Negative Cardiovascular Consequences of Small Molecule Immunosuppressants

Abstract

Immunosuppressants are critical after transplantation and prescribed as immune-modulators for autoimmune disorders and glomerulonephritides. Immunosuppressants include large (e.g., thymoglobulin, alemtuzumab, and rituximab) and small molecules (e.g., corticosteroids, calcineurin inhibitors, antimetabolites, and mammalian target of rapamycin (mTOR) inhibitors). The majority of the small molecules worsen traditional cardiovascular risks. This review describes cardiovascular risks of small molecule immunosuppressants: corticosteroids, calcineurin inhibitors (tacrolimus and cyclosporine), and mTOR inhibitors (rapamycin), by categorizing these risks into two categories: ischemic heart disease and nonischemic cardiac effects.

Cardiovascular disease after transplantation: an emerging role of the immune system

“…The majority of the immunosuppressive drugs worsen traditional cardiovascular risk conditions including weight gain (corticosteroids), hyperlipemia (CNI, corticosteroids and mTOR inhibitors), glycemic control (CNI, corticosteroids and mTOR inhibitors), and hypertension (corticosteroids and CNI) . The combination of different drugs of variable exposure hampers the interpretation of cardiovascular effects.…”

“…Calcineurin inhibitors (CNI) have pro‐atherogenic properties primarily because of effects on traditional cardiovascular risk factors . They promote vascular inflammation in murine models by increasing cytokine production through upregulation of TLR4 signaling .…”

Affairs of the Heart: Innovation in Cardiovascular Research and Development

“…Managing evidence‐based polypharmacy and therapy optimization is critical for adequate heart failure care that increasingly recognizes the growing role for clinical pharmacists within the healthcare provider team . Rigorous vigilance is essential in recognizing the undesired effects of modern therapies, in particular in vulnerable patients with multiple comorbidities such as transplant patients on immunosuppresants . Recommendations for healthcare professionals are also vital in the context of other environmental hazards, including cannabis smoking .…”

D-dimer Increasing After First Alemtuzumab Administration in a Multiple Sclerosis Patient

“…As of March 18, 2019 D-dimer increased is reported only by 3 patients treated with alemtuzumab among 4.420 people who have side effects while taking alemtuzumab (FDA report) Corticosteroids, used in alemtuzumab pre-treatment, are well known as causing significant cardiovascular side effects [7].…”