10 However, the Panel recommends sarilumab only when tocilizumab is not available or is not feasible to use (BIIa) because the evidence of efficacy for tocilizumab is more extensive than for sarilumab in addition, sarilumab is currently only approved for use as a subcutaneous (SQ) injection in the United States. If tocilizumab is not available, sarilumab may be used as an alternative because it has demonstrated a similar clinical benefit in improving survival and reducing the duration of organ support in the REMAP-CAP trial. 5,6 However, the Panel found it challenging to define the specific patient populations that would benefit from this intervention. The results of the RECOVERY and REMAP-CAP trials provide consistent evidence that tocilizumab, when coadministered with corticosteroids, offers a modest mortality benefit in certain patients with COVID-19 who are severely ill, who are rapidly deteriorating and have increasing oxygen needs, and who have a significant inflammatory response.
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7,8 Many clinicians would initiate empiric treatment (e.g., with the antiparasitic drug ivermectin) with or without serologic testing in patients who are from areas where Strongyloides is endemic (i.e., tropical, subtropical, or warm temperate areas).
#Maximum action .6 update trial
The Panel recommends against the use of anti-IL-6 mAb therapy (i.e., siltuximab) for the treatment of COVID-19, except in a clinical trial (BIII).See Therapeutic Management of Hospitalized Adults With COVID-19 for the COVID-19 Treatment Guidelines Panel’s (the Panel) recommendations on the use of IL-6 inhibitors (e.g., sarilumab, tocilizumab) in hospitalized patients who require supplemental oxygen, high-flow oxygen, noninvasive ventilation (NIV), or mechanical ventilation.
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These drugs have been evaluated in patients with COVID-19 who have systemic inflammation.
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There are 2 classes of Food and Drug Administration (FDA)-approved IL-6 inhibitors: anti-IL-6 receptor monoclonal antibodies (mAbs) (e.g., sarilumab, tocilizumab) and anti-IL-6 mAbs (i.e., siltuximab).
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2-4 It is hypothesized that modulating IL-6 levels or the effects of IL-6 may reduce the duration and/or severity of COVID-19. 1 COVID-19-associated systemic inflammation and hypoxemic respiratory failure can be associated with heightened cytokine release, as indicated by elevated blood levels of IL-6, C-reactive protein (CRP), D-dimer, and ferritin. Infection by SARS-CoV induces a dose-dependent production of IL-6 from bronchial epithelial cells. Interleukin (IL)-6 is a pleiotropic, proinflammatory cytokine produced by a variety of cell types, including lymphocytes, monocytes, and fibroblasts.