COVID-19 Curbside Consults

Practical aspects of targeting IL-6 in COVID-19 disease

Cassandra Calabrese, DO, Prabalini Rajendram, MD, Gretchen Sacha, PharmD and Leonard Calabrese, DO
Cleveland Clinic Journal of Medicine May 2020, DOI: https://doi.org/10.3949/ccjm.87a.ccc018
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  • TABLE 1

    Currently available IL-6 inhibitors

    AgentMechanism of actionCurrent FDA-approved indications and dosingContraindications and cautions
    Tocilizumab (Actemra)Binds to soluble and membrane-bound IL-6 receptors and inhibits IL-6-mediated signalingRheumatoid arthritis: 4 mg/kg IV every 4 weeks (up to 8 mg/kg every 4 weeks); 162 mg SQ every other week (up to every week)

    Giant cell arteritis: 162 mg SQ once weekly or every other week

    Polyarticular juvenile idiopathic arthritis: 8 mg/kg IV every 4 weeks (10 mg/kg if < 30 kg); 162 mg SQ every other week (every 3 weeks if < 30 kg)

    Systemic juvenile idiopathic arthritis: 8 mg/kg IV every other week (12 mg/kg if < 30 kg); 162 mg SQ every week (every other week if < 30 kg)

    Cytokine release syndrome (due to CAR-T cell therapy): 8 mg/kg IV (10 mg/kg if < 30 kg)    		Avoid use in patients with:
    • ANC < 2,000/mm3
    • Platelet count < 100,000/mm3
    • ALT/AST > 1.5 x ULN
    • Tuberculosis or latent tuberculosis infection

    Use with caution in patients with:
    • Serious active infection
    • Increased risk of gastrointestinal perforation
    Sarilumab (Kevzara)Binds to soluble and membrane-bound IL-6 receptors and inhibits IL-6-mediated signalingModerately to severely active rheumatoid arthritis: 200 mg SQ every other weekAvoid use in patients with:
    • ANC < 2,000/mm3
    • Platelet count < 150,000/mm3
    • ALT/AST > 1.5 × ULN
    • Tuberculosis or latent tuberculosis infection
    Use with caution in patients with:
    • Serious active infection
    • Increased risk of gastrointestinal perforation
    Siltuximab (Sylvant)Binds to IL-6 and prevents binding of IL-6 to soluble and membrane-bound IL-6 receptorsMulticentric Castleman disease: 11 mg/kg IV over 1 hour every 3 weeks until treatment failureUse with caution in patients with:
    • Serious active infection
    • Increased risk of gastrointestinal perforation

    • ALT = alanine aminotransferase; ANC = absolute neutrophil count; AST = aspartate aminotransferase; CAR-T = chimeric antigen receptor T cell; IV = intravenously; SQ = subcutaneously; ULN = upper limit of normal

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