Amanda Staubs, BCPS, PharmD
Critical Care Pharmacist
Berkeley Medical Center
Martinsburg, West Virginia
Disclosure information not submitted.
Feroz Noori, MD, FCCP
MD
Berkeley Medical Center, United States
Disclosure information not submitted.
Title: Bradycardia following tocilizumab administration for COVID-19
Introduction:
Case reports and observational studies have suggested the use of tocilizumab for cytokine release syndrome in hospitalized patients with COVID-19. Tocilizumab is an interleukin-6 receptor antagonist that may improve oxygenation and decrease inflammatory biomarkers in COVID-19 patients. Well known side effects related to tocilizumab are related to an increased risk of infection secondary to immunosuppression. While there are reports of bradycardia in COVID-19 patients, this study will look incidence of bradycardia following administration of tocilizumab.
Methods:
A single-center retrospective review of thirty COVID-19 patients who received tocilizumab was done. The study included patients admitted between April 1st, 2020 to July 26, 2021. The electronic medical record system identified adult patients who received tocilizumab during their hospital stay for the diagnosis of COVID-19.
Results:
In a retrospective review of thirty COVID-19 patients who received tocilizumab, there was as much as a 30 bpm decrease in heart rate following infusion. The approximate average decrease in heart rate was 12 bpm twelve hours post-infusion. Bradycardia was observed up to 24 hours post infusion of tocilizumab and in some cases, bradycardia continued up to 72 hours. The time to onset of lowest heart rate following tocilizumab ranged from 5-9 hours. The duration of bradycardic episodes varied; however, heart rate in all patients stabilized 72 hours after last dose of tocilizumab.
Conclusion:
While bradycardia is suggested to occur in patients with COVID-19, it does appear to be more pronounced in these patients after tocilizumab. With tocilizumab being used more for treatment of cytokine release syndrome related to COVID-19, patients may require monitoring related to bradycardia especially in the presence of beta-blockers and/or calcium channel blockers. The effects of bradycardia may be more pronounced with additional or higher dosages. It does warrant further research to explore the relationship between tocilizumab and bradycardia. Healthcare professionals caring for COVID-19 patients should be aware of transient bradycardia that may follow tocilizumab administration.