I'd like this to be its own thread because I believe it deserves it. Curious as to input and experiences of others.......
Tocilizumab (Actemra) Criteria*
Inclusion
ARDS with worsening oxygenation PLUS worsening radiographic imaging, and at least one of the following:
Vented with PF ratio <200 or increasing FIO2 > 70%
Increasing oxygen requirements > 6L/min or < 93% saturation
PLUS
Markers of Inflammation in Cytokine Storm (2 or more of the following):
Ferritin > 1000 ng/ml
LDH > 250 IU/L
CRP > 200 mg/L
D-dimer > 1000
Lymphocytes < 800
Persistent Fever > 101 F
Exclusion
AST or ALT > 5 X ULN
Active bacterial or fungal infection (Relative exclusion; weigh risk/benefit ratio)
*Consider weighing risk/benefit ratio (i.e., age, comorbidities) as very limited evidence to support the safety and efficacy of IL-6 inhibitors for the treatment of Covid-19 at this time.
Tocilizumab (Actemra) Criteria*
Inclusion
ARDS with worsening oxygenation PLUS worsening radiographic imaging, and at least one of the following:
Vented with PF ratio <200 or increasing FIO2 > 70%
Increasing oxygen requirements > 6L/min or < 93% saturation
PLUS
Markers of Inflammation in Cytokine Storm (2 or more of the following):
Ferritin > 1000 ng/ml
LDH > 250 IU/L
CRP > 200 mg/L
D-dimer > 1000
Lymphocytes < 800
Persistent Fever > 101 F
Exclusion
AST or ALT > 5 X ULN
Active bacterial or fungal infection (Relative exclusion; weigh risk/benefit ratio)
*Consider weighing risk/benefit ratio (i.e., age, comorbidities) as very limited evidence to support the safety and efficacy of IL-6 inhibitors for the treatment of Covid-19 at this time.