methylprednisolone + sirolimus + tacrolimus

This is a combination immunosuppressive regimen consisting of three agents: - **Methylprednisolone** is a synthetic glucocorticoid corticosteroid that suppresses inflammation and modulates immune responses by binding to the glucocorticoid receptor, inhibiting pro-inflammatory gene expression. - **Sirolimus** (also known as rapamycin) is an mTOR inhibitor that blocks T-cell activation and proliferation by inhibiting the mammalian target of rapamycin (mTOR), thereby interfering with interleukin-driven cell cycle progression. - **Tacrolimus** is a calcineurin inhibitor that suppresses T-cell activation by inhibiting calcineurin phosphatase activity, leading to reduced transcription of interleukin-2 and other cytokines. This triple-drug regimen has been studied primarily in the context of organ transplantation (such as kidney or lung) and for treatment-resistant chronic graft-versus-host disease (cGVHD). The combination aims to provide potent immunosuppression through complementary mechanisms, reducing the risk of rejection or immune-mediated complications. However, it carries risks such as nephrotoxicity, hyperlipidemia, cytopenias, increased infection risk, and potential drug interactions[1][4][5].