Siltuximab
SYLVANT
What it isIL-6 monoclonal antibody; idiopathic multicentric Castleman disease.
Why this oneIt is the only approved therapy for idiopathic multicentric Castleman disease.
What limits itIt suppresses CRP, so infection is masked. GI perforation; infusion reactions.
FDA-approved for
- multicentric Castleman disease (2014)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Multicentric Castleman disease (HIV-negative, HHV-8-negative) | Adults | 11 mg/kg IV over 1 h q3wk | 11 mg/kg q3wk | 11 mg/kg q3wk |
Renal No adjustment needed (CLcr ≥15 mL/min)
Hepatic No adjustment needed (mild-moderate; severe/Child-Pugh C not studied)
Every 3 weeks; delay (do not reduce) dose if ANC/platelet/hemoglobin criteria not met
Instructions
- Intravenous infusion only, over 1 hour
- Do not reduce dose — delay treatment if hematology criteria not met
- Perform hematology tests before each dose for first 12 months, then every 3 cycles
- Do not administer to patients with severe infection until it resolves
- Permanently discontinue for severe infusion reaction, anaphylaxis, or cytokine release syndrome
Cautions
- Concurrent active severe infections — do not administer until resolved
- No live vaccines
- Infusion-related reactions and anaphylaxis
- Gastrointestinal perforation
Adverse reactions
- Rash
- Pruritus
- Upper respiratory tract infection
- Increased weight
- Hyperuricemia
- Edema
Pregnancy May cause fetal harm; infants may be at increased risk of infection; animal placental transfer
Lactation Breastfeeding not recommended during and for 3 months after the last dose
NO BOXED WARNINGS
Principal riskIt suppresses CRP, so infection is masked
Classes and tags
Clinical profile
Mechanism of action: Siltuximab ballicule
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Memory aids: mascots and interaction avatars
