Potential Therapeutic Agents
Tocilizumab

Tocilizumab

Notes

ID consultation is needed for the use of tocilizumab for Covid-19

Tocilizumab is not recommended for the majority of pediatric patients who have mild or moderate COVID-19. For children with severe or critical illness, use of tocilizumab should be evaluated on a case-by-case basis in consultation with the Pediatric Infectious Diseases team

When to Consider

Recent data have suggested that tocilizumab in conjunction with dexamethasone can result in a reduction in days of organ support and mortality if used within 24 hours of receiving organ support

Use of tocilizumab can be considered in combination with dexamethasone in certain hospitalized patients who are exhibiting rapid respiratory decompensation due to COVID-19 meeting the following inclusion/exclusion criteria:

Admitted to ICU < 24 hours and:

  • mechanical ventilation
  • noninvasive mechanical ventilation
  • high-flow nasal canula oxygen (>0.4 FiO₂/30 L/min of oxygen flow)

OR

Recently hospitalized patients (not in an ICU) with:

  • Rapidly increasing oxygen needs who require NIV or HFNC and have significantly increased markers of inflammation

Without high suspicion of bacterial/fungal/mycobacterial infection

Dosing

Tocilizumab single intravenous dose of 8 mg/kg TBW/Adj BW (obese) (Max: 800 mg)

In setting of extreme shortage: Sarilumab 400mg x 1 dose may be used in lieu of tocilizumab

Monitoring

  • GI perforation
  • Superinfection
  • Hepatic injury
  • TB activation
  • GI perforation
  • Superinfection
  • Hepatic injury
  • TB activation