How do you use Kevzara (sarilumab) for the treatment of rheumatoid arthritis?

Kevzara (sarilumab) is an interleukin-6 receptor (IL-6R) antibody that may be used for the treatment of adults with rheumatoid arthritis or polymyalgia rheumatica. It is given as a subcutaneous injection, which can be self-administered.

Kevzara (sarilumab) may be used to treat moderate-to-severe rheumatoid arthritis in patients who failed, or cannot tolerate at least one other disease-modifying antirheumatic drug (DMARD). Kevzara may be used alone as monotherapy, or in combination with methotrexate or other conventional DMARDs.

Kevzara may also be used to treat polymyalgia rheumatica (PMR) after corticosteroids have been used but are ineffective or in people who cannot tolerate a slow decrease in corticosteroid dose. This is the first biologic to be approved for PMR and trials have demonstrated almost three times more people with PMR achieve sustained remission with Kevzara compared with a placebo.

The recommended dosage of Kevzara is 200 mg once every two weeks. The dosage can be reduced from 200 mg to 150 mg, if needed, to help manage certain laboratory abnormalities (neutropenia, thrombocytopenia, and liver enzyme elevations).

Kevzara is available as a single-use pre-filled syringe or single-use pre-filled pen. The injection can be self-injected into the front of the thigh or abdomen, but not the area 2 inches around the navel. If somebody else administers the injection, it can also be given in the upper arm.

How do you administer Kevzara?

If you have been shown how to self-inject Kevzara by your health professional, administer yourself a dose once every two weeks, preferably on the same day, for example, every second Monday. Otherwise, see your healthcare provider for a dose. If you forget a dose, schedule it in for as soon as you can, then continue with your regular dosing schedule.

1. Immediately before administration remove one Kevzara injection out of the refrigerator and leave it on a flat surface, away from children and pets, to warm up to room temperature for at least 30 minutes for the prefilled syringe (60 minutes for the pen). Do not warm in any other way (such as by putting in hot water). Kevzara at room temperature reduces the risk of stinging.
2. Inspect the injection for any discoloration or particulate matter and do not use if the liquid is cloudy, contains particles, or is discolored. The liquid in Kevzara should be clear, colorless, or have a slightly yellow tinge. Check the expiry date on the side of the injection and do not use Kevzara if it has expired. Do not shake Kevzara.
3. Kevzara is best administered into the front of your thighs or the lower part of your abdomen, avoiding the area around your belly button (stay an inch away from your belly button). If somebody else is giving you your injection they can also administer it into the outer area of your upper arm. Change your injection site every two weeks so that you are not injecting into the same spot each time.
4. Only inject into clear, healthy skin. Do not inject into any areas that are bruised, tender, red, scaly, or hard. You should also not inject into any scars, stretch marks, or areas of psoriasis.
5. If you feel pain when you inject Kevzara, placing an ice pack on the area of skin where you inject Kevzara for a few minutes before and after the injection can help reduce this pain.
6. Wash your hands then clean the injection site with an alcohol wipe and let the area dry. Take the needle cap off the syringe and hold the syringe between your thumb and first finger. Pinch up a fold of skin at the cleaned injection site and insert the needle into the fold of skin at a 45-degree angle. Slowly push the plunger down as far as it will go until the syringe is empty. Pull the needle out and throw the syringe away in an approved sharps container.
7. For the pre-filled pen, when you are ready to inject, twist off the orange cap, and hold the pen at a 90-degree angle to the cleaned injection site (straight up and down). Make sure you can see the window. Press down and hold the pen firmly against your skin, you should hear a click when the injection starts. The window should turn solid yellow and will take up to 15 seconds to complete. There will be a second click when the injection is complete. If the entire window does not turn solid yellow then you may have not received your full dose. Contact your health provider if this happens. Remove the pen from your skin and dispose of in an approved sharps container. Do not rub the injection site.
8. Store Kevzara in the refrigerator at 36°F to 46°F (2°C to 8°C). Once taken out of the refrigerator, use within 14 days. If you have not used it within this time throw it away. Do not put Kevzara back in the refrigerator if it has been out of the refrigerator for more than a few minutes. Do not freeze Kevzara. Protect Kevzara from light.

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