P188 Tick tock...where and when can we give toc? Review of COVID-19 patients receiving tocilizumab in a non critical care setting

Abstract

IntroductionThe REMAP-CAP trial demonstrated the positive effects of interleukin-6 receptor antagonists (tocilizumab and sarilumab), on mortality in COVID-19 patients managed in a critical care setting.1 Prior to this, adjuvant drug therapies such as remdesivir and dexamethasone have shown limited benefits regarding COVID-19 related mortality in patients requiring non-invasive respiratory, managed in non-critical care settings.During the pandemic the Mater Hospital, Belfast was designed as the local COVID-19 centre. Prior to January 2021 standard ward level care included IV antibiotics, IV remdesivir, oral dexamethasone and non-invasive ventilation. Continuous positive airway pressure was used first line (commenced when FiO2 requirements exceeded 4L/min via nasal cannula). After the release of the Department of Health’s position statement regarding tocilizumab for COVID-19 patients on respiratory support, a decision was taken to use tocilizumab off license in a non-critical care setting.Our hypothesis was that COVID-19 positive patients on non-invasive ventilation who received tocilizumab in addition to standard care would have reduced hospital mortality compared with standard care alone. The REMAP-CAP trial administered tocilizumab to COVID-19 patients in a critical care setting, however we postulated that those ‘less unwell’ patients requiring ward level respiratory support but not ‘critical care’ could still benefit.MethodsPatients commenced on tocilizumab in a non-critical care setting were identified and followed up prospectively. A control group receiving ward level standard care was established retrospectively.ResultsForty patients were recruited into both the control and treatment groups. Results were analysed using Chi-squared statistics on Microsoft Excel. The primary outcome, namely;hospital mortality, demonstrated a significant difference between the groups (p=0.048) with no discernible difference in side effect profile.ConclusionThis data supports the use of tocilizumab in patients with COVID-19 disease, noting its positive effect on hospital mortality for COVID-19 patients on non-invasive respiratory support but not requiring critical care. Moreover, the limited side effect profile witnessed suggests tocilizumab can be safely administered in a non-critical care setting.ReferenceGordon AC, Mouncey PR, Al-Beidh F, Rowan KM, Nichol AD, Arabi YM, et al. Interleukin-6 receptor antagonists in critically ill patients with COVID-19–preliminary report. medRxiv. 2021.