Rational Use of Tocilizumab in Critically Ill COVID-19 Patients: A Comprehensive Evaluation in the Intensive Care Unit

Abstract

Objectives: Tocilizumab (TCZ) is a key treatment for severe COVID-19 but poses risks due to immunosuppression and limited evidence. Concerns about misuse and limited supply necessitate a thorough assessment. This study investigates the utilization patterns and appropriateness of tocilizumab use in critically ill COVID-19 patients.
Materials and Methods: Over nine months, this descriptive-analytical study evaluated TCZ use in adult COVID-19 ICU (intensive care unit) patients at two referral hospitals in Isfahan, Iran. Data on TCZ dosing, duration, concomitant treatments, and patient demographics, including APACHE scores, were collected. Clinical outcomes, inflammatory markers, and adverse effects were monitored on days 3 and 5 post-TCZ administration. Statistical analyses were set at p < 0.05.
Results: Out of 118 patients enrolled, 108 were analyzed for TCZ use; the mean age was 64.3 years, with 58.3% males. Notably, 39.8% of patients did not meet TCZ indication criteria, and only 7.5% received TCZ according to rational clinical guidelines regarding indication, dose, and dosing intervals. CRP levels significantly decreased after TCZ treatment (p < 0.001). The rational prescription group had higher APACHE scores five days post-treatment (p = 0.05), and appropriate TCZ use was significantly more common among intubated patients (p = 0.02).
Conclusion: While rational use correlated with higher APACHE scores, no significant differences in other outcomes were observed, possibly due to sample size. Tocilizumab’s mechanism in reducing inflammation and CRP is well-established. Still, limitations include incomplete data on out-of-hospital prescriptions and patients who needed but did not receive TCZ, which necessitate further investigations.