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Dosing Information for SARCLISA® (isatuximab-irfc)


Recommended dose1

10 mg/kg

actual body weight administered as an IV infusion in combination with VRd, or Kd, or Pd

250-mL

fixed infusion volume

Treatment is repeated until disease progression or unacceptable toxicity

IV=intravenous; Kd=carfilzomib and dexamethasone; Pd=pomalidomide and dexamethasone; VRd=bortezomib, lenalidomide, dexamethasone.

Infusion time decreases to 75 minutes by the third infusion1

Incremental escalation of the infusion rate should be considered only in the absence of IRRs.

FIRST INFUSION

3 hours 20 minutes

 

SECOND INFUSION

1 hour 53 minutes

 

SUBSEQUENT INFUSIONS

75 minutes

 

IRR=infusion-related reaction. 

For patients with NDMM not eligible for transplant

SARCLISA dosing schedule in combination with VRd1

The recommended dose of SARCLISA is 10 mg/kg administered as an IV infusion at a fixed infusion volume of 250 mL in combination with VRd.

Dosing frequency for SARCLISA transitions to once monthly*

Dosing induction phase, 6-week cycles for cycles 1-4; continuous phase, 4-week cycles for cycles 5-18, 18+.

For dosing instructions for combination agents administered with SARCLISA, refer to the trial page for IMROZ and the respective manufacturer's Prescribing Information.

*Initiates after cycle 17.
Induction phase cycles=42 days each.
Continuous phase cycles=28 days each.

SARCLISA dosing schedule in combination with Kd or Pd1

The recommended dose of SARCLISA is 10 mg/kg administered as an IV infusion at a fixed infusion volume of 250 mL in combination with either Kd or Pd.

Dosing frequency for SARCLISA decreases after cycle 1

Dosing once weekly for SARCLISA during cycle 1, 4 doses total; once every 2 weeks in cycle 2 and beyond, 2 doses each cycle.

On days where both SARCLISA and carfilzomib are administered, administer dexamethasone first, followed by SARCLISA infusion, then followed by carfilzomib infusion.

For additional dosing instructions for Kd and Pd, refer to the trial pages for IKEMA and ICARIA-MM, and the respective manufacturer's Prescribing Information.

Premedication and antimicrobial prophylaxis1

Administer the following premedications prior to SARCLISA infusion to reduce the risk and severity of IRRs:

Dexamethasone

SARCLISA + Kd: 20 mg (IV on the days of SARCLISA and/or carfilzomib infusions, and orally on the other days)

SARCLISA + Pd: 40 mg orally or IV (or 20 mg orally or IV for patients ≥75 years of age)

SARCLISA + VRd: 20 mg (IV on the days of SARCLISA infusions, and orally on the other days)

Acetaminophen

650 mg to 1000 mg orally (or equivalent)

H2 antagonist

Institution-preferred agent

Diphenhydramine

25 mg to 50 mg orally or IV (or equivalent). The IV route is preferred for at least the first 4 infusions

The above recommended dose of dexamethasone (orally or IV) corresponds to the total dose to be administered only once before infusion as part of the premedication and of the backbone treatment, before SARCLISA and carfilzomib, SARCLISA and pomalidomide, or SARCLISA, bortezomib, and lenalidomide administration.

Administer the recommended premedication agents 15 to 60 minutes prior to starting a SARCLISA infusion. No post-infusion medications are required for SARCLISA.

Recommended antimicrobial prophylaxis

Initiate antibacterial and antiviral prophylaxis (such as herpes zoster prophylaxis) if needed based on standard guidelines.

Infusion rates of SARCLISA administration1

Calculate the dose (mg) of required SARCLISA based on actual patient weight (measured prior to each cycle to have the administered dose adjusted accordingly). Note that more than one vial of SARCLISA may be necessary to obtain the required dose for the patient.

Incremental escalation of the infusion rate should be considered only in the absence of IRRs.

