A comprehensive review on sarilumab in COVID-19

Expert Opin Biol Ther. 2021 May;21(5):615-626. doi: 10.1080/14712598.2021.1847269. Epub 2020 Nov 25.


Introduction: The coronavirus disease 2019 (COVID-19) pandemic, caused by a newly discovered coronavirus (severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2), continues to spread all around the world. Despite the emergency of COVID-19 worldwide, remdesivir is the only treatment that has been recently approved to treat the diseases, and other effective therapies are still lacking. SARS-CoV-2 may cause severe illness in 20% of patients. Based on available data, there is an association between interleukin-6 (IL-6) and severe COVID-19. Sarilumab is a fully human immunoglobulin G1 monoclonal antibody binding to both membrane-bound and soluble IL-6 receptors with high affinity and has been considered for off-label use in the treatment of COVID-19.Areas covered: The present article reviews recently published literature focusing on the pathophysiology of COVID-19 induced cytokine storm, the potential therapeutic role, and important clinical issues of sarilumab in the treatment of COVID-19 patients.Expert opinion: The off-label treatment administration is unavoidable in the critical situation of the COVID-19 pandemic. Further efforts should be directed to determine mechanisms of SARS-CoV-2 induced immune dysregulation as well as indications of sarilumab in the patients with COVID-19 to minimize concerns regarding its off-label administration.

Keywords: COVID-19; IL-6; SARS-CoV-2; cytokine release syndrome; end-organ damage; multi-organ damage; sarilumab.

Publication types

  • Review

MeSH terms

  • Adenosine Monophosphate / analogs & derivatives
  • Adenosine Monophosphate / metabolism
  • Adenosine Monophosphate / therapeutic use
  • Alanine / analogs & derivatives
  • Alanine / metabolism
  • Alanine / therapeutic use
  • Animals
  • Antibodies, Monoclonal, Humanized / metabolism
  • Antibodies, Monoclonal, Humanized / pharmacology
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antiviral Agents / metabolism
  • Antiviral Agents / pharmacology
  • Antiviral Agents / therapeutic use
  • COVID-19 / drug therapy*
  • COVID-19 / epidemiology
  • COVID-19 / metabolism
  • Cytokine Release Syndrome / drug therapy*
  • Cytokine Release Syndrome / epidemiology
  • Cytokine Release Syndrome / metabolism
  • Humans
  • Pandemics
  • SARS-CoV-2 / drug effects*
  • SARS-CoV-2 / metabolism


  • Antibodies, Monoclonal, Humanized
  • Antiviral Agents
  • remdesivir
  • Adenosine Monophosphate
  • sarilumab
  • Alanine

Supplementary concepts

  • COVID-19 drug treatment