Sarilumab administration in patients with severe COVID-19: A report of four cases and a literature review

Almost 2 years have passed since the World Health Organization declared a pandemic state for severe acute respiratory syndrome coronavirus 2 infection. The pathogenesis of coronavirus disease 2019 (COVID‑19) consists of an initial viral phase responsible for early symptoms followed by an inflammatory phase, which is cytokine‑mediated, responsible for late‑onset symptoms, culminating in acute respiratory distress syndrome. Considering that IL‑6 plays a key‑role in the development and maintenance of inflammation, drugs targeting both IL‑6 and IL‑6 receptors have been evaluated. The present study reports the cases of four hospitalized patients with severe respiratory COVID‑19 treated with a single dose of sarilumab, a monoclonal anti‑IL‑6 antibody, along with standard of care medications and oxygen therapy. A few days following sarilumab administration, the clinical and biochemical conditions began to improve, until the discontinuation of O2 therapy and discharge. The present study demonstrates that sarilumab may represent a promising drug that may be used to treat the hyperinflammatory phase; however, further trials are required to determine whether it should be used combination with other drugs or alone, and to better understand the pharmacokinetics and related side‑effects.