What should be considered when discontinuing immunosuppressive drugs?

Immunosuppressive drugs are often taken over very long periods of time. Organ transplanted patients must take immunosuppressive drugs throughout their lives to avoid rejection after years. Due to the severe side effects of immunosuppressive drugs, many patients are unwilling to take the medication.

In the worst case, however, the patient may lose the transplant if he or she stops taking immunosuppressive drugs on his or her own. Patients who are considering discontinuing their medication should therefore consult their doctor, as he or she can adjust the therapy if necessary to reduce side effects. Therapy with glucocorticoids is also a challenge for many patients due to the massive side effects.

When discontinuing glucocorticoids, the entire dose should never be discontinued at once. The drug must be “sneaked out”. In this case “sneaking out” means a slow reduction of the dose until the patient stops taking it.

Sudden discontinuation of glucocorticoid therapy can either lead to a recurrence of the treated disease or to adrenal cortex insufficiency. The adrenal cortex produces glucocorticoids in a healthy body. If glucocorticoids are additionally taken as medication, the body perceives the increased level, the adrenal cortex reduces the production of glucocorticoids. After sudden discontinuation, the adrenal cortex can no longer “ramp up” its production and symptoms such as low blood pressure, low heart rate and muscle weakness occur.

Immunosuppressive drugs for the treatment of ulcerative colitis

Ulcerative colitis is a chronic inflammation of the intestinal mucosa that begins in the rectum. The causes of this disease are not yet fully understood, but genetic, autoimmune and environmental or nutritional influences are suspected. Patients suffer severely from the symptoms, such as bloody diarrhea and cramping abdominal pain.

Acute ulcerative colitis is treated according to its stage. In the first, usually somewhat less severe stages, therapy attempts are made with glucocorticoids. Here, care is taken to keep the dose as low as possible to reduce side effects.

In the later stages, the dose of glucocorticoids is first increased, possibly other immunosuppressive drugs such as Ciclosporin are added. If particularly severe courses or complications occur, such as a perforation (“bursting”) of the intestine or bleeding, surgery is performed. The primary goal of drug therapy is to relieve symptoms for as long as possible without recurring attacks of the disease.