Evaluation of Tocilizumab for Covid-19 Treatment in the Intensive Care Unit

ABSTRACT

INTRODUCTION: Tocilizumab is recognized as a safe and efficacious treatment option for critically ill patients with COVID-19. Controversy remains regarding appropriate criteria for use. This evaluation assessed tocilizumab use for COVID-19 treatment and clinical outcomes following implementation of an institutional guideline. METHOD(S) This was a 2-center (1 community;1 academic), retrospective review of adult patients admitted to the ICU that received tocilizumab for COVID-19. Baseline demographics, length of stay (LOS), mechanical ventilation (MV), morbidity, mortality, and drug cost were collected. C-reactive protein (CRP), ferritin, and lactate dehydrogenase (LDH) were reviewed and compared to institutional criteria for use. RESULT(S) Forty (26 community;14 academic) critically ill patient cases were reviewed. No differences were observed in baseline demographics, with a pool median age and weight of 58 (49-65) years and 102 (88-117) kg, respectively. No difference (community, 4 [15.4%] vs academic, 0 [0%];p=0.28) was seen in vaccination status. No differences were seen in time to tocilizumab administration, dose, hospital and ICU LOS, or progression to MV. Pooled median inflammatory markers included a CRP 131 (92-200) mg/L, ferritin 1074 (418-1936) ng/mL, and LDH 589 (414-803) IU/L with no differences between groups. Median ferritin values were noted as numerically higher, but non-significant in the community group (1331 [614-2306] ng/L vs 555 [341- 1851] ng/mL;p=0.16). Pooled all-cause in-hospital mortality was observed in 14 (35%) patients, with numerically higher, but non-significant rates in the community group (12 [46.2%] vs 2 [14.3%];p=0.08). Median charge per patient was $15,625.55. CONCLUSION(S) Critically ill patients receiving tocilizumab for COVID-19 treatment have high rates of mortality despite early use upon ICU admission. Baseline inflammatory markers were markedly above institutional criteria for use, leading to adjustments in the institutional guideline. Routine evaluation of tocilizumab use criteria may be warranted during strained supplies and COVID-19 surges.