Tocilizumab for the Critically Ill With Severe COVID-19: A Community Hospital Case Series.

McKenzie, Matt G; Lee, Yeunju Michelle; Mathew, Julin; Anderson, Megan; Vo, Alison T; Akinyele, Samuel; Narayanan, Malarvizhi

OBJECTIVE To evaluate the use of tocilizumab in a community hospital setting for critically ill patients with severe COVID-19. DESIGN A retrospective case series. SETTING Five community hospitals within 1 urban health system. PATIENTS Adult patients whom received tocilizumab between March 27th, 2020 to April 30th, 2020 for severe COVID-19. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Sixteen patients in total were evaluated from the 5 community hospitals. The mean (± SD) age of the patients was 53.9 ± 9.2 years, 56% were men, and the most common comorbidities present on admission were hypertension (31%) and diabetes mellitus (25%). All patients received at least 1 other treatment modality for COVID-19 (steroids, hydroxychloroquine, or convaslescent plasma). Additionally, all patients on admission to intensive care units had severe COVID-19 with 56% requiring mechanical ventilation with a pre-tocilizumab median (IQR) Pao2: Fio2 of 84 (69 - 108.6), 19% requiring vasopressor support, and inflammatory markers (CRP, LDH, ferritin, and IL-6) were elevated. The median (IQR) tocilizumab dose was 400 mg (400-600) which correlated with a weight-based mean (± SD) dose of 5.4 mg/kg ± 1.3. Of the 16 patients that received tocilizumab, 8 (50%) were discharged home, 7 (44%) died, and 1 (6%) was still hospitalized at the end of data collection. Patients who died were more likely to be older 62 ± 2 years, female (57%), had a higher rate of mechanical ventilation (86%) and vasopressors (43%) use at baseline, and had a higher median (IQR) IL-6 level prior to tocilizumab administration 550 pg/mL (IQR 83-1924). There were no reported adverse drug reactions reported after the administration of tocilizumab for any patient. CONCLUSIONS Our findings do not support the effectiveness of tocilizumab in treatment of severe COVID-19 infection in critically ill patients.