Casirivimab, Imdevimab and Sotrovimab are US FDA approved recombinant neutralizing human IgG1 monoclonal antibodies that target the receptor binding domain of the spike protein of SARS-CoV-2. Whilst not yet evaluated and NICE approved in UK, they may become available for use in the near future; updates to follow.
Invasive mechanical ventilation: any method of controlled ventilation delivered through a translaryngeal or tracheostomy tube, or other methods as defined by the Intensive Care National Audit & Research Centre definition of ‘advanced respiratory support’.
Conditional recommendation
Consider sarilumab for adults in hospital with COVID-19 only if tocilizumab cannot be used or is unavailable. Use the same eligibility criteria as those for tocilizumab. That is, if all of the following apply:
they are having or have completed a course of corticosteroids such as dexamethasone, unless they cannot have corticosteroids
they have not had another interleukin-6 inhibitor during this admission
there is no evidence of a bacterial or viral infection (other than SARS-CoV-2) that might be worsened by sarilumab.
And they either:
need supplemental oxygen and have a C-reactive protein level of 75 mg/litre or more, or
are within 48 hours of starting high-flow nasal oxygen, continuous positive airway pressure, non-invasive ventilation or invasive mechanical ventilation.
Anti-COVID therapy is a fast and dynamic changing landscape, consideration should be given to clinical suitability and eligibility to newer classes of drugs.Last updated: December 2020.
