Jump to comment:
- Page navigation anchor for Sarilumab for hospitalized patients with COVID-19Sarilumab for hospitalized patients with COVID-19
Afra and colleagues provide a timely review of a crucial treatment for hospitalized patients with COVID-19.(1) Unfortunately, ongoing tocilizumab shortages with uncertain future supply threatens our ability to optimally care for patients.(2)
Akin to tocilizumab, another repurposed interleukin-6 (IL-6) receptor inhibitor is sarilumab, a fully human monoclonal antibody that is currently approved in Canada for moderate-severe rheumatoid arthritis.(3)
In the Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia study, both tocilizumab (n=353) and sarilumab (n=48) treated patients had improved outcomes, including survival.(4) Median organ support-free days with sarilumab was 11 (10 with tocilizumab). Mortality with sarilumab was 22%, versus 36% in the standard of care group - a number needed to treat of approximately 7, acknowledging the small sample size.(4) These outcomes are somewhat tempered by the results of a placebo-controlled randomized trial of sarilumab 200mg (n=159) and 400mg (n=178),(5) which demonstrated a non-statistically significant trend towards improved survival. This study acknowledges they may not have recruited sufficiently critically ill patients, with only approximately 60% of patients receiving at least one dose of systemic corticosteroids.(5)
The main practical limitations of sarilumab include uncertain supply and logistical preparation/administration barriers. While sarilumab is formulated as...
Show MoreCompeting Interests: Peter Wu and Elizabeth Leung are members of, and Andrew Morris co-chairs, the Ontario COVID-19 Drugs and Biologics Clinical Practice Guidelines Working Group – a volunteer provincial working group aimed at providing consensus-based, evidence-informed treatment guidelines for COVID-19. No other competing interests declared.References
- 1. Afra K, Chen LYC, Sweet D. Tocilizumab for hospitalized patients with COVID-19. CMAJ 2021 Apr 12;193(15):E521.
- 2. Pai M, Morris A, Murthy S. Opinion: Canadians should ask why we are running out of drugs to treat COVID-19. The Globe and Mail 2021 April 25.
- 3. Product monograph: KEVZARA® sarilumab. Sanofi-aventis Canada Inc., Laval (QC). 2017 Jan. 12, revised 2019 Aug. 8. Available from: https://pdf.hres.ca/dpd_pm/00052589.PDF.
- 4. REMAP-CAP Investigators; Gordon AC, Mouncey PR, Al-Beidh F, et al. Interleukin-6 receptor antagonists in critically ill patients with COVID-19. N Engl J Med 2021 Apr 22;384(16):1491-1502.
- 5. Lescure FX, Honda H, Fowler RA, et al. Sarilumab in patients admitted to hospital with severe or critical COVID-19: a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med 2021 Mar 4:S2213-2600(21)00099-0.