The following is a summary of “Low dose vs high dose tocilizumab in COVID-19 patients with hypoxemic respiratory failure,” published in the April 2023 issue of the Critical Care by Chung, et al.
The normal dose of tocilizumab in COVID-19 was 8 mg/kg (maximum 800 mg), and it was demonstrated to reduce mortality when taken with steroids. Therefore, this study aimed to determine if COVID patients taking the same median dose of steroids at both the low and high doses had equivalent benefits from the low dose (400 mg). Between March 2020 and August 2021, individuals with COVID-19 who were given tocilizumab in combination with steroids were the subject of a retrospective, multi-hospital observational research.
Of the 407 individuals studied, those receiving the low dose had a higher prevalence of receiving vasopressors, being admitted to the intensive care unit (ICU), and being on mechanical breathing at the outset. There was no significant difference in 28-day mortality (P=0.613) between the groups given a median dexamethasone equivalent dose of 10 mg. However, the high-dosage group had more fungal and viral infection cases.
High-dose tocilizumab was associated with more fungal and viral infections, but it did not improve efficacy or decrease mortality further than low-dose treatment. This research shows that in the event of a tocilizumab drug shortage, low-dose treatment can be used instead of high-dose treatment without compromising efficacy or safety.