Tocilizumab for Covid-19 in the Medical Intensive Care Unit: Maternal and Fetal Outcomes

ABSTRACT

INTRODUCTION: Tocilizumab has been used for treatment of COVID-19 in hospitalized patients who require supplementation oxygen. Various concerns regarding its use in pregnant patients have been presented, however very limited data exists regarding the use of tocilizumab in this population. METHOD(S) Between July 2021 and November 2021, 7 pregnant patients unvaccinated against COVID-19 were admitted to the medical intensive care unit with acute hypoxemic respiratory failure secondary to COVID-19 infection. The average age of patients was 29 with average gestational term of 27 weeks and average BMI of 38kg/m2. All patients had received dexamethasone and remdesivir per standard hospital protocols and antibiotics for superimposed bacterial pneumonia in patients with infiltrates concerning for concomitant bacterial picture. However, these patients still had high oxygen requirements prompting administration of tocilizumab. Each patient received 800mg of tocilizumab as a single dose. RESULT(S) After administration of tocilizumab, oxygen requirements decreased in 6 out of 7 patients, resulting in an avoidance of mechanical ventilation. Typical serum markers used to measure inflammatory response in COVID-19, including C-reactive protein and D-dimer, showed improvement after administration of tocilizumab in 6 out of 7 patients. All pregnancies progressed to successful live birth with no notable fetal deformities or malformations. Out of the 7 patients, there were 5 preterm deliveries, defined as gestational age of 37-38 weeks. 2 of the 7 patients underwent caesarean delivery for maternal hypoxia, both in the setting of severe COVID-19 infection. All infants had a birth weight within normal limits for their gestational age. No complications were noted during vaginal birth of caesarean delivery. CONCLUSION(S) Based on this review, it appears that the use of tocilizumab provided benefit in 85.7% of patients, preventing progression to mechanical ventilation. Based on this case series, tocilizumab seems to be a safe option for pregnant woman and subsequently their babies, with no severe complications or deformities noted during birth. However, 71.4% of patients did undergo preterm labor, prompting future research into whether these is any correlation between tocilizumab and preterm labor.