Sarilumab

 

What is Sarilumab?

Sarilumab is a targeted disease modifying anti-rheumatic drug (DMARD) that is used to reduce inflammation produced by the body. In certain diseases the immune system is over active, this can target healthy tissues such as joints and the skin. Sarilumab works on the inflammatory pathway to block a protein called IL-6, thereby reducing the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints.

 

What is Sarilumab used for?

Sarilumab is used for the treatments of inflammatory diseases such as rheumatoid arthritis.

 

How is it taken?

Sarilumab is given as an injection into the layer of fat between the skin and muscle. This is called a subcutaneous injection and is usually given into the thigh or abdomen. It can be given alone or in combination with other DMARDs such as methotrexate.

The injection device is available as a prefilled syringe or pen. It should be stored in the fridge at home.

 

The dose of the injections is 200mg every 2 weeks. Some patients may need a lower dose of 150mg every 2 weeks if their blood counts are lowered.

 

It can take up to 12 weeks to have a full effect. You will be seen in clinic at around this point to see how you are getting along.

 

Whilst you are taking sarilumab you will need your bloods monitored. This is done initially every 8 weeks for the first 6 months, then every 3 months on going. If you are taking other DMARDs that require blood monitoring this should be continued.

 

If your symptoms become well controlled on the injections, you may be able to have your dose reduced; increasing the time between injections does this.

 

Side effects

There are a few possible side effects that can occur in a small number of people that take sarilumab, these include:

 

• Sore throat, stuffy nose and headaches
  • These usually settle after taking the medication for a few weeks.
• Increased risk of infections
  • As sarilumab dampens the immune system, you can be more prone to infection. You should be seen by your GP if you feel unwell in case you need antibiotics. You must temporarily stop your injections whilst you are unwell and receiving treatment, they can be started up again when you feel well.
  • You should try to avoid contact with others that have chicken pox or shingles.
• Subcutaneous injection site reactions
  • Irritation, rashes and blistering can occur.
  • Mild steroid creams and antihistamines can be used to settle things down. If these don’t work, then you should see your GP.
• High cholesterol
  • Sarilumab can sometimes increase the level of cholesterol (fat) in the blood. This is checked at your 3 monthly blood tests.
• Liver derangement
  • Occasionally sarilumab can increase the levels of liver enzymes seen on blood tests, this is often temporary. Trials have not shown any damage to the liver when this occurs.
• Bowel symptoms
  • Change in bowel habit and abdominal pain can sometimes occur. This can sometimes be due to underlying bowel condition called diverticulitis, treatment with sarilumab will have to stop and your should contact your doctor about these symptoms.

 

Cautions of use

Interactions with other medications

• Your doctor will check if there are any medications that could interact.
• You can carry on taking your usual painkillers including NSAIDs.

Contraindications of other conditions

• Before starting any biological therapy, your bloods will be checked for infections that can become active again when the immune system is suppressed, this includes hepatitis B, C and HIV. A blood and chest X-ray is taken to exclude previous TB exposure. If you are found to have had previous TB exposure you may need to start preventative antibiotics for a short period before the sarilumab is commenced.
• If you have a history of diverticulitis, sarilumab cannot be used.
• Sarilumab is not safe to be used if you are being investigated for or have been diagnosed with cancer.

Operations

• Sarilumab should be withheld for 2 weeks after the last dose would have been due. Therefore surgery can be scheduled for week 4.

During pregnancy and breastfeeding

• There is currently no data on sarilumab in pregnancy or breastfeeding. Therefore it should not be used.
• If you are considering starting a family, sarilumab should be stopped at least 12 weeks before trying to conceive.

Alcohol

• Alcohol and sarilumab do not interact, however it is recommended to take alcohol within moderation, following the guidelines of less than 14 units weekly.

Vaccinations

• Flu and the pneumonia vaccine are safe and recommended whilst taking sarilumab.
• Live vaccines including the shingles vaccine should not be given due to the dampening down of the immune system.

 

Useful Links

Versus Arthritis: http://www.versusarthritis.org