Modern immunosuppressives

Abstract

Eds HJ Schuurman , G Feutren & JF Bach . Published Birkhäuser Verlag AG 2001 . ISBN 3-7643-5981-1 This volume is a monograph in the series ‘Milestones in Drug Therapy’ and reviews present knowledge of modern immunosuppressive drugs. After an introductory chapter by Sir Roy Calne and David White, which reviews the history of immunosuppressive drugs, the book is divided into four sections: Immunosuppressive Drugs, Biologicals, New Avenues in Immunosuppression, and Perspectives. The chapter by Calne & White, who have collaborated over many years in the development and clinical application of new immunosuppressive drugs, nicely sets the scene for the remaining chapters. The section on immunosuppressive drugs covers cyclosporin, tacrolimus, sirolimus, and mycophenolate mofetil. The section on Biologicals covers the therapeutic use of monoclonal antibodies, and the targeting of IL-2 receptors with antibodies or chimeric toxins. New Avenues in Immunosuppression looks at emerging therapeutic strategies for the prevention and treatment of chronic allograft rejection, tolerance induction, and gene therapy approaches to immunosuppression. The final section on Perspectives looks at synergy among combinations of immunosuppressive therapies and the use of cyclosporin in the treatment of autoimmune diseases. The authors state in the preface that this monograph has been compiled for the use of clinicians working with immunosuppressive drugs in daily patient care and for researchers in preclinical and clinical studies. As a transplant surgeon, I found the chapters somewhat uneven, some being written with the clinician in mind and others very much for the research worker. On the whole, the chapter in the section on immunosuppressive drugs is well written indicating their pharmacological properties and their clinical benefits are clearly stated. However, the chapter dealing with tacrolimus ends with a short section comparing tacrolimus with cyclosporin, questioning which agent to use but does not satisfactorily answer this question and does not indeed fully discuss the incidence of side-effects of each drug in comparison with the other. The chapter on emerging therapeutic strategies for the prevention and treatment of chronic allograft rejection is well worth reading being crisply written and extremely well referenced. The chapter by Chou & Kahan on the approach to synergy in combination therapy contains complicated mathematics and is clearly written for the research worker although the last few pages of the chapter provide a summary of drug interactions which will be of value to clinicians. The final chapter is an overview on the use of cyclosporin in the treatment of autoimmune disease. This looks at the incidence of adverse effects when using cyclosporin in autoimmune disease, which apparently differ from those observed in clinical transplantation. I found this chapter somewhat out of place in this volume and I think it would also have benefited from some linguistic revision by the editors. Overall, this is a well-referenced and up-to-date volume and there is something in this book for everybody involved in the development and use of immunosuppressive agents. However, there are several other books available to clinicians on the subject of immunosuppressive agents and I suspect that this book will find its niche with the research worker rather than with the clinician.