Sarilumab

Sarilumab, sold under the brand name Kevzara, is a human monoclonal antibody medication against the interleukin-6 receptor.[1] Regeneron Pharmaceuticals and Sanofi developed the drug for the treatment of rheumatoid arthritis (RA), for which it received US FDA approval on 22 May 2017 and European Medicines Agency approval on 23 June 2017.[2]

Development in ankylosing spondylitis has been suspended after the drug failed to show clinical benefit over methotrexate in a phase II trial.[3]

Contents

  • 1 Medical uses
  • 2 Contraindications
  • 3 Side effects
  • 4 Clinical trials
    • 4.1 Rheumatoid arthritis
  • 5 History
  • 6 Research
    • 6.1 COVID-19
  • 7 References
  • 8 Further reading
  • 9 External links

Medical uses[edit]

Sarilumab is used for the treatment of moderately to severely active rheumatoid arthritis in people who have not responded to, or did not tolerate, more conventional treatments. It can be used alone or in combination with methotrexate or other disease-modifying antirheumatic drugs (DMARDs).[4][5]

Contraindications[edit]

In the European Union, sarilumab is contraindicated in people with active, severe infections.[4] While this is not listed as a contraindication under the US FDA approval, there is a boxed warning that recommends testing for hidden tuberculosis infection before treatment and monitoring for signs of an infection during therapy with sarilumab.[5]

Side effects[edit]

The MONARCH trial suggested a significantly higher incidence of neutropenia in patients receiving 200 mg sarilumab every 2 weeks, compared to patients being treated with adalimumab (13.6% vs 0.5%). However, infection rates were similar between both groups (28.8% vs 27.7%).[6]

Other common side effects that occurred in 1% to 10% of patients included thrombocytopenia (low platelet count), infections of the upper respiratory tract and the urinary tract, oral herpes, hyperlipidaemia, and reactions at the injection site.[4]

Clinical trials[edit]

Rheumatoid arthritis[edit]

On May 15, 2013, both companies announced that 2 new trials were starting (COMPARE and ASCERTAIN) and the first patients had already been enrolled.[7]

In June 2015, a phase III trial (with methotrexate) for RA reported meeting its three coprimary endpoints.[8]

In November 2015, the SARIL-RA-TARGET trial reported good results (meeting both its coprimary end points).[9]

In November 2016, the MONARCH phase III trial comparing sarilimab to adalimumab (an anti-TNF) found sarilumab superior at reducing the DAS28-ESR score in patients with RA after 24 weeks.[6]

In July 2019, a multi-center trial was launched to study ‘Sarilumab in Patients With Glucocorticoid-Dependent Sarcoidosis.’ [10]

History[edit]

In October 2016, the U.S. Food and Drug Administration (FDA) refused approval for marketing as a treatment for rheumatoid arthritis due to good manufacturing practice (GMP) violations.[6] The drug was eventually approved by the FDA on 22 May 2017.

Research[edit]

COVID-19[edit]

A study of 420 patients was halted in September 2020, due to lack of demonstrated effectiveness in treating COVID-19 symptoms.[11]

On January 7, 2021, following a REMAP-CAP trial, Tocilizumab and Sarilumab were added to the UK recommended list for COVID-19 treatment, the number needed to treat is 12, meaning for every 12 intensive care unit patients treated 1 additional person survives compared to treatment as normal, also speeding up patients’ recovery and reducing the length of time that critically-ill patients need to spend in intensive care by about a week
[12]

References[edit]

