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Approval of Tocilizumab for COVID-19 Treatment

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 
March 31, 2021