Coronavirus disease (COVID-19): Tocilizumab and sarilumab - Interleukin-6 receptor blockers
9 December 2021 | Questions and answers
Tocilizumab and sarilumab are interleukin-6 (IL-6) receptor blockers that WHO recommends for patients diagnosed with severe or critical COVID-19.* They should be administered by a healthcare worker in a monitored clinical setting along with the current standard of care for COVID-19, which includes oxygen, corticosteroids, and other medications.
Patients with non-severe COVID-19 should not be given this treatment.
*A patient has severe COVID-19 when they have signs of pneumonia, severe respiratory distress, and their blood oxygen level is low. A patient has critical COVID-19 when the need life sustaining treatment, have acute respiratory distress syndrome, or have septic shock (evidence of injury to other organs). More.
For optimal effect, tocilizumab and sarilumab should be administered as soon as possible once a patient is diagnosed with severe or critical COVID-19.
Tocilizumab and sarilumab should be administered intravenously as a single dose by a healthcare worker in a monitored clinical setting over one hour. In rare circumstances a second dose may be administered intravenously at the clinical discretion of the healthcare provider 12 to 48 hours after the first dose.
Patients should have routine bloodwork prior to the administration of IL-6 receptor blockers and 3 days after completing the infusion (see the guidelines for more details).
Patients with severe or critical COVID-19 should receive tocilizumab or sarilumab.
Women of childbearing age should use contraception during and up to three months after receiving tocilizumab or sarilumab. This should be discussed with the patient and their healthcare provider.
Patients with severe or critical COVID-19 often develop overstimulation of their immune system which can be very harmful to their health. IL-6 receptor blockers act to suppress this overstimulation when given in addition to corticosteroids
Known side effects of IL-6 receptor blockers, tocilizumab and sarilumab, include potential increase in cholesterol, decrease in neutrophils (type of white blood cells), increased risk of infection (bacterial, fungal, viral, and tuberculosis), liver abnormalities, discomfort at the infusion site, and infusion reaction. In rare cases patients may develop severe allergic reactions, significant liver dysfunction, neutropenia (low white blood count) or thrombocytopenia (low platelet count).
All patients receiving tocilizumab or sarilumab should be clinically monitored by a healthcare provider before, during, and after receiving an infusion. The patient should also receive optimal standard of care for COVID-19, which includes oxygen therapy.
Certain patients who received IL-6 receptor blockers may be at a higher risk for complications and need to be monitored closely. These include patients receiving concomitant immunosuppressive therapy, those with recurring chronic infections or underlying conditions that predispose them to infection, and who are on long-term IL-6 receptor blockers for chronic medical conditions.
Currently, tocilizumab and sarilumab are expensive and in short supply globally.
WHO and partners are discussing lower prices and improved access in low- and middle-income countries with the producers, Roche Pharmaceutical for tocilizumab and Sanofi S.A. for sarilumab.
WHO has launched a call to manufacturers to submit biosimilar versions of this drug for approval or prequalification. This would allow global production to be ramped up so that more people can access the drugs.