Is gilenya an immunosupprressant or an immunomodulator? What is the difference?
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These definitions are from an interview done by Medscape as part of their medical education series. http://www.medscape.org/viewarticle/734015_transcript
Dr. Bermel: When dividing therapies between immunomodulators and immunosuppressants, we should first define these terms, which have pretty traditional definitions. What do most people mean when they talk about an immunomodulator? They talk about the ability to alter immune function from its current state of activity without any cytotoxic activity or bone marrow suppression. In contrast, immunosuppression alters the immune system through direct cytotoxic activity, or through bone marrow suppression. In other words, you're decreasing blood cell counts, suppressing the bone marrow, or actually killing cells to suppress the immune system.
"Cyto" means cell, so cytotoxic means poisonous to cells.
There is conflicting information about whether Gilenya is an immunosuppressant or an immunomodulator.
Officially it's an immunomodulator because it doesn't directly kill T cells or B cells. It prevents them from leaving the lymph nodes and circulating in the blood. Because the cells don't circulate in the blood, they aren't available to fight infections so people are open to developing infections. The prescribing information says that there might be other effects on the immune system. Because those effects aren't specified it's possible in theory that they might include some kind or amount of immunosuppression.
With reduced amounts or no T cells and B cells circulating in the blood, the effect is the same as if the the cells were eliminated by being killed by the medication. That's what immunosuppressants do. So it looks like that's why some sources say that Gilenya is an immunosuppressant. Drugs.com says that by keeping the cells trapped in the lymph nodes Gilenya is an immunosuppressant.
But using the definition given by Dr. Bermal, Gilenya is an immunomodulator and not an immunosuppressant because it doesn't (or isn't known to) kill the T and B cells.
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