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FÁRMACOS INMUMODULADORES
INTEGRANTES
María Viviana Donoso Vélez
Carla Bolaños
Ricardo Zuloaga
SEXTO SEMESTRE
2018 - 2019
ANTICUERPOS UTILIZADOS
PARA EL TRATAMIENTO DE
ENFERMEDADES CON BASE
INMUNOLÓGICA
Citocinas proinflamatorias
INFLIXIMAB
Neutraliza TNF-a
Indicaciones Terapéuticas Administración
Evaluar
Reacciones existencia
Infecciones Anticuerpos Síntomas de
Cefaleas tuberculosis
Adversas VRS antinucleares lupus
activa o
latente
ADALIMUMAB
Anticuerpo expresado en célula CHO
Cambios en moléculas
de adhesión
responsables de
migración leucocitaria
Indicaciones terapéuticas Administración
Artritis
reumatoide 40 mg semanas
A. psoriásica alternas
VIA: s.c
SM: 2 semanas
Infecciones
graves
Síntomas de
•Tuberculosis
lupus
Anticuerpos
antinucleares
Efectos adversos MENOR
frecuencia:
Reacciones
•Cefaleas,
en el lugar mareos,
de la nauseas,
inyección, hipertensión,
Infecciones linfopenia.
( VRS)
Infliximab
Etanercept
Adalimumab
Dirigido contra IgE humana
OMALIZUMAB
Indicaciones Terapéuticas Administración
• Mejorar
control asma 75-375 mg c/2-3
• Tratamiento semanas
adicional en VIA: s.c
asma alérgica SV: 26 días
grave
Cefalea
Efectos adversos Mareo
Reacciones de tipo
anafilactoide
Dirigido contra el factor 5 del complemento
ECULIZUMAB
Se une al componente C5
Inhibe escisión en C5a y C5b
Previene activación de
componentes del complemento
y evita lisis intravascular de los
hematiés.
Tratamiento Hemoglubinuria
Paroxistica Nocturna
Administración Efectos adversos
Cefaleas
Nauseas
600 mg/sem durante 4 Resfriado
semanas, 900 mg/sem Dolor garganta y espalda
durante 2 semanas. + riesgo enfermedades
VIA: i.v meningocócicas
SV: 272 horas VACUNACION antes
tratamiento.
ABCIXIMAB
Inhibe agregación plaquetaria,
evitando unión del fibrinógeno
en plaquetas activadas.
Bolo de 0.25
mg/kg, infusión
continua de 0.125
ADMINISTRACION mg/kg/min
VIA: i.v
SM: inicial 10min,
segunda 30min
Indicaciones Terapéuticas Efectos adversos
Inhibe respuesta de
los LT y mejora
síntomas
Mecanismo
de acción
Síntomas pseudogripales
agudos
Efectos adversos Linfocitosis y leucocitosis
MENOR frecuencia:
Artralgia, astenia, edema
periférico y
empeoramiento psoriasis
OTRAS INMUNOPROTEINAS
MECANISMO DE ACCION
SEÑALES
1. Antígeno asociado a MHC
CT interacciona con un receptor en la
proliferan célula T.
2. Interacción LFA-3 y CD2.
DOSIS
EFECTOS ADVERSOS
MECANISMO DE ACCION
Modelador de la coestimulación
DOSIS
EFECTOS ADVERSOS
MECANISMO DE ACCION
1. Se une al TNF-a
2. Actuando como receptor soluble
3. Bloqueando la interacción del TNF-a
4. Con los receptores de la superficie
celular.
OTRAS INMUNOPROTEINAS
DOSIS
500mg
25 a 1000
2 semana
mg cada
o 502mg
semanas.
semana.
EFECTOS ADVERSOS
Artritis reumatoide
Reacciones lugar inyección, infección de las Artritis idiopática juvenil poliarticular
VRS, bronquitis, cititis, infecciones piel, Artritis psoriásica
TBC Espondilitis anquilosante
Psoriasis en placa
OTRAS INMUNOPROTEINAS
IL-1Ra
OTRAS INMUNOPROTEINAS
MECANISMO DE ACCION
DOSIS
100 mg.
