Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Sarilumab vs Standard care/Placebo

This comparison will not be updated. Last search date 14 Dec, 2022.

Studies included but not extracted/included in the analysis: Ilaria Mastrorosa I, SSRN, 2022; Conference abstract Mastrorosa I, Top. antivir. Med, 2022

On March 18th, 2021, we published results of the living systematic review on IL-6 blocking agents which included all preprints and published trials published online up to February 11th, 2021.

We updated the the evidence on the effectiveness and safety of IL-6 blocking agents compared to standard care alone or to a placebo for people with COVID-19. On June 1, 2023, an update of the systematic review on IL-6 blocking agents was published. It included all preprints and published trials published online up to June 7, 2022.

Hospitalized patients

Forest plots
(last update: 2022-11-17)

Summary of findings
(last update: 2022-11-22)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Sarilumab
Comparison: Standard care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 0.99 (0.94 - 1.05)	6 fewer per 1000 (from 39 fewer to 32 more)		Moderate certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviation from intended intervention, missing data, outcome measurement and selection of the reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Not serious
7 trials Sancho-Lopez A, 2021; Brach Elliman W, 2022; Garcia-Vicuna R, 2022; Merchante N, 2021; Mariette X, 2021; ; Sivapalasingam S, 2022 (phase 2 and 3); Hermine O, 2022 2425 participants		Sarilumab 637 per 1,000 (604 - 675)	Standard care/Placebo 643 per 1,000
Clinical improvement D60	RR: 1.22 (0.91 - 1.63)	138 more per 1000 (from 57 fewer to 396 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding deviation from intended intervention, missing data, outcome measurement and selection of the reported results Inconsistency: Serious Inconsistency downgraded by 1 level: I²=50.1% Indirectness: Serious studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
2 trials Hermine O, 2022; Mariette X, 2021 239 participants		Sarilumab 766 per 1,000 (572 - 1000)	Standard care/Placebo 628 per 1,000
WHO progression score (level 7 or above) D28	RR: 1.10 (0.90 - 1.33)	25 more per 1000 (from 25 fewer to 83 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level:some concerns regarding adequate randomization, deviation from intended intervention, and missing data Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
5 trials Sancho-Lopez A, 2021; Branch-Elliman W, 2022; Garcia-Vicuna R, 2022; Mariette X, 2021; Sivapalasingam S, 2022 886 participants		Sarilumab 275 per 1,000 (225 - 333)	Standard care/Placebo 250 per 1,000
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: 1.06 (0.86 - 1.30)	13 more per 1000 (from 31 fewer to 67 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviation from intended intervention, missing data, and selection of the reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to wide confidence interval consistent with the possibility for benefit and the possibility for harm
9 trials Sancho-Lopez A, 2021; Branch-Elliman W, 2022; Garcia-Vicuna R, 2022; Merchante N, 2021; Mariette X, 2021; Sivapalasingam S, 2021 (phase 2 and 3); Lescure FX, 2021; Hermine O, 2022; Gordon AC, 2021 3305 participants		Sarilumab 238 per 1,000 (193 - 292)	Standard care/Placebo 224 per 1,000
All-cause mortality D60	RR: 0.95 (0.84 - 1.07)	15 fewer per 1000 (from 47 fewer to 21 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviation from intended intervention, missing data, and selection of the reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to wide confidence interval consistent with the possibility for benefit and the possibility for harm
6 trials Garcia-Vicuna R, 2022; Mariette X, 2021; Sivapalasingam S, 2021 (phase 2 and 3) Lescure FX, 2021; Hermine O, 2022; Derde L, 2021 3379 participants		Sarilumab 279 per 1,000 (247 - 314)	Standard care/Placebo 294 per 1,000
Viral negative conversion D7	Outcome not yet measured or reported
Adverse events	RR: 1.12 (0.97 - 1.28)	49 more per 1000 (from 12 fewer to 114 more)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding deviation from intended intervention, missing data, outcome measurement, and selection of reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for no effect/trivial effect and the possibility for harm
4 trials Sacho-Lopez A, 2021; Mariette X, 2021; Lescure FX, 2021; Hermine O, 2022 860 participants		Sarilumab 457 per 1,000 (396 - 522)	Standard care/Placebo 408 per 1,000	1 additional study was identified that assessed this outcome, but no results were reported.
Serious adverse events	RR: 1.08 (0.96 - 1.20)	18 more per 1000 (from 9 fewer to 46 more)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviation from intended intervention, missing data, outcome measurement and selection of reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for no effect/trivial effect and the possibility for harm
7 trials Sancho-Lopez A, 2021; Garcia-Vicuna R, 2022; Mariette X, 2021; Sivapalasingam S, 2021 (phase and 3); Lescure FX, 2021; Hermine O, 2022; Gordon AC, 2021 3137 participants		Sarilumab 248 per 1,000 (220 - 275)	Standard care/Placebo 229 per 1,000	1 additional study was identified that assessed this outcome, but no results were reported.

