Immunomodulators are a group of drugs that manipulate the immune system to treat various conditions, including multiple myeloma and autoimmune diseases. They can be classified into immunostimulants, which enhance immune responses, and immunosuppressants, which decrease immune activity. The document discusses various types of immunomodulating drugs, their mechanisms of action, therapeutic uses, and potential side effects.

1. K.RAHUL
GRACE COLLEGE OF PHARMACY,
PALAKKAD

2. Immunomodulators are a group of drugs that mainly target the pathways
that treat multiple myeloma and a few other cancers. They have many ways
to work, including working on the immune system directly by turning down
some proteins and turning up others

3. • Immunostimulators are prescribed to enhance the immune
response against infectious diseases, tumours, primary or secondary
immunodeficiency, and alterations in antibody transfer, among others
• Immunosuppressive drugs are used to reduce the immune response
against transplanted organs and to treat autoimmune diseases such as
pemphigus, lupus, or allergies

5. Immunostimulants, also known as immunostimulators, are substances (drugs and
nutrients) that stimulate the immune system by inducing activation or increasing
activity of any of its components. One notable example is the granulocyte
macrophage colony-stimulating factor.
Thalidomide (Thalomid), lenalidomide (Revlimid), and pomalidomide (Pomalyst) are
known as immunomodulating drugs (or IMiDs).
The use of a variety of agents to enhance immunological and nonspecific host defences and
thus to modify the defences favourably is an exciting development in
immunopharmacology. Such agents may act by:
• Increasing the humoral antibody responses,
• Enhancing the phagocytic activity of macrophages, or
• Modifying the cell-mediated immune responses

7. There are two main categories of immunostimulants:
•Specific immunostimulants provide antigenic specificity in immune response, such as
vaccines or any antigen.
•Non-specific immunostimulants act irrespective of antigenic specificity to augment
immune response of other antigen or stimulate components of the immune system
without antigenic specificity, such as adjuvants and non-specific immunostimulators.
Non-specific
Many endogenous substances are non-specific immunostimulators. For example, female
sex hormones are known to stimulate both adaptive and innate immune responses. Some
autoimmune diseases such as lupus erythematosus strike women preferentially, and their
onset often coincides with puberty. Other hormones appear to regulate the immune
system as well, most notably prolactin, growth hormone and vitamin D.

8. •Bacterial vaccines
•Colony stimulating factors
•Interferons
•Interleukins
•Other immunostimulants
•Therapeutic vaccines
•Vaccine combinations
•Viral vaccines

10. •Levamisole
•Thalidomide
•Bcg
•Recombinant
cytokines
• Interferons
• Interleukin-2
•Vaccines
•Immune globulin
•Rho (d) immune
globulin

11. Imiquimod is a drug that is applied to the
skin as a cream. It stimulates a local
immune response against skin cancer cells.
It is used to treat some very early stage skin
cancers (or pre-cancers), especially if they
are in sensitive areas such as on the face.
The cream is applied anywhere from once a
day to twice a week for several months.
Some people have serious skin reactions to
this drug.

12. Levamisole is orally active levo isomer of
tetramisole,restores depressed T-cell function
used as an adjunct in malignancies,aphthous
ulcers & recurrent herpes,also used as disease
modifying drug in Rheumatoid Arthritis
Mainly acts by raising c-GMP levels through
interaction with thymopoietien receptor sites
leads to decrease in metabolic inactivation of
c-GMP accompanied with increased
breakdown of c-AMP
increase inc-GMP level induces lymphocyte
proliferation &augmentation of chemotactic
responses
this reflects into increased antibody
production,lymphokine production,increased

13. This is a synthetic co-polymer with
some immunological similarity to myelin
basic protein, one of the major
components of myelin. Given SC, it is
claimed to reduce the relapse rate in
relapsing - remitting multiple sclerosis.
It probably
acts as an immunomodulator.