EFECTOS ADVERSOS
NTRODUCTION
Corticosteroids are the standard of care for first line treatment of patients who develop grades II-IV of acute
Graft-versus-Host Disease (a-GvHD), but the optimal second-line treatment has not been determined yet. We
prospectively evaluated the use of anti-TNFα monoclonal antibody Etanercept (ET) as second line treatment in
children with steroid-refractory a-GvHD.
MATERIALS AND METHODS
Twenty-five children with either malignant or non malignant diseases experiencing grade II-IV steroid-refractory
(SR)-a-GvHD received ET as second line treatment. ET was administered after a median of 14 days (5-135 days)
from onset of a-GvHD.
RESULTS:
Seventeen out of 25 patients (68%) developed complete or partial response (CR or PR) to ET. Overall response
rate (ORR) (CR or PR) was 78% of patients with cutaneous SR-a-GvHD, 78% with gastro-intestinal a-GvHD, and
57% with hepatic a-GvHD. On day +100 after the start of ET, 52% of children were in CR, 16% in PR, while the
remaining 32% failed to respond. Overall Survival (OS) in responders was 76.5% and 16.7% in non- responders
(p=0.004). Transplant-related mortality (TRM) at 5 years was 34.1% (95% CI; 18.6%- 57.1%).
CONCLUSION:
In our experience, ET proved to be effective as second line treatment in children with SR-a-GvHD.
Lefacept provides sustained clinical and immunological effects in new-
onset type 1 diabetes patients.
BACKGROUND:
Type 1 diabetes (T1D) results from destruction of pancreatic β cells by autoreactive effector T cells. We hypothesized that the
immunomodulatory drug alefacept would result in targeted quantitative and qualitative changes in effector T cells and
prolonged preservation of endogenous insulin secretion by the remaining β cells in patients with newly diagnosed T1D.
METHODS:
In a multicenter, randomized, double-blind, placebo-controlled trial, we compared alefacept (two 12-week courses of 15 mg/wk
i.m., separated by a 12-week pause) with placebo in patients with recent onset of T1D. Endpoints were assessed at 24 months
and included meal-stimulated C-peptide AUC, insulin use, hypoglycemic events, and immunologic responses.
RESULTS:
A total of 49 patients were enrolled. At 24 months, or 15 months after the last dose of alefacept, both the 4-hour and the 2-
hour C-peptide AUCs were significantly greater in the treatment group than in the control group (P = 0.002 and 0.015,
respectively). Exogenous insulin requirements were lower (P = 0.002) and rates of major hypoglycemic events were about 50%
reduced (P < 0.001) in the alefaceptgroup compared with placebo at 24 months. There was no apparent between-group
difference in glycemic control or adverse events. Alefacept treatment depleted CD4+ and CD8+ central memory T cells (Tcm) and
effector memory T cells (Tem) (P < 0.01), preserved Tregs, increased the ratios of Treg to Tem and Tcm (P < 0.01), and increased
the percentage of PD-1+CD4+ Tem and Tcm (P < 0.01).
CONCLUSIONS:
In patients with newly diagnosed T1D, two 12-week courses of alefacept preserved C-peptide secretion, reduced insulin use and
hypoglycemic events, and induced favorable immunologic profiles at 24 months, well over 1 year after cessation of therapy.
INHIBIDORES DE LA CALCINEURINA
DOSIS DOSIS
INDICACIONES:
• Aumento de la
REACCIONES
supervivencia en ADVERSAS:
trasplantes. • Depresión de la
• Enfermedad función de la
inflamatoria medula ósea.
intestinal. • Leucopenia y
• Esclerosis múltiple. nauseas.
• AR, LES.
METOTREXATO
• Es un análogo del ac. Fólico con efectos antineoplásicos,
antiinflamatorios e inmunosupresores.
REACCIONES
INDICACIONES: ADVERSAS:
• Artritis • Aumento de
reumatoidea transaminasas
• Psoriasis vulgar • Estomatitis
grave y • Dispepsias
generalizada • Nauseas
• Perdida de apetito.