Medication Class Introduction

Immunomodulator medications represent a class of therapies introduced in the 1960s to manage inflammatory bowel disease (IBD).^1,2 These drugs target the immune system, aiming to modulate the dysregulated immune response that drives intestinal inflammation in IBD.^3–6 Their therapeutic effect generally involves suppressing immune activity by limiting the proliferation and survival of immune cells involved in driving inflammation.^2,5,7

IBD Treatment Landscape^8–18

JAK=Janus kinase; S1P=sphingosine-1-phosphate; TNF=tumor necrosis factor.

Role in IBD Pathogenesis

IBD is characterized by immune cell dysregulation, which may impair the clearance of activated cells and promote their continued proliferation and survival.^3–5,19 This dysregulation can result in elevated pro-inflammatory cytokine production, ultimately resulting in chronic intestinal inflammation.^4,5,19

Mechanism of Action in IBD

Immunomodulators can exert their effects by inhibiting immune cell proliferation and survival, though the specific mechanisms vary by agent.^{1,2,5,6,11,20,21} Some immunomodulator mechanisms of action inhibit key enzymatic processes involved in purine synthesis, disrupting DNA replication and cell division in lymphocytes, while others alter intracellular signaling pathways, leading to the induction of immune cell apoptosis (programmed cell death).^1,2,5–7,11 Additionally, immunomodulatory therapy can suppress production of pro-inflammatory cytokines, further reducing signaling that drives chronic inflammation.^2,5,6

DNA=deoxyribonucleic acid.