Tocilizumab or sarilumab are equally suitable for treatment of COVID-19, new advice says

The advice comes as the government warns of shortages of tocilizumab.

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Tocilizumab or sarilumab are equally suitable to treat adult patients hospitalised with COVID-19, according to the latest advice from health officials.

The National Institute for Health and Care Excellence (NICE) rapid guideline on managing COVID-19 currently recommends the use of sarilumab for adults in hospital with COVID-19 if tocilizumab cannot be used or is unavailable.

However, a rapid policy statement, issued jointly by the Department of Health and Social Care (DHSC) and Scottish and Welsh governments on 12 September 2021, says “new evidence and guidance have since emerged to indicate the possibility of equivalence between the two IL-6 inhibitors”.

“These results led to a strong recommendation for the use of both IL-6 inhibitors (tocilizumab and sarilumab) to treat severe and critical COVID-19 in the World Health Organization (WHO) Therapeutics and COVID-19 Living Guideline,” the statement continues.

“The guideline, which was updated in July 2021, did not recommend the use of one IL-6 inhibitor over the other.”

The organisations propose that tocilizumab and sarilumab should be recommended as treatment options through routine commissioning for adult patients, aged 18 years and over, who have been hospitalised with COVID-19.

The recommended dose of tocilizumab is 8mg/kg to be administered as an intravenous infusion, with a maximum dose of 800mg, while the recommended dose of sarilumab is 400mg to be delivered as a once-only intravenous infusion.

The combined policy replaces previous separately published policies for sarilumab and tocilizumab, respectively.

The statement was published at the same time as a supply issues update for primary and secondary care from the DHSC reveals that tocilizumab (RoActemra) 80mg and 200mg solution for infusion vials are currently out of stock with no resupply date.

The update details that RoActemra 400mg solution for infusion vials are currently available but in limited supply and that “allocations” have been put in place at a trust level, on a weekly basis, to safeguard remaining stock.

RoActemra 162mg/0.9ml solution for injection pre-filled syringes and pre-filled pens remain available and are unaffected by this shortage.

In January 2021, NHS guidance was issued recommending the consideration of the rheumatoid arthritis drugs tocilizumab and sarilumab in the treatment of COVID-19 patients admitted to intensive care.

The advice followed results from the Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired pneumonia (REMAP-CAP), which suggested that tocilizumab and sarilumab led to a 24% reduced risk of mortality when administered to patients within 24 hours of them entering intensive care.

READ MORE: Clinicians encouraged to consider tocilizumab or sarilumab in treatment of hospitalised COVID-19 patients

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Citation
The Pharmaceutical Journal, PJ, September 2021, Vol 307, No 7953;307(7953)::DOI:10.1211/PJ.2021.1.105318