NAV

Sarilumab

Identification

Summary

Sarilumab is a monoclonal antibody used to treat moderate to severe rheumatoid arthritis who have responded poorly or are intolerant of other DMARDs.

Brand Names
Kevzara
Generic Name
Sarilumab
DrugBank Accession Number
DB11767
Background

Sarilumab is a fully human anti-interleukin 6 (IL-6) receptor monoclonal IgG1 antibody that binds to both membrane-bound and soluble IL-6 receptor forms, thus blocking the cis- and trans-inflammatory signalling cascades of IL-6.1 Sarilumab was developed by Sanofi and Regeneron Pharmaceuticals, Inc; it was US FDA-approved in May 2017 and followed by EU approval in June 2017 for the treatment of moderate to severe rheumatoid arthritis (RA) in combination with methotrexate.4 RA is a chronic inflammatory disease characterized by polyarthritis, and its treatment has been challenged by the different responses in every patient.3 Subcutaneous administration of sarilumab has been shown to decrease acute-phase reactant levels and improve clinical RA symptoms.2

Type
Biotech
Groups
Approved, Investigational
Biologic Classification
Protein Based Therapies
Monoclonal antibody (mAb)
Protein Structure
Protein Chemical Formula
C6388H9918N1718O1998S44
Protein Average Weight
150000.0 Da (143900 Da in absence of N-glycosylation in heavy chains (Asn296))
Sequences
> Heavy chain
EVQLVESGGGLVQPGRSLRLSCAASRFTFDDYAMHWVRQAPGKGLEWVSGISWNSGRIGY
ADSVKGRFTISRDNAENSLFLQMNGLRAEDTALYYCAKGRDSFDIWGQGTMVTVSSASTK
GPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYS
LSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKKVEPKSCDKTHTCPPCPAPELLGGPSVF
LFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYR
VVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKN
QVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGN
VFSCSVMHEALHNHYTQKSLSLSPGK
>Light chain
DIQMTQSPSSVSASVGDRVTITCRASQGISSWLAWYQQKPGKAPKLLIYGASSLESGVPS
RFSGSGSGTDFTLTISSLQPEDFASYYCQQANSFPYTFGQGTKLEIKRTVAAPSVFIFPP
SDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLT
LSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC
Download FASTA Format
Synonyms
  • REGN88
  • SAR153191
  • Sarilumab
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Pharmacology

Indication

Sarilumab is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response or intolerance to one or more disease-modifying antirheumatic drugs (DMARDs); and adult patients with polymyalgia rheumatica (PMR) who have had an inadequate response to corticosteroids or who cannot tolerate corticosteroid taper.6

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Associated Conditions
Indication TypeIndicationCombined Product DetailsApproval LevelAge GroupPatient CharacteristicsDose Form
Treatment ofPolymyalgia rheumatica (pmr)••••••••••••••••••••••••••••••• ••••• ••• ••••••••••••••••••
Treatment ofPolymyalgia rheumatica (pmr)••••••••••••••••••••••••••• •••••••• •• •••••••• ••••••••••••••••••••••••
Treatment ofModerate, active rheumatoid arthritis••••••••••••••••••••••••••• •••••••• •• ••••••••••• •• •••••••••••••••
Treatment ofSevere, active rheumatoid arthritis••••••••••••••••••••••••••• •••••••• •• ••••••••••• •• •••••••••••••••
Contraindications & Blackbox Warnings
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Pharmacodynamics

Single-dose subcutaneous administration of sarilumab produced a rapid reduction of CRP levels, leading to normal levels after two weeks of treatment. Peak reduction in the absolute neutrophile count was observed after 3 to 4 days of treatment, followed by a recovery to baseline levels. A decrease in fibrinogen and serum amyloid A and an increase in hemoglobin and serum albumin were also detected.6

