Single versus multiple doses of Tocilizumab in critically ill patients with coronavirus disease 2019 (COVID-19): A two-center, retrospective cohort study

Abstract

Purpose To evaluate the effectiveness and safety of the optimal tocilizumab dosing regimen. Methods A two-center, retrospective cohort study, for COVID19 critically ill patients admitted to the intensive care units (ICUs). We included critically ill patients aged 18 years or older who received tocilizumab during ICU stay. Patients were divided into two groups based on the number of the received tocilizumab doses. The primary outcome was the in-hospital and 30-day mortality. Propensity score (PS) matching was used (1:1 ratio) based on the selected criteria. Results A total of 298 patients were included in the study; 70.4% (210 patients) received a single dose of tocilizumab. After adjusting for possible confounders, the 30-day mortality (HR 0.79 95% CI 0.43–1.45 P = 0.44) and in-hospital mortality (HR 0.81; 95% CI 0.46–1.49; P = 0.53) were not significantly different between the two groups. On the flip side, patients who received multiple doses had higher pneumonia odds than a single dose (OR 3.81; 95% CI 1.79–8.12 P = 0.0005). Conclusion Repeating tocilizumab doses were not associated with a mortality benefit in COVID-19 critically ill patients, but it was associated with higher odds of pneumonia compared to a single dose.

Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis

“…The 148 included studies were published between December, 2019, and May, 2021. 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , ...…”

Association between tocilizumab and emerging multidrug-resistant organisms in critically ill patients with COVID-19: A multicenter, retrospective cohort study

“…However, this was limited by the study design and the short follow-up period to confirm the association between tocilizumab and the higher rate of secondary infections [ 29 ]. Another recently published retrospective cohort study conducted on critically ill patients with COVID-19 found that multiple doses of tocilizumab were associated with higher odds of pneumonia than a single dose [ 30 ].…”

Rationalizing the Use of COVID-19 Questionable Efficacy Drugs in a Low Middle-income Country: A Hospital Tocilizumab Committee Experience

“…A study done by Sulaiman et al found no significant mortality benefit when assessing single-dose versus multiple-dose arm COVID-19 patients in Saudi Arabia. 18 The novelty of the present study lies in making a decision support system in the name of HTC, assessing the rational utilization of costly drugs with uncertain benefits. To the best of our knowledge, there exists no study comparing the dead versus survived COVID-19 pneumonia patients receiving tocilizumab.…”