14. This drug, chemically related to barbiturates, and introduced as
a
hypnotic and antiemetic, was found to be teratogenic and
hence
rejected. It has now staged
a comeback in therapeutics as an immunomodulator.
Mechanism of action:
(a) Anti-inflammatory: It inhibits the production of TNF
alpha and interferon, and has
stimulatory effects on IGF1, IL-6 and IL-2.
(b) Immunomodulatory: It reduces phagocytosis by neutrophils
and enhances CMI by
interacting with T cells.
(c) Antiangiogenic: It inhibits the induction of COX-2 and the
biosynthesis of PGE 2 needed
for angiogenesis.
Given orally, it is well absorbed and is metabolised to several

15. Therapeutic uses:
• Drug of choice in symptomatic treatment of moderate to severe ENL ,
Multiple myeloma, refractory to other treatments.
• Refractory cutaneous lupus lesions.
• Crohn’s disease.
• Treatment of cachexia and weight loss in HIV and that due to TNF-α in
cancer patients.
•It counters nausea, vomiting and anorexia due to TNF-α in cancer patients.
• In advanced prostatic cancer, as an immunomodulator.
Adverse reactions:
• It can cause sedation, dizziness,
constipation, tremors, mood changes.
• Increased risk of DVT and
• rarely, peripheral neuropathy and
hypothyroidism may
occur.
• It is highly teratogenic.

16. •It is used as immunological enhancer to stimulate intact immune
system(i.e.a non-specific immunoenhancer)of the body.
•BCG &its methanol extracted residue(MER) contain muramyl dipeptide
as an ctive immunostimulant ingredient
•t-lymphocytes are principle target cells for the action of BCG vaccine
•it causes stimulation of macropage function,phagocytic
activity,lysosomal enzyme activity &chemotaxis mechanisms
•it induces the production of lymphocyte activity factor resulting of phase
1 of immune response
•because of its activity against tumor antigen it is beneficial in treatment
of lungs& breast cancer ,acute lympholytic& myelogeneous leukaemia
•it is available as unlyophilized,live or killed lyophilized form
Therapeutic uses:
Treatment and prophylaxis of Bladder Carcinoma
Adverse Reactions:
Hypersensitivity shock chills

17. It is a derivative of
thalidomide and is used
for multiple myeloma and
myelo-plastic syndrome.
It is also teratogenic.

18. These are now use by rDNA technology Application
in treatment of viral infection, autoimmune and
neoplastic diseases.
INTERFERONS
•low molecularweight glycoprotein cytokines
produced by host cells in response to viral
infections
•immunomodulatory activity
•bind to cell surface receptors-initiate intracellular
events
• Enxyme induction
• inhibition of cell proliferation

19. MOA
Interferon alfa-2b inhibits virus replication in virus-infected cells and
suppresses cell proliferatio;although the exact MOA of ribavirin is not
known;it has antiviral inhibitory activity against respiratory syncytial
virus,influenza virus,and herpes simplex virus.
Uses
hairy cell leukemias
malignant melanoma
hepatitis B
ADR
•flu like symptoms:- fever,chills,headache
•cvs-hypotension,arrhythmia
•cns-depression,confusion

20. It is a protein that regulates the activities of
WBC(leukocytes,often lymphocytes)that are
respomsible for immunity. IL-2 is a part of the
body's natural response to microbial
infection,and in discriminating between
foreign and self.
Uses
• metastatic renal cell carcinoma
•melanoma
•toxicity
•hypotension

21. Leads the production of
cytokines such as IL-I, IL- 2,
and IFN- y, increase
proliferation of lymphocytes
in response to mitogenic or
antigenic stimuli
Therapeutic uses: Herpes simplex
infection, Measles viruses
Adverse reactions: Rise in uric
acid in serum and urine,
Nausea

22. Active — Stimulation with an Antigen
Passive — Preformed antibody

23. VACCINES
Impart active immunity –
Active immunization more
efficacious & longer lasting than
passive immunization
Booster doses required at certain
intervals
Anticancer vaccines — immunizing
patients with APCs expressing

25. Indications
Individual is deficient in
antibodies —
immunodeficiency
Individual is exposed to an
agent, inadequate time for
active immunization
— Rabies
— Hepatitis B
Nonspecific
immunoglobulins
— Antibody-deficiency
disorders
Specific immune globulins
High titers of desired

26. Antibodies against Rh(D) antigen on the
surface of RBC
Binds the Rho antigens & does not allow
them to induce antibody formation in Rh -
ve individuals
Used for prevention of postpartum/post-
abortion formation of antibodies in Rho-D -
ve women (Hemolytic disease of newborn)
Given at 28th week of pregnancy

27. colony stimulating factors are glycoprotiens that promote
production of white blood cells(mainly granulocytes such
as neutrophils), in response to infection.
An administration of exogenous colony stimulating factors
stimulates the stem cells in the bone marrow to produce
more of the particular white blood cells. The new white
blood cells migrate into the blood and fight the infection.
Uses:-
Colony stimulating factors are used in patients who are
undergoing cancer treatment that causes low white blood
counts ( neutropenia) and puts the patient at risk of
infections. Colony stimulating factors tend to reduce the
time where patients are neutropenic.

