Abby Heavner
Novant Health Forsyth Medical Center
Winston Salem, North Carolina
Disclosure information not submitted.
Jeremy Hodges, BS, RPH, BCPS, BCCCP, CPP
Clinical Pharmacist
Novant Health Forsyth Medical Center, United States
Disclosure information not submitted.
Robert Crawford III, PharmD, BCIDP, AAHIVP
Infectious Diseases Pharmacist
Novant Health, United States
Disclosure information not submitted.
Bria Benson, PharmD, BCIDP
Infectious Diseases Pharmacist
Novant Health, United States
Disclosure information not submitted.
Title: Efficacy of Fixed Versus Weight Based Dosing of Tocilizumab In Patients Admitted With COVID-19
Introduction: Tocilizumab is an interleukin-6 receptor antagonist thought to suppress the inflammatory response in patients with severe coronavirus disease 2019 (COVID-19). Initial international treatment guidance recommended fixed-dose tocilizumab (400 mg) in patients with severe COVID-19 in the absence of contraindications. As prospective data were published, guidance documents transitioned to recommending weight-based dosing (8 mg/kg with 800 mg maximum) for one or two doses. This study aimed to compare outcomes in patients hospitalized with COVID-19 treated with tocilizumab utilizing fixed dosing strategy (FDS) versus weight-based dosing (WBDS) strategy.
Methods: A retrospective chart review was conducted in 140 patients hospitalized with COVID-19 who received tocilizumab. Outcomes were compared based upon the utilized dosing strategy. The primary outcome was 90-day mortality.
Results: A total of 140 patients were included, 70 in the FDS group and 70 in the WBDS group. Average age was higher in the FDS group (64 vs 59 years, p = 0.003). Treatment with corticosteroids occurred in 49% of patients in the FDS group and in 97% of patients in the WBDS group (p < 0.001). Average time to treatment with tocilizumab from symptom onset was 10 ± 5 days for both groups (p = 0.912). Death at 90 days occurred in 30% of patients in the FDS group versus 30% in the WBDS group (p = 0.853). Average duration of mechanical ventilation was 11 ± 11 days in the FDS group versus 16 ± 9 in the WBDS group (p = 0.023). Average hospital length of stay was 20 ± 18 days in the FDS group versus 19 ± 14 days in the WBDS group (p = 0.881). Average ICU length of stay was 11 ± 12 days versus 13 ± 13 days (p = 0.234), respectively. The rate of microbiologically-confirmed secondary infections was 29% in the FDS group versus 20% in the WBDS (p = 0.237). Renal replacement therapy occurred in 6% versus 9% of patients, respectively (p = 0.743).
Conclusions: In this retrospective cohort of patients hospitalized with COVID-19, no significant differences were observed in mortality at 90 days, hospital or ICU length of stay, microbiologically-confirmed secondary infections, or need for renal replacement therapy when treated with tocilizumab utilizing either FDS or WBDS. Patients in the WBDS group required extended durations of mechanical ventilation.