Emergency P&T approval to add tocilizumab to the network formulary for the treatment of hospitalized adults with COVID-19 was obtained. There will be strict inclusion and exclusion criteria as well as a peer-to-peer review process via Dr. Jeffrey Weinstein. An Epic build is currently in production.
Additional details:
- Dose: tocilizumab 8mg/kg (using actual body weight; max 800mg) IV over 60 minutes x 1 dose ONLY
- Round to the nearest 200mg dose
- Must be used in addition to dexamethasone (or another corticosteroid equivalent to dexamethasone 6mg)
- Ordering process:
- Peer-to-peer approval by designated P&T-appointed physician reviewer (Dr. Jeffrey Weinstein) is required prior to pharmacy verification.
- The ordering physician is responsible for initiating the review by Dr. Weinstein by contacting him via MatchMD. Dr. Weinstein will then call the pharmacy with the approval/denial decision.
Patient inclusion/exclusion criteria for use:
- Patients must have all of the following:
- Adults 18 years or older
- SARS-CoV-2 positive
- Recently admitted or rapidly worsening within last 48 hours
- Rapidly worsening hypoxemia requiring
- Invasive mechanical ventilation; OR
- Non-invasive ventilation; OR
- High-flow nasal canula at >40% FiO2 or 30L/min; AND
- At least one elevated inflammatory marker:
- C-reactive protein (CRP)
- D-dimer
- LDH
- QuantiFERON Gold TB test ordered and sent (Note: therapy will not be delayed awaiting results)
- Patients must not have any of the following:
- Significant immunosuppression, including recent use of biologic immunomodulating drugs (including tocilizumab and sarilumab)
- Alanine transaminase >5 x ULN
- High risk for gastrointestinal perforation
- Uncontrolled, serious bacterial, fungal, or non-SARS-CoV-2 viral infection
- ANC <500 cells/uL
- Platelet count <50,000 cells/Ul