Immunomodulators

From: 'Chronic Fatigue Syndrome, A Roadmap for Testing and Treatment' <a href="https://sites.google.com/site/cfstestingandtreatmentroadmap/home">https://sites.google.com/site/cfstestingandtreatmentroadmap/home</a>

These are drugs and supplements that modulate (modify) the functioning of immune system. Some immunomodulators used in ME/CFS shift the immune response from the Th2 mode to the Th1 mode. There is evidence that ME/CFS patients are stuck in the Th2 mode, whereas they should really be in the Th1 mode, because it is the Th1 immune response that fights the viruses and intracellular bacteria linked to ME/CFS.<a href="http://wayback.archive.org/web/20101214023010/http://cfids-cab.org/cfs-inform/Immunology/patarca-montero.etal01.pdf" rel="nofollow" target="blank" >1</a> These Th2 to Th1 shifting immunomodulator drugs and supplements include: inosine pranoxbex(Imunovir) and oxymatrine.<a href="http://www.ncbi.nlm.nih.gov/pubmed/26011933" target="blank" rel="nofollow" >1</a> <a href="http://forums.phoenixrising.me/index.php?threads/what-are-the-commonly-available-immune-modulators.33847/page-3#post-525111" target="_blank" rel="nofollow" >2</a>

Note that Th2 to Th1 shifting immunomodulators can make you feel worse for the first few months, but benefits accrue after that initial period. Dr Paul Cheney believes that the immunomodulator Imunovir will lose it's effect if you do not "pulse" it. Pulsing means taking regular breaks Imunovir, using an on/off regimen such as taking Imunovir for 5 days, then stopping for 2 days. Oxymatrine however should not be pulsed. Note that several ME/CFS doctors say that the supplement inosine is just as effective as Imunovir, but much cheaper (Imunovir is based on inosine).

Azithromycin is an antibiotic that acts as an immunomodulator and can lessen ME/CFS symptoms.<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1562448/" target="_blank" rel="nofollow" >1</a>

Low-intensity exercises like walking, tai chi and yoga help shift towards the desirable Th1 mode, whereas higher intensity exercise and longer workout durations shift towards the undesirable Th2 mode.<a href="http://www.biomedsearch.com/article/Exercise-medicine-using-exercise-to/202661767.html" target="_blank" rel="nofollow" >1</a>

Rintatolimod (Ampligen) is an immunomodulator drug that anecdotally has produced near full remission in a very small subset of ME/CFS patients, though for most patients, this drug only appears to yield minor improvements. The drug has been shown efficacious in phase III clinical trials.<a href="http://www.ncbi.nlm.nih.gov/pubmed/27045557" target="blank" rel="nofollow" >1</a> Ampligen is administered by intravenous infusion twice a week. Ampligen is expensive, costing around $15,000 a year (excluding the medical costs of the infusions). More info: <a href="http://me-pedia.org/wiki/Ampligen" target="blank" rel="nofollow" >Ampligen - MEpedia</a>.

Intravenous immunoglobulin (IVIG) has had mixed results, but can bring benefits (cost is around $25,000 for a course of treatment). More info: <a href="http://me-pedia.org/wiki/Intravenous_immunoglobulin" target="blank" rel="nofollow" >IVIG - MEpedia</a>, <a href="http://www.healthrising.org/treating-chronic-fatigue-syndrome-mecfs/drugs-for-chronic-fatigue-syndrome-mecfs-treatment/ivig-intravenous-gamma-globulin-therapy-for-chronic-fatigue-syndrome-mecfs-and-fibromyalgia/" target="blank" rel="nofollow" >IVIG and ME/CFS</a>.

Rituximab (Rituxan) is an anti-autoimmunity drug which depletes B-cells in the blood, thereby reducing the autoantibodies made by B-cells which attack the body. A phase II clinical trial of rituximab for ME/CFS showed that around two-thirds of patients derived benefit, sometimes very major benefits.<a href="http://www.ncbi.nlm.nih.gov/pubmed/22039471" target="blank" rel="nofollow" >1</a> A phase III clinical trial is now underway. The fact that rituximab clearly works suggest that ME/CFS may be an autoimmune disease (at least in part, or at least in a subset of patients). Rituximab is expensive, costing around $15,000 to $50,000 a year. More info: <a href="http://me-pedia.org/wiki/Rituximab" target="blank" rel="nofollow" >Rituximab - MEpedia</a>. Rituximab treatment for ME/CFS patients is available at: the <a href="http://www.openmedicineinstitute.org" target="blank" rel="nofollow" >Open Medicine Institute</a>, California ($50,000); and <a href="https://translate.google.com/translate?langpair=no%7Cen&u=http://kolibrimedical.no/" target="blank" >Kolibri Medical</a>, Stavanger, Norway ($15,000). <a href="http://translate.google.com/translate?langpair=no%7Cen&u=http://www.dagensmedisin.no/artikler/2015/11/23/tilbyr-privat-me-behandling-med-kreftmedisin--forskere-reagerer/" target="blank" >More info</a> about Kolibri. Kolibri find that rituximab treatment cures ⅓ of ME/CFS patients, makes an improvement in another ⅓ of patients, and has no effect in the final ⅓ of patients.<a href="http://forums.phoenixrising.me/index.php?threads/rituximab-im-from-holland.47807/#post-784919" target="blank" rel="nofollow" >1</a>