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Immunomodulatory, Immunoablative, and Biologic Therapies

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Book cover Scleroderma

Abstract

Immunosuppressive drugs constitute a heterogeneous group of therapeutic compounds, each with a unique mode of action and toxicity profile (Table 41.1). Their main function is to dampen the immune system – notably T and B lymphocytes – functionally and/or numerically, hence their utility in inducing remission and control of specific rheumatic manifestations that result from inflammation. Immunosuppressive drugs alone do not permanently correct the fundamental imbalance of immune regulation in autoimmune disease and, as such, they have only limited curative potential when used in standard doses. By contrast, immunoablative therapy and autologous hematopoietic stem cell transplantation (HSCT) corrects the fundamental imbalance in immune regulation in autoimmune disease and appears to result in significant mortality and morbidity benefit, albeit with a substantial potential risk. Biologic therapies directed at various cytokine and cellular targets hold the promise of more directed intervention, although the evidence for their efficacy in systemic sclerosis (SSc) remains limited.

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Authors and Affiliations

  1. Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands

    Jacob M. van Laar MD, PhD

  2. Department of Rheumatology, Boston Medical Center and Boston University School of Medicine, 72 East Concord Street Evans 501, Boston, MA, 02118-2526, USA

    Robert W. Simms MD

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Correspondence to Jacob M. van Laar MD, PhD .

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Editors and Affiliations

  1. Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

    John Varga

  2. Division of Medicine, Department of Inflammation, Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Hospital, London, United Kingdom

    Christopher P. Denton

  3. Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA

    Fredrick M. Wigley

  4. Service de Rhumatologie A, INSERMU1016, Universit. Paris Descartes, Hôpital Cochin, Paris, France

    Yannick Allanore

  5. Department of Allergy and Rheumatology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan

    Masataka Kuwana

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van Laar, J.M., Simms, R.W. (2017). Immunomodulatory, Immunoablative, and Biologic Therapies. In: Varga, J., Denton, C., Wigley, F., Allanore, Y., Kuwana, M. (eds) Scleroderma. Springer, Cham. https://doi.org/10.1007/978-3-319-31407-5_41

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