 Dilution volumeInitial rateAbsence of IRRRate incrementMaximum
rate
Total time
(if no rate adjustments)2

First infusion

250 mL25 mL/h60 min25 mL/h
every
30 min

150 mL/h

3 h 20 min

Second infusion

250 mL

50 mL/h

30 min50 mL/h for 30
min, then
increase by 100
mL/h
200 mL/h1 h 53 min

Subsequent infusions

250 mL

200 mL/h

-

200 mL/h

75 min

SARCLISA should be administered by a healthcare professional with immediate access to emergency equipment and appropriate medical support to manage IRRs if they occur. 

75-minute infusion time starting after the second infusion in the absence of IRRs1

Administering SARCLISA1

Prepare the solution for infusion using an aseptic technique

  • Administer the infusion solution by IV infusion using an IV tubing infusion set (in PE, PVC with or without DEHP, PBD, or PU) with a 0.22-micron in-line filter (PES, polysulfone, or nylon)
  • The infusion solution should be administered for a period of time that will depend on the infusion rate (see the table above)
  • Use prepared SARCLISA infusion solution within 48 hours when stored refrigerated at 36°F to 46°F (2°C to 8°C), followed by 8 hours (including the infusion time) at room temperature
  • Do not administer SARCLISA infusion solution concomitantly in the same IV line with other agents
  • On days where both SARCLISA and carfilzomib are administered, administer dexamethasone first, followed by SARCLISA infusion, then followed by carfilzomib infusion

DEHP=di-(2-ethylhexyl) phthalate; PBD=polybutadiene; PE=polyethylene; PES=polyethersulfone; PU=polyurethane; PVC=polyvinyl chloride.

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SARCLISA Dosing Guide

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Patient ID

Provide this document to your patients so they can easily inform other HCPs that they are receiving SARCLISA if they need to receive a blood transfusion

Mechanism of Action

Important Safety Information

CONTRAINDICATIONS
SARCLISA is contraindicated in patients with severe hypersensitivity to isatuximab-irfc or to any of its excipients.

WARNINGS AND PRECAUTIONS
Infusion-Related Reactions
Serious infusion-related reactions (IRRs), including life-threatening anaphylactic reactions, have occurred with SARCLISA treatment. Severe signs and symptoms include cardiac arrest, hypertension, hypotension, bronchospasm, dyspnea, angioedema, and swelling.

In clinical trials (ICARIA-MM, IKEMA, and IMROZ), in patients treated with SARCLISA (N=592), infusion-related reactions occurred in 206 patients (35%). Among these 206 patients, 92% experienced infusion-related reactions during the first infusion and 12% after the first cycle.

The most common symptoms (≥5%) of an infusion-related reaction included dyspnea and cough. Grade 1 infusion-related reactions were reported in 6% of patients, grade 2 in 28%, and grade 3 or 4 in 1.2%. Anaphylactic reactions occurred in less than 1% of patients. The total incidence of SARCLISA infusion interruptions was less than 1% and the incidence of patients with at least one SARCLISA infusion interruption due to infusion-related reactions was 26%. The median time to first SARCLISA infusion interruption was 61 minutes (range 4 to 240 minutes). SARCLISA was discontinued in 1% of patients due to infusion-related reactions. To decrease the risk and severity of IRRs, premedicate patients prior to SARCLISA infusion with acetaminophen, H₂ antagonists, diphenhydramine or equivalent, and dexamethasone.

Monitor vital signs frequently during the entire SARCLISA infusion. For patients with grade ≥2 reactions, interrupt SARCLISA infusion and provide appropriate medical management. For patients with grade 2 or grade 3 reactions, if symptoms improve to grade ≤1, restart SARCLISA infusion at half of the initial infusion rate, with supportive care as needed, and closely monitor patients. If symptoms do not recur after 30 minutes, the infusion rate may be increased to the initial rate, and then increased incrementally. In case symptoms do not improve to grade ≤1 after interruption of SARCLISA infusion, persist or worsen despite appropriate medications, or require hospitalization, permanently discontinue SARCLISA and institute appropriate management. Permanently discontinue SARCLISA if an anaphylactic reaction or life-threatening (grade 4) IRR occurs and institute appropriate management.

Infections
SARCLISA can cause severe, life-threatening, or fatal infections. In patients who received SARCLISA at the recommended dose in ICARIA-MM, IKEMA, and IMROZ (N=592), serious infections, including opportunistic infections, occurred in 46%, grade 3 or 4 infections occurred in 43%, and fatal infections occurred in 4.7%. The most common serious infection reported was pneumonia (32%).

