Immunomodulating drugs (under construction)
Dimethyl fumarate is a prodrug with neuroprotective and anti-inflammatory effects. Its active metabolite is monomethylfumarate (used to treat psoriasis). Oral dimethyl fumarate is used for the treatment of adults with relapsing-remitting multiple sclerosis.
Fingolimod is used in the treatment of highly active relapsing-remitting multiple sclerosis in patients who have high disease activity despite treatment with at least one disease modifying therapy or in those with rapidly evolving severe relapsing-remitting multiple sclerosis (initiated under specialist supervision). Fimgilimod acts as a cell migration inhibitor, promoting T cell retention in lymphoid tissues thereby reducing autoimmune responses associated with MS.
Other immunostimulants
- Bacillus calmette-guérin (BCG), the live attenuated agent used for immunisation against tuberculosis, isalso used as a nonspecific stimulant of the reticuloendothelial (macrophage) system in the treatment of high-grade non-muscle invasive bladder cancer (NMIBC) and carcinoma in-situ (CIS). Applied locally, BCG induces an inflammatory response (including infiltration of granulocytes, macrophages and lymphocytes, especially helper T cells) in the vicinity of the tumours (e.g. bladder instillation) and this leads to killing of cancer cells.
- Glatiramer acetate is a MS drug used for treatment of initial symptoms in patients at high risk of developing multiple sclerosis (initiated under specialist supervision). It is also effective for reducing relapse frequency in ambulatory patients with relapsing-remitting multiple sclerosis who have had at least 2 clinical relapses in the past 2 years (again under specialist supervision). Chemically, glatiramer acetate is a mixture of four amino acids found in myelin basic protein so is presumed to limit myelin loss in MS, however its mechanism of action is not fully understood.
- Histamine dihydrochloride is used in maintenance therapy, in combination with aldesleukin (recombinant interleukin-2), in patients with acute myeloid leukaemia in first remission.
- Mifamurtide is a chemotherapy adjunct, used after complete surgical resection in the treatment of high-grade, resectable, non-metastatic osteosarcoma. Chemically mifamurtide is a synthetic analogue of the bacterial cell wall component, muramyl dipeptide (MDP). Mifamurtide mimics MDP's action of stimulating the immune system via activation of microbial pattern recognition receptors such as TLR4 and NOD2.