IV Tocilizumab Shortage for Rheumatology Patients: A Result of the COVID-19 Pandemic

IV Tocilizumab Shortage for Rheumatology Patients: A Result of the COVID-19 Pandemic Posted By:
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The COVID-19 pandemic has brought many challenges to our daily rheumatology practices: From the initial switch to mostly telemedicine appointments in early 2020, to the constant updates in practice and treatment guidelines for our rheumatic patients, to trying to persuade our immunocompromised patients to get the COVID-19 vaccine, new challenges seem to present themselves on a weekly basis.

Within the past 2 months—and coinciding with the increase in COVID-19 cases and hospitalizations due to the Delta variant—there has been a shortage of IV tocilizumab for rheumatology patients. This shortage (technically beginning August 16, 2021) has been caused by a stockpiling of IV tocilizumab by hospital systems across the country in response to an increase in patients presenting to their facilities with moderate to severe cases of COVID-19. On June 24, 2021, the US FDA issued an emergency use authorization (EUA) for IV tocilizumab for the treatment of hospitalized adults and pediatric patients (≥2 years of age) who are receiving systemic corticosteroids and require supplemental oxygen, noninvasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).

Tocilizumab has multiple other indications including rheumatoid arthritis, giant cell arteritis, juvenile idiopathic arthritis, and cytokine storm syndrome. It is an interleukin (IL)-6 inhibitor that has been shown to decrease the "hyperactive" and often damaging response of the immune system in many autoimmune diseases, as well as those with COVID-19 infection.

We are now faced with the challenge of waiting for the shortage of the medication to resolve or switching our rheumatology patients to another form of treatment. Unfortunately, there are no good options to this dilemma. There is an injectable form of tocilizumab for some indications, but there are various insurance hurdles and certain patients who are needle-phobic cringe at the thought of injecting themselves. Also, in some instances, injectable tocilizumab has been found to be in short supply as well. Often, we are forced to switch to the other FDA-approved IL-6 inhibitor, sarilumab. Switching medications or route of administration can lead to treatment delays during prior authorization, less efficacy in certain patients, and less optimal disease management—including flares in disease.

A statement was released by Genentech/Roche in early September stating that they are working quickly to increase manufacturing capacity and supply, as well as updating distribution strategies to hospitals and clinics across the country.

At this time, the tocilizumab shortage persists. Some patients are able to receive their medication as scheduled while others are in limbo as to when they will receive their next dose of tocilizumab. We, as healthcare providers, can only hope that COVID-19 cases and hospitalizations will continue to decline in the upcoming weeks and months, leading to less IV tocilizumab being needed for patients hospitalized with COVID-19 and more being available for the treatment of our rheumatology patients.

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Filed under: Miscellaneous , Rheumatology

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