28. Bacterial vaccines contain killed or attenuated bacteria
that activate the immune system. Antibodies are built
against that particular bacteria, and prevents bacterial
infection later.
An example of a bacterial vaccine is the Tuberculosis
vaccine.
Uses:-
BCG(TB) vaccine is used in many countries with a high
prevalence of TB to prevent childhood tuberculous
meningitis and miliary disease.
Side effects of TB vaccine,
serious side effect of BCG(TB) vaccine, such as
anaphylactic reaction( a serious allergic reaction), are
rare

29. DRUG NAME GENERIC NAME
Pneumovax 23
(Pro)
pneumococcal 23-
polyvalent vaccine
Prevnar 13 (Pro) pneumococcal 13-
valent vaccine
Menactra meningococcal
conjugate vaccine
ActHIB haemophilus b
conjugate (prp-t)
vaccine
Bexsero meningococcal
group B vaccine
Biothrax (Pro) anthrax vaccine
adsorbed
Hiberix (Pro) haemophilus b
conjugate (prp-t)
vaccine
DRUG NAME GENERIC NAME
Liquid
PedvaxHIB
haemophilus b
conjugate (prp-omp)
vaccine
MenHibrix haemophilus b
conjugate (prp-t)
vaccine /
meningococcal
conjugate vaccine
Vivotif Berna typhoid vaccine, live
Vaxchora (Pro) cholera vaccine, live
Te Anatoxal
Berna
tetanus toxoid
Prevnar (Pro) pneumococcal 7-
valent vaccine
Menveo (Pro) meningococcal
conjugate vaccine

30. Therapeutic vaccines are vaccines which are intended to
treat or cure a disorder or disease by stimulating the immune
system.
Uses:-
they may be used to treat certain types of cancer, by
stimulating the body's immune system to help it respond
against certain cancer cell.
they may also be used in the prevention of tuberculosis who
are at high risk for exposure.

31. Vaccine combinations merge antigens that
prevent different diseases or that protect
against multiple strains of infectious agents
causing the same disease, into a single
product. This reduces the number of
injections required to prevent some diseases.
uses
Combination vaccines combined protection
against two or more diseases into one shot.
The measles, mumps & rubella
vaccine(MMR) and diphtheria, tetanus and
pertusis vaccine(DTaP) each protect our child
against three diseases & that means fewer
delays in disease protection for children.

32. some example of common combination vaccine for children,
•comvax, which combines Hib and Hep B.
•Twnrix, which combines Hep A and Hep B.
•pediarix, which combines DTaP, Hep B and IPV(polio).
•kinrix, which combines DTaP and IPV (polio)
•pentacel, which combines DTaP, IPV(polio) and Hib.
side effects of Combination vaccine
Side effects from combination vaccines are usually mild. they are
similar to those individual vaccines given separately.
Sometimes combination vaccines are usually causes slightly more
pain or swelling where the shot was given. But child got the shots
individually, he or she might have pain or swelling in two or three
spots, instead of just one.

33. Viral vaccines contains either inactivated
virus or attenuated(alive but not capable of
causing disease) viruses.
inactivated or killed viral vaccines contain
viruses, which have lost their ability to
replicated and in order it to bring about a
response it contains more antigen live
vaccines. Attenuated or live vaccines contain
live from of the virus. These viruses are not
pathogenic but are able to induce an immune
response.
Side effects
•common side effects are
•blood in urine or stools

34. •Pharmacology & pharmacotherapeutics by R.S Satoskar , Nirmala N. Rege ,
S.D.Bhandarkar ,24th edition ,Page No. 1619-1620
•https://www.cancer.org/treatment/treatments-and-side-effects/treatment-
types/immunotherapy/immunomodulators.html
•https://en.wikipedia.org/wiki/Immunotherapy
•https://www.slideshare.net/JoonJyotiSahariah/immunostimulants-76870153
•https://www.slideshare.net/drswarnankparmar/immunomodulators-66778161
•https://www.slideshare.net/sameenrashid1/immunomodulators-63004559
•https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909428/
•https://www.uspharmacist.com/article/medication-safety-concerns-
surrounding-immunomodulators