Mechanism of action

Sarilumab is a human recombinant IgG1 antibody that binds to both forms of interleukin 6 receptors (IL-6R), thus inhibiting IL-6-mediated signaling. IL-6 is a pleiotropic cytokine that activates immune cells (T and B cells) and hepatocytes for the release of acute phase proteins like CRP, serum amyloid A and fibrinogen, which are biomarkers of rheumatoid arthritis (RA) activity. IL-6 is also found in synovial fluid and plays a major role in the pathological inflammation and joint destruction features of RA. Thus, it is used for the treatment of RA due to its ability to inhibit intra-articular and systemic IL-6 signaling.6

TargetActionsOrganism
AInterleukin-6 receptor subunit alpha
antagonist
antibody
Humans
UHigh affinity immunoglobulin gamma Fc receptor I
unknown
Humans
ULow affinity immunoglobulin gamma Fc region receptor II-a
unknown
Humans
ULow affinity immunoglobulin gamma Fc region receptor II-b
unknown
Humans
ULow affinity immunoglobulin gamma Fc region receptor III-A
unknown
Humans
ULow affinity immunoglobulin gamma Fc region receptor III-B
unknown
Humans
Absorption

Sarilumab is shown to be well absorbed in patients with rheumatoid arthritis after single subcutaneous administration, with a maximum serum concentration presented after 2 to 4 days. For the 150 mg every two weeks dose regimen, the AUC, Cmin and Cmax of sarilumab were 202 ± 120 mg.day/L, 6.35 ± 7.54 mg/L, and 20.0 ± 9.20 mg/L, respectively. For the 200 mg every two weeks dose regimen, the AUC, Cmin and Cmax of sarilumab were 395 ± 207 mg.day/L, 16.5 ± 14.1 mg/L, and 35.6 ± 15.2 mg/L, respectively.6

Volume of distribution

In patients with rheumatoid arthritis, the apparent volume of distribution at steady state was 7.3 L.6

Protein binding

Sarilumab is a covalent heterotetramer composed of two disulfide-linked heavy chains covalently linked to a kappa light chain. The heavy chain has an IgG1 constant region with a single N-linked glycosylation site in the Fc portion of the molecule. The complementarity-determining regions (CDRs) within variable domains of both light and heavy chains combine to form the binding site for IL-6R. As an IgG1 molecule, sarilumab may mediate Fc-effector function upon binding to IL-6Ra, and it is prompt to bind to FcγRI, FcγRIIa, FCγRIIb, FcγRIIIa and FcγRIIIB.5

Metabolism

The metabolism of sarilumab has not been characterized. As a monoclonal antibody, it is thought to be degraded into small peptides and amino acids.6

Route of elimination

At high concentrations, sarilumab is thought to be eliminated predominantly through a non-saturated proteolytic pathway, while at lower concentrations, the elimination will be done by saturable target-mediated elimination.1 As a monoclonal antibody, sarilumab is not eliminated through renal or hepatic pathways.6

Half-life

The half-life will depend on the administered concentration. At 200 mg every 2 weeks, half-life is up to 10 days in patients with rheumatoid arthritis (RA) at steady state. At 150 mg every 2 weeks, half-life is up to 8 days in patients with RA at steady state. After the last steady state dose of 150 and 200 mg, the time to reach nondetectable concentration is 28 and 43 days, respectively.6

Clearance

Sarilumab is not eliminated via renal or hepatic pathways. Patients with rheumatoid arthritis have shown a trend toward higher clearance in the presence of anti-sarilumab antibodies.6

Adverse Effects
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Toxicity

Repeat dose exposure has been shown to produce a partially reversible decrease in neutrophil count and a reversible decrease in fibrinogen.5

Pathways
Not Available
Pharmacogenomic Effects/ADRs Browse all" title="About SNP Mediated Effects/ADRs" id="snp-actions-info" class="drug-info-popup" href="javascript:void(0);">
Not Available

