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Immunosuppression: Treatment, Procedure, Cost and Side Effects

Last Updated: Dec 20, 2024

What is the treatment?

Immunosuppression is usually the decrease in the activation of efficiency of the immune system. Some parts of our immune system has immunosuppressive effects on other portions of our immune system. Therefore, immunosuppression can occur as a reaction to the treatment for other conditions. However, immunosuppression can also be induced deliberately to prevent our body from not accepting an organ transplant. This treatment is used in the cases of a bone marrow transplant, graft versus-host disease, etc. Additionally it can also be performed on people for treating auto-immune disease such a, Crohn’s disease, Sjogren’s syndrome, rheumatoid arthritis and systemic lupus erythematosus. Immunosuppression can be done by radiation, plasmapheresis, immunosuppressive drugs or splenectomy. A person who is in the process of going through immunosuppression is usually a bit weak and is said to be immunocompromised. For patients who are old and have acquired aplastic anemia usually go for immunosuppression drug therapy. This is because people with aplastic anemia don’t have a matched donor of a bone marrow. It is also used by patients with PNH and MDS.

The use of immunosuppression therapy can also trigger fungal infections, bacterial infections and viral infections. The body is unable to fight infections so there is a high risk in the progression of infection. Immunosuppression can also occur naturally due to CNS infection, diabetes, chronic alcoholism, hepatic failure and diabetes mellitus. Autoimmune diseases such as rheumatoid arthritis or systemic lupus erythematosus can also cause immunosuppression.

How is the treatment done?

Generally two drugs are used for immunosuppression therapy which includes Cyclosporine and Anti-Thymocyte Globulin (ATG). ATG is approved in the United States and is considered ideal for treating aplastic anemia and also reduces the chances of an organ transplant for example kidney or a bone transplant. ATG functions by killing cells in your immune system known as T-lymphocytes. These cells are the ones which attack the bone marrow stem cells in the case of aplastic anemia. This forms the bone marrow properly if aplastic anemia patients are to rebuild the supply of bone marrow stem cells. This in turn increases the blood count to a certain extent.

Cyclosporine is another drug used in immunosuppression which prevents T-lymphocytes from becoming active. Once a patient consumes this drug, the T-lymphocytes stop attacking the stem cells inside the bone marrow. Cyclosporine is used along with ATG to cure aplastic anemia. It comes in both pill and liquid form. This first dose is given keeping your body weight in mind and later the doses depend upon the cyclosporine content in your blood. Generally for patients who have used cyclosporine along with ATG, their blood count has increased in about seven to ten cases of aplastic anemia.

Who is eligible for the treatment? (When is the treatment done?)

A patient who is suffering from aplastic anemia or is going in for an organ transplant surgery is the perfect candidate for this treatment. A person eligible for immunosuppression should only consume immunosuppressive drugs as prescribed by their physician because a high dosage can be very risky for the body. If you miss a dosage it is very important to call you physician as it can disrupt your cycle.

Who is not eligible for the treatment?

Pregnant women should avoid immunosuppressant drugs as it might cause birth defects in their baby. If you are suffering from an autoimmune disease, a change in the regimen can flare up your condition to a great extent. If you have gone through an organ transplant and are under immunosuppressive therapy, missing a single dose can provoke your body to reject the organ right away. Patients who are allergic to specific kinds of drugs, who have had chickenpox or shingles in the past and are liver or kidney disease patients should avoid immunosuppression at all cost.

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Are there any side effects?

Immunosuppression can have quite a few side effects as your immune system is weak during undergoing this therapy. Consuming immunosuppressant drugs can make you more susceptible for getting an infection. The body becomes weak and less resistant to harmful infections. This also means that it will be harder for you to recover in a short span of time like you usually did before consuming this drug. However some side effects include, chills, fever, pain in the lower abdomen, trouble urinating, pain during urination, frequent need to empty your bladder and unusual fatigue or weakness. Side effects also vary for different kind of immunosuppressant drugs.

What are the post-treatment guidelines?

Since immunosuppression is associated with a lot of side effects and weakens the immune system for the time being so that the new organ can be accepted by the body, it should be stopped after some days. It is important to consult a doctor and he/she will gradually decrease your dosage as soon as the organ starts functioning properly in your body. After a while, immunosuppressive drugs will be stopped completely. This will make your immune system return back to normal and the risk of getting an infection will also decrease rapidly.

How long does it take to recover?

After quitting the use of immunosuppressive drugs, your body can recover quickly if you follow a healthy diet and exercise to bring back you immune system back to normal. While on immunosuppression therapy, one should take extra care of their body and not over-expose themselves in the sun. This is because, immunosuppressants can make your skin more susceptible to allergic reactions and skin rash. Herbal treatments or alternative treatments should be included in your regime after quitting immunosuppression therapy.

What is the price of the treatment in India?

In India, the National Pharmaceutical Pricing Authority has decreased the price of immunosuppressive drugs. Some drugs have been slashed by 60% to 65%. Patients generally spend 15,000 to 20,000 each month on anti-rejection or immunosuppressive drugs.

Are the results of the treatment permanent?

The results of this treatment are however not permanent. After quitting immunosuppression therapy, the body returns back to its normal functioning in some time. The body’s energy and immune system start getting stronger after quitting immunosuppression therapy and following a healthy and active lifestyle.

What are the alternatives to the treatment?

Herbal medicines can be used as an alternative to immunosuppressive drugs. They can help after organ transplant, by preventing the body from rejecting the new organ and can also treat autoimmune diseases.

References

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Written ByDr. Sanjaya MishraMD - OncologyOncology
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Reviewed ByDr. Bhupindera Jaswant SinghMD - Consultant PhysicianGeneral Physician
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