Are Immunotherapy Medications Different From Immunosuppressive Medications?

Immunotherapy is a type of treatment that’s grown in popularity over the last few years. It’s even led to a shift in how healthcare providers treat many types of cancer. Immunosuppressive medications (immunosuppressants) may be more familiar to you. These are a large and versatile family of medications.

These treatments sound similar, but they affect the immune system in different ways. Even so, both can treat and manage many health conditions, such as cancer and autoimmune diseases.

In this article, we'll discuss the differences between immunotherapy and immunosuppressants.

What are examples of immunotherapy medications?

Immunotherapy is an exciting and newer approach to fighting cancer. Immunotherapy can be given alone or in combination with treatments like chemotherapy. Immunotherapy works by stimulating your immune system. It should then better recognize and target certain cells in your body, like cancer cells.

Immunotherapy for cancer includes CAR T-cell therapy, cancer vaccines, immune checkpoint inhibitors, and others.

For more specific examples, let’s look at certain immune checkpoint inhibitors. These are somewhat common in cancer and include:

• Nivolumab (Opdivo)

• Pembrolizumab (Keytruda)

• Ipilimumab (Yervoy)

Other medications, like rituximab (Rituxan), also treat cancer. Rituximab is also effective for autoimmune conditions like rheumatoid arthritis (RA).

What are examples of immunosuppressive medications?

Immunosuppressants make your immune system less active. There are many different types of immunosuppressants.

Organ transplant rejection

Immunosuppressants are common for people who have received an organ transplant. This could include a kidney, liver, or heart transplant.

Your body sees transplanted organs as foreign objects. It tries to attack them in self-defense. Immunosuppressants help stop the body from rejecting transplanted organs.

Examples of medications used for prevention of organ rejection include:

• Tacrolimus (Prograf)

• Cyclosporine (Neoral, Sandimmune)

• Sirolimus (Rapamune)

• Everolimus (Afinitor, Zortress)

• Mycophenolate (CellCept)

These same medications can also help people who have had a stem cell transplant to prevent graft-versus-host disease (GVHD). We'll discuss this more later on.

Autoimmune conditions

Immunosuppressants can also treat autoimmune conditions like RA, psoriasis, and lupus.

Immunosuppressants can help manage many autoimmune conditions. These conditions often make your immune system attack your body's healthy cells and tissues. By suppressing the immune system, it allows disease progression to slow and symptoms to lessen. 

Examples of medications used for treating autoimmune conditions are:

• Infliximab (Remicade)

• Adalimumab (Humira)

• Etanercept (Enbrel)

• Golimumab (Simponi)

• Natalizumab (Tysabri)

Other health conditions

Other common immunosuppressants are corticosteroids. These can be used short- or long-term for many health conditions. For example, they can treat conditions like allergies, asthma symptoms, and prostate cancer.

There’s a good chance you may have taken a corticosteroid or two in the past. Common corticosteroids are dexamethasone, prednisone, and methylprednisolone.

Can immunosuppressants also help treat cancer?

Yes. Both immunotherapy and immunosuppression have various roles when treating cancer.

But immunosuppressants have unique roles.

Immunosuppressants can help people who have received a stem cell transplant. An allogeneic stem cell transplant involves receiving a transplant of stem cells from a donor, also known as a graft.

Stem cell transplants can treat many cancer and non-cancer-related health conditions. After a stem cell transplant, your immune system can recognize donor cells as foreign and attack them. This leads to a phenomenon called graft-versus-host disease (GVHD). Immunosuppressants help prevent and manage GVHD.

Specific immunosuppressants are also relevant. For example, everolimus is an immunosuppressant marketed as Afinitor for cancer treatment. It can also help prevent liver or kidney transplant rejections. When used for this purpose, everolimus is marketed as Zortress.

Immunosuppressants can also help control side effects from cancer treatments. This is discussed more below. 

What are the major differences between immunotherapy and immunosuppression?

The immune system plays an important role. It's your body’s main defense against things like bacteria, viruses, and even cancer. The differences between these two treatments are how they change your immune system.

Immunosuppression works by making your immune system less active. But immunotherapy works by activating the immune system to better target and attack cells like cancer cells.

Sometimes immunotherapy activates the immune system too much. This can cause immune-related side effects like skin rash and organ inflammation. These side effects often resemble symptoms of some autoimmune conditions. People with autoimmune conditions should talk to their healthcare provider about immunotherapy.

Immunosuppressants like corticosteroids and infliximab can sometimes help manage the immune-related side effects of immunotherapy. But because of these side effects, people should still talk with their healthcare provider about if the treatment is right for them. 

Do immunotherapy and immunosuppressive both weaken your immune system?

Your body depends on its immune system to fight off infections. If your immune system is weaker, your body may have a harder time fighting off infections.

This can lead to a higher risk of getting infections like pneumonia, skin infections, and blood infections. This is a relatively common risk when using immunosuppressants, especially long-term.

And while immunotherapy medications work to enhance the immune system, they still affect the way it works in your body. This may make it easier to get an infection. This isn’t as common as it is for immunosuppressants, but it’s still possible.

So if you’re receiving either medication type and develop any of the following symptoms of an infection, you should notify your healthcare provider right away:

• Fever

• Shaking chills/sweats

• New or persistent cough

• Shortness of breath

• Urine changes (in pain or frequency)

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Written by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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