Your body’s immune system has the important job of fighting off invaders so that you can stay healthy.

Sometimes, for reasons medical researchers still don’t understand, it attacks healthy tissues. When this happens, it’s called an autoimmune disorder. Immunosuppressants can help treat these conditions by turning down the immune system’s activity.

You and your care team will talk about which drugs you take and for how long. If you have an autoimmune condition, you may take them long-term. 

Some of these autoimmune conditions include:

• Rheumatoid and other inflammatory arthritis
• Lupus
• Vasculitis (some types)
• Psoriasis
• Inflammatory bowel disease
• Multiple sclerosis

If you’ve had a stem cell transplant or an organ transplant, you’ll also take immunosuppressants. This keeps your immune system from attacking the organ or stem cells. For organ transplants, you’ll likely take them for the rest of your life.

Not all immunosuppressants are the same. Some drugs target specific parts of the immune system. That means that some put you more at risk for infections than others.

Biologics are a newer type of targeted treatment made from living cells, not small chemicals. These medicines use large molecules called proteins to target very specific parts of the immune system.

Because the stomach breaks down proteins, you’ll need to inject biologic medicines under the skin or have it infused through an IV at the clinic. Infusions also give your care team a chance to monitor you closely while you receive treatment.

Corticosteroids

Corticosteroids are one of the most common immunosuppressants. They include such medications as prednisone. They’re often the first step in reducing inflammation. They work quickly to calm the immune system across the entire body and ease symptoms. 

Prednisone can be a temporary treatment for a wide range of conditions. However, being on prednisone long-term can cause problems, so your team will want to manage you closely.

Cell-targeting medicines

Cell-targeting medicines slow down or block immune cells, such as B cells and T cells, that drive inflammation. Some are pills, while others are biologics given as injections or infusions.

• Methotrexate: Stops certain immune cells from growing
• Mycophenolate: Blocks an enzyme B and T cells need to grow
• Rituximab (biologic): Targets and reduces B cells
• Abatacept (biologic): Prevents T cells from “switching on”
• Belimumab (biologic): Blocks a signal that helps B cells survive

Signal-blocking medicines

Many immunosuppressive medicines have the name “inhibitor” in them. This is because they’re turning down specific parts of the immune system. 

Signal-blocking medicines target the proteins and enzymes that send inflammation signals through the body. By blocking these signals, they can reduce symptoms and protect long-term health. Some are pills, while others are biologics.

• JAK inhibitors: Block JAK enzymes inside immune cells that fuel inflammation
• TNF blockers (biologic): Block a protein called TNF that causes inflammation
• Interleukin blockers (biologic): Target interleukin proteins that send inflammation signals

Immunosuppressive therapy can help prevent or reduce flares from inflammatory conditions. We know that these drugs work, but they can have side effects. There’s no way to predict what side effects you may have. 

Immunosuppressants have a range of side effects, including:

• Getting more infections, like colds, ear infections and urinary tract infections
• Stomach upset and nausea
• Feeling extra tired
• High blood pressure
• Mouth sores
• Headaches
• Weight gain

People can have varying responses to the same medicine. With autoimmune conditions, it’s common to start with one medicine and switch to another.

For example, many people with rheumatoid arthritis start by taking methotrexate. However, if you struggle with the side effects, you may try a different medicine.

Once you’re on an immunosuppressant, your care team will monitor you. You might need blood draws or other tests to make sure the medicine isn’t hurting your organs. 

It’s extra essential to get all recommended vaccines, since your immune system is weaker. It’s still working, but the response isn’t always as strong.