C H A P T E R 1 7
Immune modulators
261
Adverse effects
The adverse effects associated with the use of interfer-
ons are related to the immune or inflammatory reaction
that is being stimulated (stimulating the immune and
inflammatory response causes a flu-like syndrome with
lethargy, myalgia, arthralgia, anorexia, nausea). Other
commonly seen adverse effects include headache, dizzi-
ness, bone marrow depression, depression and suicidal
ideation, photosensitivity and liver impairment.
Clinically important drug–drug interactions
There are no reported clinically important drug–drug
interactions with the interferons.
I
nterleukins
Interleukins are synthetic compounds much like
endogenous interleukins; they communicate between
lymphocytes, which stimulate cellular immunity and
inhibit tumour growth. Interleukin-2 stimulates cellular
immunity by increasing the activity of natural killer
cells, platelets and cytokines. Not available in Australia,
one interleukin preparation is available for use in New
Zealand. Aldesleukin (
Proleukin
) is a human interleukin
produced by recombinant DNA technology using
E. coli
bacteria (see Table 17.1).
Therapeutic actions and indications
Natural interleukin-2 is produced by various lymphocytes
to activate cellular immunity and inhibit tumour growth
by increasing lymphocyte numbers and their activity.
TABLE 17.1
DRUGS IN FOCUS Immune stimulants
Drug name
Dosage/route
Usual indications
Interferons
interferon alfa-2a
(Roferon-A)
Individualised; dose varies widely
Treatment of leukaemias, Kaposi’s
sarcoma, non-Hodgkin’s lymphoma,
chronic hepatitis C
interferon alfa-2b
(Intron-A)
Adult: dose varies widely based on indication
Treatment of leukaemias, Kaposi’s
sarcoma, warts, hepatitis B, malignant
melanoma
interferon beta-1a
(Avonex)
30 mcg IM once a week
Treatment of multiple sclerosis in adults
interferon beta-1b
(Betaferon)
Individualised; dose varies widely
Treatment of multiple sclerosis in adults
interferon gamma-1b
(Imukin)
Individualised; dose varies widely
Treatment of serious, chronic
granulomatous disease in adults; delaying
time to disease progression in severe,
malignant osteopetrosis
peginterferon alfa-2a
(Pegasys)
180 mcg SC once weekly
Treatment of chronic hepatitis B, C
peginterferon alfa-2b
(Peg-Intron)
0.5 mcg/kg SC weekly for 6 months
Treatment of chronic hepatitis C in adults
Interleukins
aldesleukin (Proleukin)
Two 5-day cycles of 600,000 IU/kg IV q
8 hours given over 15 minutes
Treatment of specific renal carcinomas in
adults; also, drug is being investigated for
use in the treatment of AIDS and AIDS-
related disorders
Prototype summary: Interferon alfa-2b
Indications:
Hairy cell leukaemia, malignant
melanoma, AIDS-related Kaposi’s sarcoma, chronic
hepatitis B and C, intralesional treatment of
condylomata acuminata in individuals 18 years of
age or older.
Actions:
Inhibits the growth of tumour cells and
enhances the immune response.
Pharmacokinetics:
Route
Onset
Peak
IM, SC
Rapid
3–12 hours
IV
Rapid
End of infusion
T
1/2
:
2 to 3 hours; metabolised in the kidney,
excretion is unknown.
Adverse effects:
Dizziness, confusion, rash, dry
skin, anorexia, nausea, bone marrow suppression,
flu-like syndrome.
