Immunosuppressive drugs in XXXX . A review of their mechanisms of efficacy and place in therapy.

@entity1 @entity32 @entity8 @entity500 @entity2983 @entity1199 @entity31 @entity7305 @entity29 @entity4446 @entity205 @entity1200 @entity27009 @entity30 @entity3378 @entity288
Immune effector mechanisms are central to the disease process in @entity29 , but it is not clear whether the mucosal or @entity1200 are primary phenomena, or are secondary to disease activity. Corticosteroid drugs remain the most effective treatment for active disease, but there is no evidence that they are useful for maintenance therapy. Some @entity1 , however, are dependent on low-dose @entity288 , and relapse when the drug is withdrawn. These drugs have widespread actions on the immune response, and monocytes are particularly sensitive to @entity288 . In contrast, @entity3378 and @entity2983 are effective in maintenance therapy, but do not act primarily by immunosuppressive mechanisms. They are effective in maintenance therapy of @entity31 , and mild relapses of @entity31 and @entity30 . New preparations of @entity2983 have reduced side effects, many of which are due to @entity27009 . @entity500 and @entity4446 are used less widely: in @entity30 there is reasonable evidence for benefit in chronic active disease unresponsive to @entity288 , and maintenance of remission. In @entity31 , the position is less clearcut. Overall, trials favour an effect in chronic active disease, and there are pointers to an effect in maintenance of remission. Because of their side effects, in particular marrow suppression, these drugs should be reserved for second-line therapy. Similarly, other cytotoxic drugs are not used because of their side effects. More recently, @entity205 , with its selective action on @entity1199 release and/or synthesis, and inhibition of helper T cell function, has been shown to be helpful in @entity30 . At present it should only be used in controlled trials, for @entity1 with unresponsive disease in whom surgery is contraindicated. @entity8 may limit long term use. There is little data for @entity205 in @entity31 . On the basis that there may be an underlying @entity1200 in @entity30 leading to @entity32 , immunostimulant therapy has been used, but there is no evidence for benefit from treatment with BCG or @entity7305 in active disease or in maintenance therapy. 7S-Immunoglobulin, plasmapheresis or T-lymphocyte apheresis have been used in acute relapse, but evidence is anecdotal, and does not support their use except as a desperate measure to avoid surgery. Further well-designed controlled trials are needed to define the role of all these drugs, and further research into the mechanism of action on the immune response may shed light on the pathogenesis of @entity29 .