Monitor patients for signs and symptoms of infection prior to and during treatment with SARCLISA and treat appropriately. Administer prophylactic antimicrobials according to guidelines.

Neutropenia
SARCLISA may cause neutropenia.

In clinical trials (ICARIA-MM, IKEMA, and IMROZ), in patients treated with SARCLISA (N=592), neutropenia based on laboratory values occurred in 81%, with grade 3 or 4 occurring in 52%. Neutropenic infections occurred in 12% of patients, with grade 3 or 4 in 4.9%, and febrile neutropenia in 4%.

Monitor complete blood cell counts periodically during treatment. If needed, use antibacterial and antiviral prophylaxis during treatment. Monitor patients with neutropenia for signs of infection. In case of grade 4 neutropenia, delay SARCLISA dose until neutrophil count recovery to at least 1 x 109/L, and provide supportive care with growth factors, according to institutional guidelines. No dose reductions of SARCLISA are recommended.

Second Primary Malignancies
The incidence of second primary malignancies, during treatment and post-treatment, is increased in patients treated with SARCLISA-containing regimens. In clinical trials (ICARIA-MM, IKEMA, and IMROZ), in patients treated with SARCLISA (N=592), second primary malignancies occurred in 71 patients (12%).

In ICARIA-MM, at a median follow-up time of 52 months, second primary malignancies occurred in 7% of patients treated with SARCLISA, pomalidomide, and dexamethasone (Isa-Pd) and in 2% of patients treated with Pd.

In IKEMA study, at a median follow-up time of 57 months, second primary malignancies occurred in 10% of patients treated with SARCLISA, carfilzomib, and dexamethasone (Isa-Kd) and in 8% of patients treated with Kd.

In IMROZ study, at a median follow-up time of 60 months, second primary malignancies occurred in 16% of patients treated with SARCLISA, bortezomib, lenalidomide, and dexamethasone (Isa-VRd) and in 9% of patients treated with VRd.

The most common (≥1%) second primary malignancies in ICARIA-MM, IKEMA, and IMROZ (N=592) included skin cancers (7% with SARCLISA-containing regimens and 3.1% with comparative regimens) and solid tumors other than skin cancer (4.6% with SARCLISA-containing regimens and 2.9% with comparative regimens). Patients with non-melanoma skin cancer continued treatment after resection of the skin cancer, except 2 patients in the Isa-VRd arm and 1 patient in the VRd arm of the IMROZ study. Monitor patients for the development of second primary malignancies.

Laboratory Test Interference
Interference with Serological Testing (Indirect Antiglobulin Test)
SARCLISA binds to CD38 on red blood cells (RBCs) and may result in a false-positive indirect antiglobulin test (indirect Coombs test). This interference with the indirect Coombs test may persist for approximately 6 months after the last infusion of SARCLISA. The indirect antiglobulin test was positive during Isa-Pd treatment in 68% of the tested patients, and during Isa-Kd treatment in 63% of patients. In patients with a positive indirect antiglobulin test, blood transfusions were administered without evidence of hemolysis. ABO/RhD typing was not affected by SARCLISA treatment.

Before the first SARCLISA infusion, conduct blood type and screen tests on SARCLISA-treated patients. Consider phenotyping prior to starting SARCLISA treatment. If treatment with SARCLISA has already started, inform the blood bank that the patient is receiving SARCLISA and that SARCLISA interference with blood compatibility testing can be resolved using dithiothreitol-treated RBCs. If an emergency transfusion is required, non–cross-matched ABO/RhD-compatible RBCs can be given as per local blood bank practices.

Interference with Serum Protein Electrophoresis and Immunofixation Tests
SARCLISA is an IgG kappa monoclonal antibody that can be incidentally detected on both serum protein electrophoresis and immunofixation assays used for the clinical monitoring of endogenous M-protein. This interference can impact the accuracy of the determination of complete response in some patients with IgG kappa myeloma protein.