Interactions

Drug Interactions Learn More" title="About Drug Interactions" id="structured-interactions-info" class="drug-info-popup" href="javascript:void(0);">
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
DrugInteraction
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interactions in your software
AbataceptThe risk or severity of adverse effects can be increased when Abatacept is combined with Sarilumab.
AbciximabThe risk or severity of adverse effects can be increased when Abciximab is combined with Sarilumab.
AbemaciclibThe metabolism of Abemaciclib can be increased when combined with Sarilumab.
AcalabrutinibThe metabolism of Acalabrutinib can be increased when combined with Sarilumab.
AcenocoumarolThe serum concentration of Acenocoumarol can be increased when it is combined with Sarilumab.
Food Interactions
No interactions found.

Products

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Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
KevzaraInjection, solution200 mgSubcutaneousSANOFI WINTHROP INDUSTRIE2020-12-16Not applicableEU flag
KevzaraInjection, solution200 mg/1.14mLSubcutaneoussanofi-aventis U.S. LLC2017-05-22Not applicableUS flag
KevzaraInjection, solution200 mgSubcutaneousSANOFI WINTHROP INDUSTRIE2020-12-16Not applicableEU flag
KevzaraInjection, solution150 mgSubcutaneousSANOFI WINTHROP INDUSTRIE2020-12-16Not applicableEU flag
KevzaraSolution200 mg / 1.14 mLSubcutaneousSanofi Aventis2017-02-08Not applicableCanada flag

Categories

ATC Codes
L04AC14 — Sarilumab
Drug Categories
Chemical TaxonomyProvided by Classyfire
Description
Not Available
Kingdom
Organic Compounds
Super Class
Organic Acids
Class
Carboxylic Acids and Derivatives
Sub Class
Amino Acids, Peptides, and Analogues
Direct Parent
Peptides
Alternative Parents
Not Available
Substituents
Not Available
Molecular Framework
Not Available
External Descriptors
Not Available
Affected organisms
  • Humans and other mammals

Chemical Identifiers

UNII
NU90V55F8I
CAS number
1189541-98-7

References

General References
  1. Huizinga TW, Fleischmann RM, Jasson M, Radin AR, van Adelsberg J, Fiore S, Huang X, Yancopoulos GD, Stahl N, Genovese MC: Sarilumab, a fully human monoclonal antibody against IL-6Ralpha in patients with rheumatoid arthritis and an inadequate response to methotrexate: efficacy and safety results from the randomised SARIL-RA-MOBILITY Part A trial. Ann Rheum Dis. 2014 Sep;73(9):1626-34. doi: 10.1136/annrheumdis-2013-204405. Epub 2013 Dec 2. [Article]
  2. Genovese MC, Fleischmann R, Kivitz AJ, Rell-Bakalarska M, Martincova R, Fiore S, Rohane P, van Hoogstraten H, Garg A, Fan C, van Adelsberg J, Weinstein SP, Graham NM, Stahl N, Yancopoulos GD, Huizinga TW, van der Heijde D: Sarilumab Plus Methotrexate in Patients With Active Rheumatoid Arthritis and Inadequate Response to Methotrexate: Results of a Phase III Study. Arthritis Rheumatol. 2015 Jun;67(6):1424-37. doi: 10.1002/art.39093. [Article]
  3. Cooper S: Sarilumab for the treatment of rheumatoid arthritis. Immunotherapy. 2016;8(3):249-50. doi: 10.2217/imt.15.127. Epub 2016 Feb 9. [Article]
  4. Kaufman MB: Pharmaceutical Approval Update. P T. 2017 Sep;42(9):562-580. [Article]
  5. EMA Assessment Report: Kevzara, INN-sarilumab [Link]
  6. FDA Approved Drug Products: KEVZARA (sarilumab) injection for subcutaneous use (February 2023) [Link]
PubChem Substance
347911238
RxNav
1923319
Wikipedia
Sarilumab
FDA label
Download (1.31 MB)
MSDS
Download (90.8 KB)

