Sarilumab

Sarilumab is used to treat inflammatory types of arthritis, such as rheumatoid arthritis (RA).

Sarilumab is used when there has been an inadequate response to DMARD therapy. Sarilumab is recommended to be used in combination with methotrexate (MTX) or other traditional DMARDs. For patients who cannot tolerate MTX, sarilumab may be given as monotherapy.

Sarilumab is never used in combination with other biologic medications. Combining sarilumab with another biologic therapy is not recommended because of the increased risk of infection.

Sarilumab is given by subcutaneous (s.c.) injection (meaning in the fatty layer of tissue just under the skin). You, a family member or a friend can be taught how to give the injection.

The usual dose of sarilumab is 200 mg once every 2 weeks.

The medication comes in single-use pre-filled syringes or pre-filled pens for administration.

In some people with arthritis, a signalling protein called Interleukin 6 (IL-6) is present in the blood and joint in excessive amounts where it increases inflammation. Sarilumab works by suppressing the body’s immune system, specifically it binds to IL-6 and prevents it from causing inflammation. By doing this, sarilumab can help to reduce pain and swelling in the joints, improve day-to-day function, and prevent long term damage to the joints.

As with all of the biologics, you may not feel the effects of the sarilumab right away. Some people begin to feel the effects of the medication fairly quickly; however, it may take three to six months to feel its full effect. It is important to be patient and keep taking your medication.

To provide symptom relief while you are waiting for sarilumab to take effect, your healthcare provider may recommend taking a steroid, such as prednisone, or a non-steroidal anti-inflammatory drug (NSAID).

Sarilumab can make it more difficult for your body to fight infections. People with active infections should not take sarilumab. If you have a fever, think you have an infection or have been prescribed an antibiotic, contact your healthcare provider. People who have had frequent infections in the past or a history of tuberculosis should discuss the use of sarilumab with their prescriber.

Also contact your healthcare provider if you are having surgery as you may need to stop sarilumab until you are healed and there is no sign of infection.

Sarilumab has not been studied in pregnant people or lactating parents so its effect(s) on pregnant people or nursing babies are unknown. You should tell your doctor if you are pregnant or are planning to become pregnant. Because of the potential for adverse reactions in nursing infants, a decision should be made on whether or not to discontinue nursing or the medication, taking into account the importance of the drug to the lactating parent.

Anyone who has had a previous allergic reaction to sarilumab should avoid the medication.

Anyone with a history of cancer should discuss the use of sarilumab with their healthcare provider.

Before starting this medication, you will likely be tested for inactive (“latent”) tuberculosis (TB) and hepatitis B because sarilumab can dampen the immune system and cause these infections to become active. If TB or hepatitis is found, it will need to be treated before you start sarilumab.

Ideally, your vaccinations should be up to date prior to starting sarilumab. If you have already started therapy with sarilumab, your healthcare provider will likely recommend most inactive vaccines (e.g., influenza, pneumococcal). Live vaccines are not recommended due to risk of causing infection. Before receiving any vaccinations while taking sarilumab, you should speak with your healthcare provider.

Like all medications, taking sarilumab carries some risk of side effects, which must be balanced with the potential benefits. In general, the risk of joint damage and permanent disability (resulting from arthritis) is much greater than the risks of side effects from sarilumab. When monitored properly the vast majority of side effects are rare, most improve over time and are reversible.

As with all DMARD and biologic medications, sarilumab can lower the ability of your immune system to fight infections and increase your risk of infections. You should take precautions to minimize your risk of being infected by common contagious infections such as COVID-19, influenzae, pneumonia, and the common cold.

The most common side effects of sarilumab are cold sores and upper respiratory tract infections/symptoms (coughs and cold, sore throat, runny nose, nasal congestion, sneezing, and coughing). Some people also experience urinary tract infections. Sarilumab can rarely cause a reaction (redness, pain, and itching) at the injection site. Talk to your healthcare provider if these symptoms become severe.

Sarilumab may affect your blood counts, liver or kidney function and cholesterol levels. Your healthcare provider will use blood tests to monitor for these changes.

Very rarely sarilumab has been associated with stomach perforations (holes in the lining of the stomach), usually as a complication of diverticulitis (infection of the large intestine). Sarilumab should be used with caution in patients who may be at increased risk for stomach perforation (e.g., using NSAIDs and/or corticosteroids, people with a history of diverticulitis). Stomach perforations require immediate medical attention. If you develop fever and severe stomach pain that does not go away, seek medical attention.

Take sarilumab as prescribed and contact your healthcare provider if you have any concerns while taking the medication.

To avoid injection reactions, injection sites should be rotated and avoid areas where the skin is tender, bruised, red and/or hard.

You will need blood tests 4 to 8 weeks after starting sarilumab, and then approximately every 3 months during treatment. This is important to ensure sarilumab is having no harmful effects on your blood counts, liver, kidneys, or cholesterol levels.

Sarilumab must be refrigerated at 2 to 8 degrees Celsius and protected from light. Keep the product in the original package and out of the light.

Sarilumab must be kept cool while travelling. Ask your pharmacist for a cool carrier if you are not able to put the drug in your refrigerator right away.

The patient support program for Kevzara is called “Mobilize”. Their phone number is 1-888-972-6634.