Sarilumab
Interleukin inhibitors
Interleukin inhibitors
A human antibody against the IL-6 receptor, injected under the skin, for rheumatoid arthritis, polymyalgia rheumatica and juvenile arthritis.
Quick facts
- Group
- Interleukin inhibitors
- Target
- Interleukin-6 receptor (IL-6R)
- Key effects
- Stuffy or runny nose
- Monitor
- Latent tuberculosis test before starting
- ATC
- L04AC14
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows the human IL-6 receptor bound to the sarilumab Fab (cryo-electron microscopy).
Sarilumab is a human IgG1 monoclonal antibody that binds the soluble and membrane IL-6 receptor, like tocilizumab. IL-6 can no longer signal through gp130 and JAK-STAT, so the acute-phase response, fever and joint inflammation fall.
- Antibody binds the IL-6 receptor
- IL-6 cannot signal through gp130
- Acute-phase response falls
- Joint pain, stiffness and swelling ease
Indications
- Rheumatoid arthritis after an inadequate response to DMARDs Rheumatoid arthritis →
- Polymyalgia rheumatica when other treatments failed Polymyalgia rheumatica →
- Polyarticular juvenile idiopathic arthritis Juvenile idiopathic arthritis →
Adverse effects
Common
- Stuffy or runny nose
- Redness or itching at the injection site
Contraindications
- Hypersensitivity to sarilumab
- Active serious infection
Key interactions
- Other medicines that suppress the immune system
- Added immunosuppression and infection risk.
- Aspirin and other NSAIDs
- Named on the patient information: easy bruising or bleeding is watched for.
- Live vaccines
- Avoided during treatment; vaccines are updated before starting.
What is monitored
- Latent tuberculosis test before starting
- Laboratory tests ordered by the team
- Signs of infection during and after treatment
Administration and safety
- Injected under the skin; the first dose is often given in a clinic, later doses at home.
- Not given during an active infection.
- Surgeons and dentists are told about the treatment before procedures.
Pregnancy and breastfeeding
Human data are limited; if it was used in pregnancy, the infant's clinician is told before vaccines.
Nursing care
- Confirm the tuberculosis test and ask about diabetes, HIV, hepatitis, diverticulitis and ulcers.
- Teach to report fever, chills, cough or painful skin, even if mild.
- Teach to report easy bruising or bleeding, and stomach pain or vomiting.
- If exposed in pregnancy, remind the family to tell the infant's clinician before vaccines.
Pharmacokinetics
- Absorption
- Subcutaneous injection from a prefilled syringe or pen
- Metabolism
- Broken down like other antibodies
Test yourself
Think of the answer, then tap the question to see it.
What does sarilumab bind?
The interleukin-6 receptor (soluble and membrane), like tocilizumab.
Which risk is in the boxed warning of sarilumab?
Serious infections (bacterial, viral and fungal, including tuberculosis), some of them fatal.
Besides rheumatoid arthritis, which rheumatic disease is treated with sarilumab?
Polymyalgia rheumatica (also polyarticular juvenile idiopathic arthritis).
Connections
← Back to the class: Interleukin inhibitors
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Sarilumab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2024); RCSB PDB - 8IOW: Cryo-EM structure of the sarilumab Fab/IL-6R complex (RCSB Protein Data Bank, 2024); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.