMMUNE, GENGRAF, others)

  • Daclizumab (ZENAPAX)

  • Efalizumab (RAPTIVA)

  • Etanercept (ENBREL)

  • Everolimus

  • Glatiramer acetate (GA; COPAXONE)

  • Immune globulin preparations such as ATG (see Table 23-1)

  • Infliximab (REMICADE)

  • Interferon-α-2b (IFN-α-2b; INTRON A)

  • Interferon-β-1a (IFN-β-1a; AVONEX, REBIF)

  • Interferon-β-1b (IFN-β-1b; BETASERON)

  • Interferon-γ-1b (IFN-γ-1b; ACTIMMUNE)

  • Lenalidomide (REVLIMID)

  • Mitoxantrone (NOVANTRONE, others)

  • MPA (MYFORTIC)

  • Muromonab-CD3 (OKT3, ORTHOCLONE OKT3)

  • Mycophenolate mofetil (MMF, CELL-CEPT)

  • Natalizumab (TYSABRI)

  • Rilonacept (IL-1 TRAP)

  • Sirolimus (rapamycin; RAPAMUNE)

  • Some cancer chemotherapeutic agents (see Chapter 45)

  • Tacrolimus (PROGRAF, FK506)

  • Tacrolimus (PROGRAF, PROTOPIC, others)

  • Thalidomide (THALOMID)

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Table Graphic Jump Location
Table 23-1Selected Immune Globulin Preparations
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THE IMMUNE RESPONSE

  • The immune system is composed of 2 complementary mechanisms, described as innate and adaptive immunity, capable of discriminating self from nonself (microbes and tumors).

  • Characterisitics of innate (natural) immunity:

    • Does not require priming

    • Broadly reactive

    • Relatively low affinity

    • The ...

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