It was suggested to switch from intravenous (IV) tocilizumab (TCZ) to its subcutaneous formulation with the arrival of the SARS-CoV-2 pandemic in 2020 to prevent rheumatological patients from having to visit the day hospital and ensure there would be enough IV TCZ for those COVID patients who required it. For a study, researchers sought to outline the frequency and causes of switching back from subcutaneous to IV TCZ.
Patients from the rheumatology service who began IV TCZ therapy in February 2020 and were monitored through March 2021 were included in the study. Patients who continued receiving subcutaneous TCZ were contrasted with those who went back to receiving IV TCZ (switch-back group). It was done a subgroup analysis by rheumatic illness.
Around 55 patients—28 with rheumatoid arthritis, 19 with giant cell arteritis, four with polymyalgia rheumatica, 2 with juvenile idiopathic arthritis, and 2 with systemic sclerosis—changed from topical to subcutaneous TCZ. Ineffectiveness (n = 8), patient preference (n = 4), adverse events (n = 4), and problems with the SC administration route (n = 1) all led to 17 patients switching back to IV TCZ. About 4 of 23 patients in the giant cell arteritis/polymyalgia rheumatica group switched back to IV TCZ in the analysis by illness as a result of inefficiency (n = 2), an adverse response at the injection site (n = 1), or patient choice (n = 1). 11 of 28 patients with rheumatoid arthritis returned to receiving IV TCZ for a variety of reasons, including inefficiency (n = 5), patient choice (n = 3), headache (n = 1), injection site response (n = 1), and trouble with the SC delivery route (n = 1).
After a year of follow-up, the mass transition from IV to subcutaneous TCZ during the SARS-CoV-2 pandemic has been safe, efficient, and well-tolerated.