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

To access all information :

click here for Hospitalized patients

You can print it as a pdf. You can also click on each forest plot with your right mouse button and download.

Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=179

Back to your research

Trial	Funding	Comparisons		Design	Participants	Sample size	Overall risk of bias Highest assessment	Full description
		Treatment 1	Treatment 2
NCT04359901 Branch-Elliman W, PloS one, 2022 Full text Commentary Commentary	Public/non profit	Sarilumab	Standard care	RCT	Patients with confirmed COVID-19 (mild-severe) admitted to 5 centers in USA	N=50	Some concerns Details	Full description
NCT04357860; EUDRACT:2020-001531-27 SARICOR Merchante N, Antimicrob Agents Chemother, 2021 Full text Commentary	Mixed	Sarilumab 200 mg Sarilumab 400 mg	Standard care	RCT	Patients with confirmed COVID-19 (moderate-severe) treated in ten hospitals in Andalusia, Southern Spain.	N=118	Some concerns Details	Full description
NCT04324073 CORIMUNO-SARI-1 Mariette X, Lancet Rheumatol, 2021 Full text Commentary	Public/non profit	Sarilumab	Standard care	RCT	Patients with confirmed COVID-19 (moderate-severe) admitted to six centers in France	N=148	Some concerns Details	Full description
NCT04357808 SARCOVID Garcia-Vicuna R, Front Med, 2022 Full text Commentary	Mixed	Sarilumab	Standard care	RCT	Patients with confirmed COVID-19 (mild-severe) admitted to a single center in Spain.	N=30	Some concerns Details	Full description
NCT04324073 CORIMUNO-SARI-2 Hermine O, Eur Respir J, 2022 Full text Commentary	Public/non profit	Sarilumab	Standard care	RCT	Patients with suspected or confirmed COVID-19 (severe-critical) admitted to 8 centers in France.	N=91	Some concerns Details	Full description
EU-CTR 2020-002037-15 SARTRE Sancho-Lopez A, Infect Dis Ther, 2021 Full text Commentary	Private	Sarilumab	Standard care	RCT	Patients with confirmed COVID-19 (moderate) admitted to 5 centers in Spain	N=201	Some concerns Details	Full description
NCT02735707 REMAP-CAP Derde L, medRxiv, 2021 Full text Commentary Commentary	Mixed	Tocilizumab Sarilumab Anakinra	Standard care	RCT	Patients with suspected or confirmed COVID-19 (moderate to critical) admitted to 133 centers in 9 countries	N=2253	Some concerns Details	Full description
NCT04315298 Sivapalasingam S, Clin Infect Dis, 2022 Full text Full text Commentary Commentary	Private	Sarilumab 400mg Sarilumab 200mg Sarilumab 400mg	Placebo Placebo Sarilumab 200mg	RCT	Patients with confirmed COVID-19 (moderate-critical) admitted to 56 centers in the USA	N=1330	Some concerns Details	Full description
NCT04315298 Sivapalasingam S, Clin Infect Dis, 2022 Full text Full text Commentary Commentary	Private	Sarilumab 400mg Sarilumab 200mg Sarilumab 400mg	Placebo Placebo Sarilumab 200mg	RCT	Patients with confirmed COVID-19 (moderate-critical) admitted to 56 centers in the USA	N=457	Some concerns Details	Full description
NCT04327388; EudraCT2020-001162-12; U1111-1249-602 Lescure FX, Lancet Respir Med, 2021 Full text Commentary Commentary	Private	Sarilumab 400mg Sarilumab 200mg Sarilumab 400mg	Placebo Placebo Sarilumab 200mg	RCT	Patients with confirmed COVID-19 (moderate-critical) admitted to 45 centers in Argentina, Brazil, Canada, Chile, France, Germany, Israel, Italy, Japan, Russia, and Spain.	N=420	Some concerns Details	Full description
NCT02735707 REMAP-CAP Gordon AC, N Engl J Med, 2021 Full text Full text Commentary Commentary	Mixed	Tocilizumab Sarilumab	Standard care	RCT	Patients with confirmed or suspected COVID-19 (severe-critical) admitted to 113 centers in Australia, Ireland, the Netherlands, New Zealand, Saudi Arabia, UK.	N=826	Some concerns Details	Full description