USE UNDER SPECIALIST SUPERVISION ONLY 

Approved for use in the management of less complex Behcet's disease

Dose = up to 4mg BD (based on plasma trough concentration)

Refer to SE London immunomodulatory shared care guidance for list of indications (link above at start of BNF section)

Refer to SE London immunomodulatory shared care guidance for list of indications (link above at start of BNF section)

Refer to SE London immunomodulatory shared care guidance for list of indications (link above at start of BNF section)

Refer to SE London immunomodulatory shared care guidance for list of indications (link above at start of BNF section)

Refer to SE London immunomodulatory shared care guidance for list of indications (link above at start of BNF section)

Refer to SE London immunomodulatory shared care guidance for list of indications (link above at start of BNF section)

Refer to SE London immunomodulatory shared care guidance for list of indications (link below)

• Restricted to use where there is intolerance to mycophenolate mofetil.
• Refer to APC recommendation (link below)

Approved off-label indications:

• Moderate to severe systemic lupus erythematosus as a steroid sparing agent
• Polymyositis and dermatomyositis, including secondary ILD from these conditions

Approved as per NICE technology appraisal guidance

Approved as per NICE technology appraisal guidance

Biosimilar products available, to be prescribed by brand name.  Contact pharmacy department for advice on brand for routine prescribing if unsure.

Approved for use as per NHSE policy criteria (see link below)

Note: Anakinra and Tocilizumab cannot be used concurrently

Approved as per NICE technology appraisal guidance

Approved as per NICE technology appraisal guidance

Lupus Consultants only 

Approved for use as per NICE technology appraisal guidance

Approved as per NICE technology appraisal guidance

Biosimilar products available, to be prescribed by brand name.

Contact pharmacy department for advice on brand for routine prescribing if unsure

Approved as per NICE technology appraisal guidance

Approved as per NICE technology appraisal guidance

Biosimilar products available, to be prescribed by brand name.

Contact pharmacy department for advice on brand for routine prescribing if unsure

Approved as per NICE technology appraisal and NHSE policy guidance below

Biosimilar products available, to be prescribed by brand name.

Contact pharmacy department for advice on brand for routine prescribing if unsure

Approved as per NICE technology appraisal guidance below

Biosimilar products available, to be prescribed by brand name.

Contact pharmacy department for advice on brand for routine prescribing if unsure

Approved off-label indication:

Patients with severe COVID-19 pneumonia on ICU requiring respiratory support

Dose = 400mg to be delivered as a once-only intravenous infusion. Two 200mg doses should be used to make up the total 400mg dose. 400mg of sarilumab should be diluted in a 100mL bag of 0.9% sodium chloride, after removing an equivalent volume of saline (total volume 100mL) and given over 1 hour. Sarilumab should not be infused concomitantly in the same IV line with other medications.

Refer to the DHSC Interim Position Statement (link below)

Approved as per NICE Technology Appraisal guidance

Approved as per NICE technology appraisal guidance

Approved off-label indication:

Patients with severe COVID-19 pneumonia on ICU requiring respiratory support

Dose = 8mg/kg (max 800 mg) IV infusion (in 100mL sodium chloride 0.9% infused over 1 hour) as a single dose, with a repeat dose after 12-24 hours if there has not been sufficient clinical improvement.

Refer to the DHSC Interim Position Statement (link below)

Refer to SPC for management of cytokine release syndrome (including dosing) following CAR T-cell therapy

Approved for use as per NHSE policy criteria (see link below)

Note: Anakinra and Tocilizumab cannot be used concurrently

Approved as per NICE technology appraisal guidance

Approved as per NICE technology appraisal guidance

Approved as per NICE technology appraisal guidance

Tofacitinib monotherapy (off-label use) approved for treatment active psoriatic arthritis (PsA) where methotrexate is not tolerated or is contraindicated. Refer to Seronegative Spondyloarthropathy Drug Treatment Pathway for more information (link below)

Approved as per NICE technology appraisal guidance

Approved off-label indication:

Severe refractory Behcet's disease including Behcet's Eye disease, pulmonary and peripheral arterial aneurysms

To be prescribed as per the Barts Health Satellite Unit Biologic Referal Pathway. Contact formulary team for further info.

Note: Biosimilar products available, to be prescribed by brand name. Contact pharmacy department if unsure of brands. 

Approved off-label indications:

Treatment of resistant acute autoimmune connective tissue disorders (CTDs) such as:

• Systemic lupus erythematosus (SLE) - Blueteq application required
• Inflammatory myopathies
• Sjogren’s syndrome
• Systemic vasculitides
• IgG4-related disease (as per NHSE Policy 16057/P - see link below)
• Behcet's Disease; including Behcet's Eye disease (as per Barts Health Satellite Unit Biological Referal Process)
• Dermatomyositis and polymyositis (as per NHSE Policy 16036/P - see link below)

Reserved for patients with severe active autoimmune diseases that have failed to respond to or are intolerant of at least two immunosuppressants (azathioprine, methotrexate, mycophenolate or cyclophosphamide), each having been taken for at least three months

Biosimilar products available, to be prescribed by brand name.

Contact pharmacy department for advice on brand for routine prescribing if unsure

Approved off-label indication:

For Takayasu arteritis, as per criteria in NHSE commissioning policy 16056/P

Refer to SE London immunomodulatory shared care guidance for list of indications (link above at start of BNF section)