Immunomodulators – IM: Definition, Mechanism of Action and Secondary Effects

Immunomodulators (IM), also known as “immunosuppressants.”

They are types of medications that can be used as a treatment option for people with inflammatory bowel diseases, including Crohn’s disease (CD) and ulcerative colitis.

These conditions cause chronic and lasting inflammation within the digestive tract, which can cause symptoms that affect the mouth to the anus and outside the digestive tract.

Many medications used to treat people with CD, including MI, work by reducing the inflammation in the digestive tract that causes the symptoms.

Reducing symptoms over time can lead to a period of remission for many patients. The goal of using IM medications to treat CD by reducing inflammation is to help patients by:

  • The improvement of your symptoms.
  • Allowing them to enter periods of remission.
  • Supporting your remission periods last longer.

How do immunomodulators work? Mechanism of action

Each type of immunomodulatory drug contains a specific active ingredient that works by changing how the immune system carries out its functions in a person’s body.

Some of these medications work by suppressing or weakening the immune system, and others modify how it works in different ways.


Inflammation is the body is a standard response of the immune system to an infection or disease.

Researchers think that in people with inflammatory bowel diseases, their immune system can be overactive in a way that causes excessive inflammation in a person’s digestive tract.

This means that people with CD or ulcerative colitis have an immune system that mistakenly looks at the digestive tract, or parts of it, as a foreign object that must be attacked.

This triggers inflammation, which is the body’s natural protective response to a foreign object or infection.

However, this inflammation is chronic and harmful for people with CD because the immune system is constantly trying to attack the digestive tract (the perceived “foreign object”).

What types of immunomodulators are used to treat CD?

Immunomodulators have been used to treat people with inflammatory bowel diseases for more than 50 years. Immunomodulators can also be called “immunosuppressants.”

Five types of IM medications are used regularly to treat people with CD:

  • Azathioprine.
  • 6-mercaptopurine (6-MP).
  • Cyclosporine.
  • Tacrolimus.
  • Methotrexate

Immunomodulators are used more frequently to treat patients with moderate or severe CD. There are several situations in which a person with CD can try immunomodulator treatment.

Suppose a person has tried treatment with aminosalicylates, antibiotics, or corticosteroids, but they have not worked well enough to reduce CD symptoms. In that case, health professionals may recommend testing an immunomodulator.

Immunomodulators may also be recommended for patients with fistulas or symptoms located around the anus (perianal disease) that do not respond to treatment with other medications.

The perianal disease can be severe and painful, so patients will often try treatment with different types or combinations of medications, such as antibiotics, corticosteroids, and aminosalicylates.

If they do not sufficiently relieve the person’s symptoms, they can try treatment with immunomodulators. Immunomodulators may also be prescribed to help prevent EC from restarting after surgery.

Some immunomodulators (azathioprine and 6-mercaptopurine) are long-term treatments for Crohn’s disease because sometimes people must take them for 3 to 6 months before they experience improvements in their symptoms.

Others (cyclosporine, tacrolimus, and methotrexate) generally affect more quickly, often in weeks.

What is the relationship between corticosteroids and immunomodulators?

Because immunomodulators can take a long time to start working, sometimes healthcare providers recommend that patients begin taking a corticosteroid when they begin taking the immunomodulator.

This is because corticosteroids generally have a faster effect in improving a person’s symptoms.

Corticosteroids can cause many different side effects, some of which can be very serious.

Some people who take corticosteroids can also become physically dependent on them because of how much they alter the body while a person is taking this type of medication.

Many patients with inflammatory bowel disease may experience an outbreak when they stop taking them.

One of the benefits of immunomodulators for some patients is that they remain in remission for longer, which means they do not need to use corticosteroids to treat rashes as often.

What are some common side effects related to immunomodulatory treatment?

Several forms of immunomodulators can cause different side effects. However, some common side effects include:

  • Headache.
  • Nausea.
  • He retched.
  • Diarrhea.

Immunomodulators work by suppressing or weakening a patient’s immune system to reduce inflammation and the symptoms it causes. However, they can also have the effect of decreasing the body’s ability to fight infections.

Patients taking immunomodulators should contact their doctor if they begin to experience fever or chills, as these may be signs of an infection.

People who take immunomodulators are also more likely to get infections such as a cold or the flu because the medicine tells their immune systems not to trigger inflammation to fight infections or foreign objects.

While this may help relieve the symptoms of Crohn’s disease, it can also make it easier for infections to take root.

Some patients experience a decreased kidney or liver function if they take some forms of long-term immunomodulators.

For a few patients, specific immunomodulators can cause other severe side effects.

For this reason, physicians will take extensive medical histories before prescribing immunomodulators and then monitor patients carefully for any signs of these effects.

As with any prescription medication, patients should consult their doctors about all possible forms of treatment and any potential interaction with other medicines.

Pregnant women who plan to become pregnant should inform their doctors before starting treatment with immunomodulators, as some may cause pregnancy loss or possible congenital disabilities.