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Created: 03Dec96
Immunosuppressive Agents in Skin Disorders: A Comparative Review
Jan P. Dutz and Vincent C. Ho
The corticosteroid-sparing immunosuppressive agents commonly used in dermatology include azathioprine, cyclophosphamide, methotrexate and cyclosporin. The pharmacology, use and adverse effects of these agents are reviewed.
Azathioprine is an antimetabolite whose immunosuppressive effects involve mainly suppression of cellular cytotoxicity and to a lesser degree antibody responses. The role of genetic polymorphisms in its metabolism and efficacy and in the incidence of adverse effects is increasingly being recognized.
Cyclophosphamide is an antimetabolite that has potent B cell inhibitory effects as well as a differential effect on subsets of macrophages. Its immunosuppressive effect is of more rapid onset than that of azathioprine. Intravenous pulse administration of cyclophosphamide is becoming more popular in an effort to decrease the overall dosage and toxicity.
The immunomodulatory role of methotrexate is being more fully appreciated, as is the role of rescue therapy with folic and folinic acids in reducing haematological and gastrointestinal toxicity. Hepatotoxicity remains a major concern with methotrexate, and its use in renal insufficiency requires dosage modification.
Clin. Immunother. 1996 Apr;5(4):268-293
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