COVID-19 Curbside Consults

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

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

Article Figures & Data

Tables

  • TABLE 1

    Currently available interleukin 6 (IL-6) inhibitors

    Tocilizumab (Actemra)Sarilumab (Kevzara)Siltuximab (Sylvant)
    Mechanism of actionTocilizumab and sarilumab: Bind to soluble and membrane-bound IL-6 receptors and inhibit IL-6-mediated signalingBinds to IL-6 and prevents binding of IL-6 to soluble and membrane-bound IL-6 receptors
    Approved indications and dosingRheumatoid arthritis: 4 mg/kg IV every 4 weeks (up to 8 mg/kg every 4 weeks); 162 mg SQ everyother 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 chimeric antigen receptor T-cell therapy): 8 mg/kg IV (10 mg/kg if < 30 kg)    		Moderately to severely active rheumatoid arthritis: 200 mg SQ every other weekMulticentric Castleman disease: 11 mg/kg IV over 1 hour every 3 weeks until treatment failure
    ContraindicationsTocilizumab, sarilumab, and siltuximab:

    • Safety data are insufficient to recommend use of these agents during pregnancy or breastfeeding

    • Use with caution in patients with serious active infection or increased risk of gastrointestinal perforation

    Tocilizumab and sarilumab: 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

    COVID-19 dosing4-8 mg/kg IV for one or two doses (doses given within 24 hours of each other)200 mg SQ once
    400 mg IV once    		11 mg/kg IV once
    Maximum dose: 800 mg IV
    Current COVID-19 clinical trialsNCT04317092, NCT04335071,
    NCT04320615, NCT04306705,
    NCT04310228, NCT04335305,
    NCT04333914, NCT04339712,
    NCT04330638, NCT04322773,
    NCT04331795, NCT04332094,
    NCT04332913, NCT04331808    		NCT04341870, NCT04315298,
    NCT04327388, NCT04324073,
    NCT04321993, NCT04322773    		NCT04329650, NCT04322188,
    NCT04330638

    • ALT = alanine aminotransferase; ANC = absolute neutrophil count; AST = aspartate aminotransferase; IV = intravenously; SQ = subcutaneously; ULN = upper limit of normal

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