Health Tips

Everyone wants a strong immunity, right? After all, our immune system plays a key role in keeping us healthy, fighting off germs and ensuring no “foreign invaders” would harm our body. 

Such a complex system does so by deploying an army of soldiers that consists of white blood cells, lymphocytes, mast cells, dendritic cells and a whole bunch of chemical signals, just to name a few. However, such an amazing system that is supposed to serve us in our best interest, can sometimes backfire. In such circumstances, a therapy known as immunosuppressive therapy may be required.

What’s immunosuppressive therapy?

When we say “suppressing” something, it means we restrain or prevent something from developing further — hence an immunosuppressive therapy essentially means that we deliberately suppress the immune system with medications.

White blood cells (and red blood cells)

It may sound crazy to suppress our immune system, after all, we would always want a good immune system? Not really. In fact, there is a wide range of medical conditions that call for immunosuppressive therapy. 

Medical conditions that require immunosuppression

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Immunosuppressive therapy is widely used to help many patients live longer and better lives. Here are a few medical conditions that require immunosuppressive therapy, with varying duration, intensity and types of treatments:

• After organ, stem cells or bone marrow transplant — Our immune system is conditioned to reject whatever that is foreign (i.e. does not belong to the host). However, when a person needs a newly transplanted organ, stem cells or bone marrow for whatever reasons to sustain one’s life, immunosuppressive therapy reduces the activity of immunity to reduce the unpleasant effects that may be resulted from the rejection.

• Severe cases of autoimmune disease — Autoimmune disease is an umbrella term for a wide range of conditions that share similar characteristics: the person’s immune system attacks his or her own body cells.  Immunosuppressive therapy is often required to “tone down” the person’s immune system, so to speak. The exact reasons behind autoimmune disease are poorly understood, but it is thought to be associated with genetic and environmental factors. Examples of autoimmune disease are systemic lupus erythematosus (SLE), Crohn's disease, type 1 diabetes, rheumatoid arthritis and thyroiditis. 

• Widespread or severe inflammation in the body — Similar to autoimmune disease, immunosuppression is required by some people who experienced widespread or more severe inflammation in the body for various reasons, although the duration of treatment for such circumstance is generally shorter than those who had organ transplant or autoimmune disease. For instance, asthma patients who just experienced a severe episode of asthma attack (called acute exacerbation) would be prescribed a course of steroids (which is a type of immunosuppressive therapy) to reduce the inflammation in the lung. It’s also common for hospitalised COVID-19 patients to receive steroid therapy, as COVID-19 infection is known to cause “cytokine storm”— a potentially life-threatening systemic inflammation in some patients, akin to an immunity “overdrive”. 

Read how is COVID-19 patients are being treated in the hospital here.

Types of immunosuppressants

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Corticosteroids (or widely known as “steroids” by the general public), such as prednisolone, are among the most common immunosuppressants that healthcare providers prescribe. But there are many types of immunosuppressants. Your doctor will select a medicine (or a combination of immunosuppressants) based on your specific condition and symptoms.

You may receive immunosuppressants as a pill or liquid, IV or injection (shot). Types of immunosuppressants include:

• Corticosteroids (prednisone)

• Calcineurin inhibitors such as tacrolimus (E.g. Protopic®) and cyclosporine (E.g. Neoral® or Sandimmune®)

• Imidazolyl derivative of mercaptopurine such as azathioprine (E.g. Imuran®)

• Biologics such as adalimumab, secukinumab and infliximab

• Inosine monophosphate dehydrogenase (IMDH) inhibitors such as mycophenolate mofetil (CellCept®)

• Monoclonal antibodies

These immunosuppressants have different treatment regimens and side effects profiles. For example, corticosteroids can lead to side effects such as acne, weight gain, osteoporosis and increased blood sugar level (which can affect diabetic patients). 

Do consult your pharmacist on how to handle these side effects, as well as what to do if you happened to miss a dose. It is very important for you to take the prescribed medicine daily, preferably at the same time each day.

Monitoring immunosuppressive therapy

Your doctor will order regular blood tests to make sure medication levels don’t get too high. This is because high doses can cause serious side effects that we will mention in the next part. Make sure to clarify with your doctor on the best timing to take your medication before or on the day of blood test so that an accurate test result can be obtained.

Precautions of taking immunosuppressive therapy

Immunosuppressive therapy can save lives and improve quality of living in many cases, but it does come with some health risks and side effects. For starters, patients who receive immunosuppressive therapy are at a higher risk of developing infections for obvious reasons— when the immune system is suppressed, it cannot fight off infection properly. Infections can range from the milder ones such as vaginal thrush to severe infections such as MRSA and sepsis. This is why if you’re taking immunosuppressive therapy, you need to practise extra precautions to prevent infections in the first place. Things you can do include taking care of personal hygiene, washing your hands frequently and practising safe food handling.

The suppression of the immune system may also predispose an individual to a large number of different cancers. This is because under normal circumstances, not only does our immune system fight off germs, but it also prevents cancers from happening. A suppressed immune system can lead to higher risks of cancers such as non-Hodgkin lymphoma (NHL) and cancers of the lung, kidney, and liver. 

For these reasons, if you experience any of the following:

• Extreme fatigue or weakness.

• Lower back pain.

• Nausea, vomiting, abdominal pain or weight concerns.

• Painful urination or frequent urination.

• Signs of infection, including fever and chills.

Do contact your doctor immediately. 

A word from Doc2Us

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Disclaimer: As a service to our users and general public, Doc2Us provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

References

1. National Cancer Institute - Immunosuppression

2. GUIDELINE OF THE MALAYSIAN MEDICAL COUNCIL - Organ Transplantation

Cover image credit: Photo by Danilo Alvesd on Unsplash

Written by

Ms Joyce Toh