• Khalid Al Sulaiman, Ohoud Aljuhani, Khalid Bin Salah, Ghazwa B Korayem, Khalid Eljaaly, Mohammed Al Essa, Abdullah Kharbosh, Feras Al Harbi, Maram Abuzaid, Sarah Al Bilal, Alaa Almagthali, Samia Alsohemi, Adel Alshabasy, Haytham Noureldeen, Mohammed Aboudeif, Asma Alshehri, and Ramesh Vishwakarma.
• Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Biostatistics and Bioinformatics Department, Riyadh, Saudi Arabia. Electronic address: alsulaimankh@hotmail.com.
• J Crit Care. 2021 Dec 1; 66: 445144-51.

PurposeTo evaluate the effectiveness and safety of the optimal tocilizumab dosing regimen.MethodsA two-center, retrospective cohort study, for COVID19 critically ill patients admitted to the intensive care units (ICUs). We included critically ill patients aged 18 years or older who received tocilizumab during ICU stay. Patients were divided into two groups based on the number of the received tocilizumab doses. The primary outcome was the in-hospital and 30-day mortality. Propensity score (PS) matching was used (1:1 ratio) based on the selected criteria.ResultsA total of 298 patients were included in the study; 70.4% (210 patients) received a single dose of tocilizumab. After adjusting for possible confounders, the 30-day mortality (HR 0.79 95% CI 0.43-1.45 P = 0.44) and in-hospital mortality (HR 0.81; 95% CI 0.46-1.49; P = 0.53) were not significantly different between the two groups. On the flip side, patients who received multiple doses had higher pneumonia odds than a single dose (OR 3.81; 95% CI 1.79-8.12 P = 0.0005).ConclusionRepeating tocilizumab doses were not associated with a mortality benefit in COVID-19 critically ill patients, but it was associated with higher odds of pneumonia compared to a single dose.Copyright © 2021 Elsevier Inc. All rights reserved.

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