Maternal and Fetal Outcome of COVID Positive Antenatal Women Treated With Tocilizumab in a Tertiary Care Center an Observational Cohort Study

Abstract

Tocilizumab, an IL-6 receptor inhibitor, halts the inflammatory stage of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. However, there is little information on Tocilizumab's effects on antenatal women and new born. This study aims to assess the effects of Tocilizumab in treating antenatal women with severe COVID infection.  To assess and compare the maternal and fetal outcomes of COVID positive antenatal women of severe disease category who have been treated with Tocilizumab. A prospective observational cohort study was conducted at a tertiary care center from May 1^st to October 31^st 2021, involving 48 antenatal women with confirmed severe COVID-19 disease. Of these, 24 received Tocilizumab after multidisciplinary team consultation and informed consent, forming the case group, while 24 similar women, who did not give consent for Tocilizumab, served as controls. Disease severity and progression was assessed clinically and biochemically and the maternal and fetal outcomes of both the groups were compared. In this study of 48 pregnant women with severe COVID-19, 24 (50%) received Tocilizumab. Notably, 92% of severe COVID-19 pregnant women were non-vaccinated. Tocilizumab group showed significantly shorter oxygen support (2.6 vs. 4.0 days, p value-0.03) and ICU stays (8.9 days vs. 11.5 days, p-0.01), lower steroid use (1876.8 mg vs. 2895 mg, p value-0.03) and higher pregnancy continuation (25% vs. 17%) than controls. Biochemical markers (Serum Ferritin, LDH, CRP) also improved after Tocilizumab therapy. Over a median follow up of 30 days, 16 patients (66.7 %) had no clinical evidence of disease on day 30, with 5 reported deaths. This study shows that Tocilizumab is beneficial in managing severe COVID-19 in pregnant women, leading to reduced oxygen and steroid use, shorter ICU and ventilator stays, improved SpO2, decreased biochemical markers and increased likelihood of continuing their pregnancies.