A 58-year-old man hospitalised with COVID-19 pneumonia is on high-flow nasal cannula with FiO2 0.7. He is on day 11 of illness, has received dexamethasone for 4 days, and CRP is 190 mg/L. Which add-on therapy has been shown in randomised trials to reduce mortality in this situation?
- A Lopinavir-ritonavir
- B Convalescent plasma
- C Tocilizumab ✓
- D Hydroxychloroquine
Correct answer: C. Tocilizumab
Explanation
The RECOVERY trial showed that tocilizumab added to standard care including corticosteroids improved survival in hospitalised patients with hypoxia and elevated CRP, reflecting the interleukin-6 driven inflammatory phase. Convalescent plasma, hydroxychloroquine and lopinavir-ritonavir each failed to show mortality benefit in the same platform trial and are no longer recommended for severe COVID-19. Antivirals act too late in the cytokine-driven phase of illness.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.