Clinical Trials

Clinical Trials Learn More" title="About Clinical Trials" id="clinical-trials-info" class="drug-info-popup" href="javascript:void(0);">
PhaseStatusPurposeConditionsCount
4CompletedTreatmentRheumatoid Arthritis1
4Unknown StatusTreatmentAtherosclerosis / Rheumatoid Arthritis1
3CompletedTreatmentCoronavirus Disease 2019 (COVID‑19) / Infections, Coronavirus1
3CompletedTreatmentRheumatoid Arthritis9
3RecruitingTreatmentCommunity-acquired Pneumonia, Influenza, COVID-19 / Coronavirus Disease 2019 (COVID‑19)1

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
FormRouteStrength
Injection, solutionParenteral; Subcutaneous150 MG
Injection, solutionParenteral; Subcutaneous200 MG
Injection, solutionSubcutaneous150 mg/1.14mL
Injection, solutionSubcutaneous200 mg/1.14mL
SolutionSubcutaneous150 mg / 1.14 mL
SolutionSubcutaneous200 mg / 1.14 mL
Injection, solutionSubcutaneous150 mg
Injection, solutionSubcutaneous200 mg
Prices
Not Available
Patents
Not Available

Properties

State
Solid
Experimental Properties
PropertyValueSource
melting point (°C)69 °C (midpoint transition), 80 °C (whole IgG1)Dashivets, et al. PLOS ONE. 10. e0143520. 10.1371/journal.pone.0143520. (2015).
isoelectric point6.6 - 7.2Jin, et al. Electrophoresis. Sep;23(19):3385-91. (2002).