Embryo-Fetal Toxicity
Based on the mechanism of action, SARCLISA can cause fetal harm when administered to a pregnant woman. SARCLISA may cause fetal immune cell depletion and decreased bone density. Advise pregnant women of the potential risk to a fetus. Advise females with reproductive potential to use an effective method of contraception during treatment with SARCLISA and for 5 months after the last dose. The combination of SARCLISA with pomalidomide or lenalidomide is contraindicated in pregnant women because pomalidomide or lenalidomide may cause birth defects and death of the unborn child. Refer to the pomalidomide or lenalidomide prescribing information on use during pregnancy.

ADVERSE REACTIONS
In combination with pomalidomide and dexamethasone: The most common adverse reactions (≥20%) were upper respiratory tract infection, infusion-related reactions, pneumonia, and diarrhea. The most common hematology laboratory abnormalities (≥80%) were decreased hemoglobin, decreased neutrophils, decreased lymphocytes, and decreased platelets.

In combination with carfilzomib and dexamethasone: The most common adverse reactions (≥20%) were upper respiratory tract infection, infusion-related reactions, fatigue, hypertension, diarrhea, pneumonia, dyspnea, insomnia, bronchitis, cough, and back pain. The most common hematology laboratory abnormalities (≥80%) were decreased hemoglobin, decreased lymphocytes, and decreased platelets.

In combination with bortezomib, lenalidomide, and dexamethasone: The most common adverse reactions (≥20%) were upper respiratory tract infections, diarrhea, fatigue, peripheral sensory neuropathy, pneumonia, musculoskeletal pain, cataract, constipation, peripheral edema, rash, infusion-related reaction, insomnia, and COVID-19. The most common hematologic laboratory abnormalities (≥80%) were decreased hemoglobin, decreased leukocytes, decreased lymphocytes, decreased platelets, and decreased neutrophils.

Serious adverse reactions occurred in 62% of patients receiving Isa-Pd. Serious adverse reactions in >5% of patients who received Isa-Pd included pneumonia (26%), upper respiratory tract infections (7%), and febrile neutropenia (7%). Fatal adverse reactions occurred in 11% of patients (those that occurred in more than 1% of patients were pneumonia and other infections [3%]).

Serious adverse reactions occurred in 59% of patients receiving Isa-Kd. The most frequent serious adverse reactions in >5% of patients who received Isa-Kd were pneumonia (25%) and upper respiratory tract infections (9%). Adverse reactions with a fatal outcome during treatment were reported in 3.4% of patients in the Isa-Kd group (those occurring in more than 1% of patients were pneumonia occurring in 1.7% and cardiac failure in 1.1% of patients).

Serious adverse reactions occurred in 71% of patients receiving Isa-VRd. The serious adverse reaction in >5% of patients who received Isa-VRd was pneumonia (30%). Fatal adverse reactions occurred in 11% of patients with Isa-VRd (those occurring in more than 1% of patients were pneumonia [5%]).

USE IN SPECIAL POPULATIONS
Because of the potential for serious adverse reactions in the breastfed child from isatuximab-irfc administered in combination with pomalidomide or lenalidomide and dexamethasone, advise lactating women not to breastfeed during treatment with SARCLISA.

Indication

SARCLISA (isatuximab-irfc) is indicated:

  • In combination with bortezomib, lenalidomide, and dexamethasone, for the treatment of adult patients with newly diagnosed multiple myeloma who are not eligible for autologous stem cell transplant (ASCT)

  • In combination with carfilzomib and dexamethasone, for the treatment of adult patients with relapsed or refractory multiple myeloma who have received 1 to 3 prior lines of therapy

  • In combination with pomalidomide and dexamethasone, for the treatment of adult patients with multiple myeloma who have received at least 2 prior therapies including lenalidomide and a proteasome inhibitor

Important Safety Information

Indication

References: 1. SARCLISA. Prescribing information. sanofi-aventis U.S. LLC; 2024. 2. Data on file. sanofi-aventis U.S. LLC.

©2025 Sanofi. All rights reserved. SARCLISA, CareASSIST, and Sanofi are registered trademarks of Sanofi or an affiliate. All the other trademarks on this website are the property of their respective owners, who have no affiliation or relationship with Sanofi. MAT-US-2102364-v5.0-07/2025 Last Updated: July 2025