Use of tocilizumab in Covid-19 positive pregnant women

Abstract

BACKGROUND: Tocilizumab reduces the need for mechanical ventilation and improves survival in COVID-19 patients. There is limited evidence on Tocilizumab use in pregnant patients with COVID-19. METHODS: Case series of pregnant patients with COVID-19 treated with Tocilizumab during hospitalisation between June to November 2021. Demographic data, maternal morbidity and neonatal outcomes were collected. RESULTS: Ten pregnant patients received Tocilizumab. Six patients received a single dose of 800 mcg, 2 patients received a single dose of 600 mcg, and 2 patients received a double dose of 800 mcg and 600 mcg respectively. Three patients received Tocilizumab postpartum, with 6 receiving it in the second and third trimester (mean gestational age 29.5 +/- 3.9 weeks). Antenatal patients received Tocilizumab at a median of 84 (IQR 63) days before delivery. In five patients, there was a trend in improvement of respiratory rate following administration of Tocilizumab (Table1). Birth outcomes were available for 8 patients. There were no significant adverse maternal outcomes or opportunistic infections, with only 1 patient experiencing chorioamnionitis with no long term sequalae. All neonates were born with Apgar of 9¹ and 9⁵. One infant was identified as having Lenticulostriatal vasculopathy and another was diagnosed with gastroenteritis, but no causative bacterial or viral organism was identified. One infant tested positive for COVID-19 on Day 5. Out of the 8 neonates who were born, 7 were breastfed and none of the neonates in this study experienced any adverse outcomes until discharge. CONCLUSIONS: Tocilizumab is efficacious and safe for COVID19 in pregnancy for the women and neonates