Evidence for use of siltuximab or anakinra as second line therapies (after failure of tocilizumab) for Cytokine Release Syndrome following use of Chimeric Antigen Receptor T-cell (CAR-T) therapy

CAR-T therapy often causes cytokine release syndrome (CRS) which is treated with tocilizumab as first-line therapy. Tocilizumab is licensed for this indication but in some cases is not sufficiently effective. Anakinra or siltuximab have been considered in this case, but both medicines are unlicensed for this indication.

This review considers the published clinical evidence which is directly relevant to the use of siltuximab or anakinra in humans for CRS. It focuses on the use of these as second-line treatments for CAR-T cell therapy associated CRS after failure of tocilizumab.

This document is not intended as a dosing guideline.

Information and advice about management of the toxicity of CAR-T therapies (including choice of products and dosing) should be sought from the SPS Pan-UK Pharmacy Working Group for ATMPs. This group are currently developing consensus ATMP toxicities management guidance – this will be published on the SPS website.

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