Targets

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insights and accelerate drug research.
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Details1. Interleukin-6 receptor subunit alpha
Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Antagonist
Antibody
General Function
Protein homodimerization activity
Specific Function
Part of the receptor for interleukin 6. Binds to IL6 with low affinity, but does not transduce a signal. Signal activation necessitate an association with IL6ST. Activation may lead to the regulati...
Gene Name
IL6R
Uniprot ID
P08887
Uniprot Name
Interleukin-6 receptor subunit alpha
Molecular Weight
51547.015 Da
References
  1. Huizinga TW, Fleischmann RM, Jasson M, Radin AR, van Adelsberg J, Fiore S, Huang X, Yancopoulos GD, Stahl N, Genovese MC: Sarilumab, a fully human monoclonal antibody against IL-6Ralpha in patients with rheumatoid arthritis and an inadequate response to methotrexate: efficacy and safety results from the randomised SARIL-RA-MOBILITY Part A trial. Ann Rheum Dis. 2014 Sep;73(9):1626-34. doi: 10.1136/annrheumdis-2013-204405. Epub 2013 Dec 2. [Article]
  2. June RR, Olsen NJ: Room for more IL-6 blockade? Sarilumab for the treatment of rheumatoid arthritis. Expert Opin Biol Ther. 2016 Oct;16(10):1303-9. doi: 10.1080/14712598.2016.1217988. Epub 2016 Aug 8. [Article]
  3. Smolen JS, Landewe R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, Nam J, Ramiro S, Voshaar M, van Vollenhoven R, Aletaha D, Aringer M, Boers M, Buckley CD, Buttgereit F, Bykerk V, Cardiel M, Combe B, Cutolo M, van Eijk-Hustings Y, Emery P, Finckh A, Gabay C, Gomez-Reino J, Gossec L, Gottenberg JE, Hazes JMW, Huizinga T, Jani M, Karateev D, Kouloumas M, Kvien T, Li Z, Mariette X, McInnes I, Mysler E, Nash P, Pavelka K, Poor G, Richez C, van Riel P, Rubbert-Roth A, Saag K, da Silva J, Stamm T, Takeuchi T, Westhovens R, de Wit M, van der Heijde D: EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017 Jun;76(6):960-977. doi: 10.1136/annrheumdis-2016-210715. Epub 2017 Mar 6. [Article]
  4. Kampan NC, Xiang SD, McNally OM, Stephens AN, Quinn MA, Plebanski M: Immunotherapeutic Interleukin-6 or Interleukin-6 receptor blockade in cancer: challenges and opportunities. Curr Med Chem. 2017 Jul 12. doi: 10.2174/0929867324666170712160621. [Article]
  5. Lin P: Targeting interleukin-6 for noninfectious uveitis. Clin Ophthalmol. 2015 Sep 11;9:1697-702. doi: 10.2147/OPTH.S68595. eCollection 2015. [Article]
Details2. High affinity immunoglobulin gamma Fc receptor I
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Unknown
General Function
Receptor signaling protein activity
Specific Function
High affinity receptor for the Fc region of immunoglobulins gamma. Functions in both innate and adaptive immune responses.
Gene Name
FCGR1A
Uniprot ID
P12314
Uniprot Name
High affinity immunoglobulin gamma Fc receptor I
Molecular Weight
42631.525 Da
References
  1. EMA Assessment Report: Kevzara, INN-sarilumab [Link]
Details3. Low affinity immunoglobulin gamma Fc region receptor II-a
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Unknown
General Function
Not Available
Specific Function
Binds to the Fc region of immunoglobulins gamma. Low affinity receptor. By binding to IgG it initiates cellular responses against pathogens and soluble antigens. Promotes phagocytosis of opsonized ...
Gene Name
FCGR2A
Uniprot ID
P12318
Uniprot Name
Low affinity immunoglobulin gamma Fc region receptor II-a
Molecular Weight
35000.42 Da
References
  1. EMA Assessment Report: Kevzara, INN-sarilumab [Link]
Details4. Low affinity immunoglobulin gamma Fc region receptor II-b
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Unknown
General Function
Not Available
Specific Function
Receptor for the Fc region of complexed or aggregated immunoglobulins gamma. Low affinity receptor. Involved in a variety of effector and regulatory functions such as phagocytosis of immune complex...
Gene Name
FCGR2B
Uniprot ID
P31994
Uniprot Name
Low affinity immunoglobulin gamma Fc region receptor II-b
Molecular Weight
34043.355 Da
References
  1. EMA Assessment Report: Kevzara, INN-sarilumab [Link]
Details5. Low affinity immunoglobulin gamma Fc region receptor III-A
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Unknown
General Function
Not Available
Specific Function
Receptor for the Fc region of IgG. Binds complexed or aggregated IgG and also monomeric IgG. Mediates antibody-dependent cellular cytotoxicity (ADCC) and other antibody-dependent responses, such as...
Gene Name
FCGR3A
Uniprot ID
P08637
Uniprot Name
Low affinity immunoglobulin gamma Fc region receptor III-A
Molecular Weight
29088.895 Da
References
  1. EMA Assessment Report: Kevzara, INN-sarilumab [Link]
Details6. Low affinity immunoglobulin gamma Fc region receptor III-B
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Unknown
General Function
Not Available
Specific Function
Receptor for the Fc region of immunoglobulins gamma. Low affinity receptor. Binds complexed or aggregated IgG and also monomeric IgG. Contrary to III-A, is not capable to mediate antibody-dependent...
Gene Name
FCGR3B
Uniprot ID
O75015
Uniprot Name
Low affinity immunoglobulin gamma Fc region receptor III-B
Molecular Weight
26215.64 Da
References
  1. EMA Assessment Report: Kevzara, INN-sarilumab [Link]

Enzymes

Details1. Cytochrome P450 3A4
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Inhibitor
Inducer
General Function
Vitamin d3 25-hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It performs a variety of oxidation react...
Gene Name
CYP3A4
Uniprot ID
P08684
Uniprot Name
Cytochrome P450 3A4
Molecular Weight
57342.67 Da
References
  1. EMA Assessment Report: Kevzara, INN-sarilumab [Link]

Drug created at October 20, 2016 20:46 / Updated at August 09, 2023 00:07