Medical Pharmacology: Immunopharmacology (Immunosuppressant/Immunomodulators) Practice Questions

Medical Pharmacology: Immunopharmacology (Immunosuppressants/Immunomodulators) Practice Questions

Anifrolumab (Saphnelo) and Spesolimab (Spevigo)

"Dr, Peggy Crow Shares Her Perspective on Aniforlumab Approval

Attribution:
- Crow P Kirou K HSS Annual Report 2021 | Dr, Peggy Crow Shares Her Perspective on Aniforlumab Approval
- https://www.youtube.com/watch?v=HzILlqvgYf4
Other videos of interest:
- Epstein A How Saphnelo (anifrolumab-fnia) Works (2023)
  - https://www.youtube.com/watch?v=9e2QjPegZlw
- Thomas D Real Saphnelo (aniforlumab-fnia) Stories for U.S. Consumers
  - https://www.youtube.com/watch?v=BDrqXZP7WbU

Click on the correct answer.

Anifrolumab (Saphnelo)
1. Human IgG1 monoclonal antibody
2. Attaches to the IFN-α receptor thus blocking IFN-α binding.
3. Both
4. Either
Anifrolumab (Saphnelo):
1. FDA approved for treating adult patients exhibiting mild to severe systemic lupus erythematosus (receiving standard therapy).
2. Recommended for patients with severe active lupus nephritis or severe active central nervous system lupus
3. Both
4. Neither
Anifrolumab (Saphnelo):
1. In anifrolumab, humanized IgG1k monoclonal antibody binds to type 1 interferon receptors in a manner that exhibits both specificity and high affinity. Furthermore, anifrolumab binding prevents the formation of the drug-receptor complex and therefore also prevents gene activation.
2. IFN-α is the main-type 1 interferon associated with systemic lupus erythematosus pathogenesis.
3. Both
4. Neither
Anifrolumab side effect/effects:
1. Most commonly reported: upper respiratory tract infections, infusion-associated reactions, urinary tract infection, bronchitis, nasal pharyngitis.
2. Additional side effects: back pain and cough
3. Both
4. Neither
Considering side effects associated with anifrolumab administration: cautious use is recommended for patients exhibiting either active infection or a herpes zoster history.
1. True
2. False
Spesolimab (Spevigo):
1. Humanized IgG1 monoclonal antibody (Mab).
2. Interleukin-36 (IL-36) antagonist
3. Both
4. Neither
Spesolimab (Spevigo):
1. Used in treatment of generalized pustular psoriasis (GPP)
2. IL-36 receptor blocker
3. Both
4. Neither
Generalized pustular psoriasis (GPP):
1. Rare type of psoriasis
2. Typical presentation involves generalized pus-filled blisters as opposed to plaques which are notable in common psoriasis presentations.
3. Both
4. Neither
Spesolimab binding to the IL-36 receptor:
1. Results in blockade of downstream inflammation and fibrosis
2. Approved for generalized pustular psoriasis flares in adults.
3. Both
4. Neither
Suggestion that the interleukin-36 (IL-36) pathway is important in generalized pustular psoriasis was supported by observing that GPP skin lesion exhibit loss of function mutations in the IL-36 receptor antagonist gene and related genes as well as by overexpression of IL-36 cytokines in the same skin lesions.
1. True
2. False

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Source Material:

Rothlin C Gutkind J Chapter 39 Immunosuppressants, Immunomodulation and Tolerance In Goodman & Gilman's The Pharmacological Basis of Therapeutics (Brunton LL Knollman BC eds) McGraw Hill LLC (2023).

Lake D & Briggs A Ch 55 Immunopharmacology in Katzung's Basic & Clinical Pharmacology (Vanderah TW, ed) 16e McGraw Hill 2023.

Bui A Patel P Sanghavi D Anifrolumab (2/2024) StatPearls https://www.ncbi.nlm.nih.gov/books/NBK555979/

Bachelez H Choon S-E Marrakchi S Burden A Tsai T-F Morita A Navarine A et al. Trial of Spesolimab for Generalize Pustular Psoriasis N Eng J Med; 385(26): 2431-2440 2021 https://www.nejm.org/doi/full/10.1056/NEJMoa2111563

Chrouos G Ch 39 Adrenocorticosteroids & Adrenocortical Antagonists in Katzung's Basic & Clinical Pharmacology (Vanderah TW, ed) 16e McGraw Hill 2023

Brezinski E Klickstein L Armstrong A Ch 46 Pharmacology of Immunosuppression in Principles of Pharmacology: The Pathophysiologic Basis of Drug Therapy. (Golan DE Armstrong EJ Armstrong AW, eds) 4e 2017

Ritter JM Flower R Henderson G Loke YK MacEwan D Robinson E Fullerton J Ch 25 Anti-inflammatory and Immunosuppressant Drugs Rang & Dale's Pharmacology 10e Elsevier 2024.

Burchum J Rosenthal L Lehne's Pharmacology for Nursing Care Ch 72 Immunosuppressants Elsevier 2022.

Burchum J Rosenthal L Lehne's Pharmacology for Nursing Care Ch 75 Glucocorticoids in Nonendrocrine Disorders Elsevier 2022.

Burchum J Rosenthal L Lehne's Pharmacology for Nursing Care Ch 76 Drug Therapy for Rheumatoid Arthritis Elsevier 2022.

Bass A Rogatsky Ch 32 Immunomodulatory Drugs in Goldman-Cecil Medicine (Goldman L Schafer, eds) Elsevier 26e 2020

Leiva M Takemoto Ch 238 Immunosuppressants in Lippincott Illustrated Reviews: Pharmacology 8e ((Walen et al, eds) Wolters Kluwer 2023.

Hall J Hall M Ch 78 Adrenocortical Hormones Guyton and Hall Textbook of Medical Physiology 14e Elsevier 2021.

Waller DG Sampson A Hitchings Ch 38 The Immune Response and Immunosuppressant Drugs Medical Pharmacology & Therapeutics 6e Elsevier 2022

Waller DG Sampson A Hitchings Ch 30 Rheumotoid Arthritis, Other Inflammatory Arthrides and Osteoarthritis Medical Pharmacology & Therapeutics 6e Elsevier 2022