  • ^ .mw-parser-output cite.citation{font-style:inherit}.mw-parser-output .citation q{quotes:”””””””‘””‘”}.mw-parser-output .id-lock-free a,.mw-parser-output .citation .cs1-lock-free a{background:linear-gradient(transparent,transparent),url(“//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg”)right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited a,.mw-parser-output .id-lock-registration a,.mw-parser-output .citation .cs1-lock-limited a,.mw-parser-output .citation .cs1-lock-registration a{background:linear-gradient(transparent,transparent),url(“//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg”)right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription a,.mw-parser-output .citation .cs1-lock-subscription a{background:linear-gradient(transparent,transparent),url(“//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg”)right 0.1em center/9px no-repeat}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-ws-icon a{background:linear-gradient(transparent,transparent),url(“//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg”)right 0.1em center/12px no-repeat}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{font-size:100%}.mw-parser-output .cs1-maint{display:none;color:#33aa33;margin-left:0.3em}.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}”Statement On A Nonproprietary Name Adopted By The USAN Council: Sarilumab” (PDF). ama-assn.org. American Medical Association.
  • ^ “Kevzara: Authorisation details”. European Medicines Agency. Retrieved 28 September 2017.
  • ^ “Sanofi and Regeneron Report Positive Phase 2b Trial Results with Sarilumab in Rheumatoid Arthritis”. regeneron.com (Press release). Paris & Tarrytown, New York: Regeneron. July 12, 2011.
  • ^ a b c “Kevzara: EPAR – Product Information” (PDF). European Medicines Agency. 2017-09-26.
  • ^ a b Drugs.com: Sarilumab Monograph. Accessed 2017-11-29.
  • ^ a b c Burmester GR, Lin Y, Patel R, van Adelsberg J, Mangan EK, Graham NM, et al. (May 2017). “Efficacy and safety of sarilumab monotherapy versus adalimumab monotherapy for the treatment of patients with active rheumatoid arthritis (MONARCH): a randomised, double-blind, parallel-group phase III trial”. Annals of the Rheumatic Diseases. 76 (5): 840–847. doi:10.1136/annrheumdis-2016-210310. PMC 5530335. PMID 27856432.
  • ^ Sanofi and Regeneron Announce Patient Enrollment in Two Phase 3 Trials with Sarilumab in Rheumatoid Arthritis (RA). May 2013
  • ^ Genovese MC, Fleischmann R, Kivitz AJ, Rell-Bakalarska M, Martincova R, Fiore S, et al. (June 2015). “Sarilumab Plus Methotrexate in Patients With Active Rheumatoid Arthritis and Inadequate Response to Methotrexate: Results of a Phase III Study”. Arthritis & Rheumatology. 67 (6): 1424–37. doi:10.1002/art.39093. PMID 25733246.
  • ^ Walker T. “Sarilumab effective in broad range of RA patients: Study”. Formulary Watch. Archived from the original on 21 November 2015.
  • ^ “More Information”. Sarcoidosis Program. Retrieved 2019-08-09.
  • ^ Sanofi halts tests of arthritis drug for use as a COVID-19 treatment
  • ^ Roberts, Michelle (2021-01-07). “Two more life-saving Covid drugs discovered”. BBC News. Retrieved 2021-01-07.
  • Further reading[edit]

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    • Bermejo I, Ren S, Simpson E, Clowes M, Scott DL, Young A, Stevenson M (June 2018). “Sarilumab for Previously-Treated Moderate or Severe Rheumatoid Arthritis: An Evidence Review Group Perspective of a NICE Single Technology Appraisal” (PDF). PharmacoEconomics. 36 (12): 1427–1437. doi:10.1007/s40273-018-0677-7. PMID 29882210. S2CID 46969760.
    • Genovese MC, van Adelsberg J, Fan C, Graham NM, van Hoogstraten H, Parrino J, Mangan EK, Spindler A, Huizinga TW, van der Heijde D (August 2018). “Two years of sarilumab in patients with rheumatoid arthritis and an inadequate response to MTX: safety, efficacy and radiographic outcomes”. Rheumatology (Oxford, England). 57 (8): 1423–1431. doi:10.1093/rheumatology/key121. PMC 6055572. PMID 29746672.
    • McCarty D, Robinson A (March 2018). “Efficacy and safety of sarilumab in patients with active rheumatoid arthritis”. Therapeutic Advances in Musculoskeletal Disease. 10 (3): 61–67. doi:10.1177/1759720X17752037. PMC 5802641. PMID 29492111.
    • Raimondo MG, Biggioggero M, Crotti C, Becciolini A, Favalli EG (2017). “Profile of sarilumab and its potential in the treatment of rheumatoid arthritis”. Drug Design, Development and Therapy. 11: 1593–1603. doi:10.2147/DDDT.S100302. PMC 5447699. PMID 28579757.

    External links[edit]

    • “Sarilumab”. Drug Information Portal. U.S. National Library of Medicine.

    InterleukinInflammatory lesions

    • #WHO-EM
    • ‡Withdrawn from market
    • Clinical trials:
      • †Phase III
      • §Never to phase III

    See also
    Receptor/signaling modulators
    Signaling peptide/protein receptor modulators
    Cytokine receptor modulators

    • Medicine portal


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