[Immunosuppression--a tightrope walk between iatrogenic harm and therapy]

Area of Science:

• Pharmacology and Toxicology
• Immunology
• Oncology

Context:

• Immunosuppressive agents are vital in managing autoimmune diseases and preventing organ transplant rejection.
• However, their therapeutic benefits are often offset by significant risks, including infections and malignancies.
• This review focuses on commonly prescribed immunosuppressants and their associated adverse effects.

Purpose:

• To provide a concise overview of the risks associated with widely used immunosuppressive drugs.
• To highlight key side effects of corticosteroids, azathioprine, methotrexate, cyclophosphamide, and cyclosporine.
• To inform clinicians about potential complications and preventive strategies.

Summary:

• Corticosteroids can cause Cushing-like symptoms, glucose intolerance, osteoporosis, and gastrointestinal issues.
• Cytotoxic agents (azathioprine, methotrexate, cyclophosphamide) primarily cause bone marrow suppression, leading to neutropenia and increased infection susceptibility.
• Cyclosporine is associated with nephrotoxicity, and cyclophosphamide with hemorrhagic cystitis and urothelial neoplasms.

Impact:

• Enhanced understanding of immunosuppressant risks can guide safer prescribing practices.
• Awareness of side effects aids in early detection and management of complications, improving patient outcomes.
• This review serves as a valuable resource for healthcare professionals managing patients on immunosuppressive therapy.