Sarilumab

KEVZARA

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Pronunciation: sar-IL-yoo-mab (KEV-za-ra)

Sarilumab ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Sarilumab ballicule

What it isIL-6 receptor antibody; rheumatoid arthritis and polymyalgia rheumatica.

Why this oneThe IL-6-receptor blocker specifically labeled for polymyalgia rheumatica when corticosteroids fail or cannot be tolerated.

What limits itIt suppresses CRP and fever, so infection can be masked. Neutropenia, transaminitis and GI perforation risk.

Pearls

Monotherapy outperformed adalimumab in RA
No head-to-head comparison with tocilizumab
Used after inadequate response to one or more DMARDs

Sarilumab molecular structure (skeletal formula) — Molecular structure: Sarilumab

FDA-approved for

rheumatoid arthritis (2017)
polymyalgia rheumatica (2023)

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryNot assigned — PLLR-era drug

Defining liabilitySerious infection, cytopenias, hepatic injury and malignancy risk require laboratory and clinical monitoring.

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Risk of serious infections (bacterial, TB, invasive fungal, opportunistic) that may lead to hospitalization or death; avoid in active infection

FDA dosing	Population	Start	Target	Max
Rheumatoid arthritis	Adult	200 mg SC q2wk	200 mg SC q2wk	200 mg SC q2wk
Polymyalgia rheumatica	Adult	200 mg SC q2wk (with tapering corticosteroids)	200 mg SC q2wk	200 mg SC q2wk
Polyarticular juvenile idiopathic arthritis (≥63 kg)	Pediatric	200 mg SC q2wk	200 mg SC q2wk	200 mg SC q2wk

Renal Undefined

Hepatic Undefined

Instructions

Subcutaneous injection once every 2 weeks
Do not initiate if ANC <2,000/mm3, platelets <150,000/mm3, or ALT/AST >1.5× ULN
Avoid live vaccines

Available strengths

inj 150, 200 mg/1.14 mL

Cautions

Serious infections — avoid during active infection
Neutropenia, thrombocytopenia, elevated liver enzymes, lipid abnormalities
GI perforation (higher with diverticulitis or NSAID/corticosteroid use)
Hypersensitivity reactions
Avoid live vaccines

Adverse reactions

Neutropenia
Increased ALT
Injection-site erythema
Upper respiratory tract infections
Urinary tract infections

Pregnancy Insufficient human data; monoclonal antibody actively crosses placenta in 3rd trimester and may affect infant immune response

Lactation No data on presence in human milk; maternal IgG is present in milk

Cost

Sarilumab (KEVZARA)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/unit	brand $/unit	CostPlus
150 mg/1.14 mL	inj	per unit		—	not offered
200 mg/1.14 mL	inj	per unit	—	$2071.68/mL	not offered

Generic entry2033 est. (biosimilar)

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Memory aids: interaction avatars

no kinetic interactions

Open Sarilumab in the interactive console ↗

Self-check

Sarilumab: When is it labeled for polymyalgia rheumatica?
When corticosteroids fail or cannot be tolerated.
Sarilumab: Why can infection be masked?
Suppression of CRP and fever.