Sarilumab

Sarilumab is a type of drug called a biological therapy. It’s sometimes known by its trade name, Kevzara.

It can be prescribed by a consultant rheumatologist for rheumatoid arthritis. If you have rheumatoid arthritis, your body may produce too much of a protein called IL-6, which can affect your immune system. Sarilumab works by blocking IL-6.

Inflammation is your immune system’s way of fighting infections in your body. Inflammation can cause swelling, heat, redness and pain – you might notice these signs when you have a cut or a wound.

In rheumatoid arthritis, the immune system attacks healthy parts of your body, such as your joints, by mistake and causes inflammation. This can cause tiredness, anaemia, and damage to bones, cartilage and soft tissues.

Sarilumab is a long-term treatment and it may be between two and 12 weeks before you notice your symptoms improving .

It may be the first biological therapy you’re given, or you may have tried others first, such as rituximab or an anti-TNF drug.

Are there any reasons I won't be prescribed sarilumab?

Sarilumab won’t be started if:

• your arthritis isn’t active
• you have an infection
• you haven’t tried two disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate and hydroxychloroquine, first.

Usually, sarilumab will be prescribed in combination with methotrexate.

Doctors sometimes use a score known as DAS28 to work out how active your arthritis is. This counts how many of 28 specific joints are tender and swollen, and looks at inflammation levels in a blood test. You'll also be asked to score how well you feel on a scale of 0 to 10 (DAWN).

Your doctor may decide not to prescribe sarilumab if you:

• get repeated or serious infections
• have high cholesterol, or if you have a high level of certain lipids or fats in your blood
• have a liver disease, or if your liver function tests are higher than the normal range
• have a history of intestinal ulcers or diverticulitis
• have chronic kidney disease.

There’s no good evidence that using sarilumab to control your immune system increases your risk of cancer. Even so, if you’ve had cancer before, you should always let your clinical team know in case this affects decisions about your treatment.

Before starting sarilumab, you’ll have a chest x-ray and blood tests to check if you’ve previously been exposed to tuberculosis (TB). You may need a course of treatment for TB before starting sarilumab, even if you don’t have any symptoms.

You’ll also be checked to see if you have previously had hepatitis, as sarilumab can increase the risk of hepatitis starting up again.

Sarilumab is given as an injection under the skin, known as a subcutaneous injection, once every two weeks. This is done using either a pre-filled syringe or an injector pen.

You, your partner, or another member of your family can learn to give these injections.

It’s important to keep taking sarilumab, unless you have severe side-effects. You should keep taking it even if it doesn’t seem to be working at first and when your symptoms start to improve, as this will help to control your arthritis.

If you miss a dose of sarilumab and realise within three days, you should take it as soon as possible, then take your next dose as planned. If it’s been four days or more since your missed dose, don’t take sarilumab – just take your next dose as normal.

The most common side-effects aren’t usually serious – they include:

• a cough or sore throat
• a blocked or runny nose
• cold sores
• urinary tract infections
• redness and itching at the site of the injection.

Sarilumab can make you more likely to pick up infections and it can also make them harder to spot. Tell your doctor or rheumatology nurse if you develop a sore throat or fever, or have unexplained bruising, bleeding or paleness. You should also tell them if you have any other new symptoms.

If any of these symptoms are severe, you should stop taking sarilumab and see your doctor straight away. Sarilumab is available in two strengths, so your dose might be reduced if you have severe side-effects.

You should also see your doctor if you develop chickenpox or shingles, or come into contact with someone who has chickenpox or shingles, as these can be severe if you’re on sarilumab. You may need antiviral treatment, and your sarilumab may need to be stopped until you’re better.

Sarilumab can sometimes increase your cholesterol levels and you may need to ask your GP for treatment to lower these. It can also affect liver function tests or reduce the numbers of white cells or platelets in your blood.

You’ll need further cholesterol checks and blood tests every four to eight weeks while you’re on sarilumab, to monitor its effects.

Reducing the risk of infection

Try to avoid close contact with people who have severe active infections.

For advice on avoiding infections from food, read NHS Live Well's 10 ways to prevent food poisoning.

You shouldn’t use sarilumab if you’re taking any other type of biological therapy, but it can be prescribed alongside other drugs, including methotrexate.

Check with your doctor before starting any new medications, and remember to mention you’re on sarilumab if you’re treated by anyone that isn’t in your usual rheumatology team.

Tell your doctor if you’re taking statins, oral contraceptives, or drugs used to treat asthma or blood clots, as sarilumab can interact with some of these drugs.

You can carry on taking non-steroidal anti-inflammatory drugs (NSAIDs) or painkillers if needed, unless your doctor advises otherwise. Don’t take over-the-counter or herbal remedies without talking to your rheumatology team first.

It’s recommended that you carry a biological therapy alert card, so anyone treating you will know that you’re on sarilumab – you can get a card from your rheumatology department.

Vaccinations

People on sarilumab should avoid live vaccines, such as yellow fever.

The live shingles vaccine (Zostavax) isn’t recommended for people taking sarilumab. However, there is a non-live shingles vaccine (Shingrix) so you may be able to have this instead.

Having an operation

If you’re having an operation, you may be advised to stop taking sarilumab for a few weeks before and after surgery – check with your rheumatology team or surgeon about this.

There’s no reason to avoid alcohol while on sarilumab, but you should stay within government guidelines for adults of no more than 14 units per week. You should try to spread these units out over the week, and not have them all in one go .

Because sarilumab is a relatively new drug, we don’t yet know how it might affect pregnancy or an unborn baby. Tell your rheumatology team immediately if you become pregnant whilst taking sarilumab.

If you’re a woman of childbearing age, it’s a good idea to use contraception while taking sarilumab and for three months after you finish your treatment. There’s some evidence that sarilumab could affect how the contraceptive pill works, so tell your doctor if you’re taking the pill when you start sarilumab as they may be able to suggest other forms of contraception you could use.

We don’t yet know whether sarilumab can pass into breastmilk, so current advice is not to breastfeed while taking this drug.