Sarilumab is recommended by NICE as an option for treating severe rheumatoid arthritis in combination with methotrexate in patients who have not responded to a combination of conventional DMARDs. It is also endorsed as an option for patients who have not responded to a biological DMARD and cannot take, or have had an indequate response to, rituximab.
If methotrexate is contraindicated or not tolerated, sarilumab can be prescribed within the NHS as monotherapy when patients have not responded to conventional DMARDs, or have not responded to a biological DMARD and cannot have rituximab.
Treatment with sarilumab should be continued only if there is a moderate response based on EULAR criteria at 6 months. Treatment should be withdrawn if at least a moderate EULAR response is not maintained.
Approval of sarilumab for NHS use was granted on the condition that the biologic continue to be provided with the discount agreed for the patient access scheme.
Sarilumab binds to both soluble and membrane-bound forms of the interleukin-6 (IL-6) receptor. It is administered by subcutaneous injection using a pre-filled syringe or pen.
Sarilumab is contraindicated in patients with active, severe infections and treated patients should be closely monitored for signs of infections, including TB.