|Other names||CNTO 328|
|Drug class||Monoclonal antibody|
|Main uses||Multicentric Castleman’s disease (MCD)|
|Side effects||Rash, itchiness, weight gain, swelling, low platelets, upper respiratory infections|
|Chemical and physical data|
|Molar mass||144983.21 g·mol−1|
|(what is this?)|
Siltuximab, sold under the brand name Sylvant, is a medication used to treat multicentric Castleman’s disease (MCD) in those who have neither HIV nor human herpesvirus-8 (HHV-8). It is given by gradual injection into a vein.
Common side effects include rash, itchiness, weight gain, swelling, low platelets, and upper respiratory infections. Other side effects may include anaphylaxis and gastrointestinal perforation. It is a monoclonal antibody which binds to interleukin 6 (IL-6) thus blocking its activity.
Siltuximab was approved for medical use in the United States and Europe in 2014. In the United Kingdom it costs the NHS about £1,700 per 400 mg vial as of 2021. This amount in the United States costs about 5,200 USD.
It is given at a dose of 11 mg/kg every three weeks.
Siltuximab may lower resistance to infections and should not be administered to patients with severe infections. Siltuximab should be discontinued in patients with severe infusion related reactions, anaphylaxis, severe allergic reactions or cytokine release syndromes. Live vaccines should not be administered to patients receiving siltuximab since IL-6 inhibition may interfere with normal immune response to new antigens.
- Peripheral edema
- Abdominal Pain
- Increased weight
- Upper respiratory tract infections
Long term exposure
Siltuximab may increase CYP450 activity leading to increased metabolism of drugs that are CYP450 substrates. Co-administration of siltuximab and CYP450 substrates with narrow therapeutic index such as warfarin, ciclosporin or theophylline should be closely monitored.
Mechanism of action
Siltuximab is a chimeric monoclonal antibody that binds to interleukin-6 (IL-6), preventing binding to soluble and membrane bound interleukin-6 receptors. Siltuximab interferes with IL-6 mediated growth of B-lymphocytes and plasma cells, secretion of vascular endothelial growth factor (VEGF) and autoimmune phenomena.
Siltuximab has demonstrated significant efficacy and safety in patients with idiopathic multicentric Castleman disease. Treatment results with Siltuximab in B-cell non-Hodgkin's lymphoma are inferior to those obtained in multicentric Castleman disease. Siltuximab has also been evaluated in the treatment ovarian cancer, however the efficacy for this cancer is debatable. In addition, siltuximab has been evaluated for multiple myeloma, but there was an insignificant increase in response rates.
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