ciclosporin + cyclophosphamide + methylprednisolone + mycophenolate mofetil

This is a combination regimen of four immunosuppressive and cytotoxic drugs—ciclosporin, cyclophosphamide, methylprednisolone, and mycophenolate mofetil. Each drug has a distinct mechanism of action but all are used to suppress the immune system in various autoimmune diseases or to prevent organ transplant rejection.

• Ciclosporin is a calcineurin inhibitor that suppresses T-cell activation by inhibiting interleukin-2 production.
• Cyclophosphamide is an alkylating agent that crosslinks DNA, leading to cell death, particularly affecting rapidly dividing immune cells.
• Methylprednisolone is a synthetic glucocorticoid corticosteroid that reduces inflammation by modulating gene expression and suppressing multiple inflammatory pathways.
• Mycophenolate mofetil inhibits inosine monophosphate dehydrogenase (IMPDH), blocking de novo purine synthesis in lymphocytes and thus preventing their proliferation.

This combination may be used for severe or refractory autoimmune conditions (such as lupus nephritis) or as part of aggressive immunosuppression protocols in transplantation.