Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai.

Abstract

Pregnancy, complicated by coronavirus disease 2019 (COVID-19), results in higher hospitalization and mortality rate. Pathogenesis of COVID-19 is similar to any other systemic inflammatory condition but results in a cytokine storm ofhigher magnitude causing severe acute respiratory distress syndrome and multiorgan failure. Tocilizumab, a humanized monoclonal antibody, targets soluble and membrane-bound IL-6 receptors and is used in the treatment ofjuvenile idiopathic arthritis, rheumatoid arthritis, and cytokine release syndrome. However, studies exploring itsrole in pregnancy are minimal. Hence, this study was done to study the effect of tocilizumab on maternal and fetal outcomes incritical COVID-19 pregnant women. A retrospective study was conducted on 28 pregnant women with critical COVID-19 who received tocilizumab. Clinical status, chest x-ray, biochemical parameters, and fetal well-being were monitored and documented. The discharged patients were followed up through telemedicine. On treatment with tocilizumab, improvement was seen in thenumber of zones and patterns of chest x-ray, along with 80% reduction in the c-reactive protein (CRP) levels. Based on the WHO clinical progression scale, 20 patients improved by theend of first week, and by the end of first month, 26 patients became asymptomatic. Two patients died during thecourse of the disease.No fetal adverse effects were noted. Based on the encouragingresponse and as tocilizumab did not impartany adverse effects on the pregnancy, tocilizumab may be administered as an adjuvant to criticalCOVID-19 pregnant women in their second and third trimesters.