COVID-19 therapeutics for low- And middle-income countries: A review of candidate agents with potential for near-term use and impact

Daniel Maxwell, Kelly C. Sanders, Oliver Sabot, Ahmad Hachem, Alejandro Llanos-Cuentas, Ally Olotu, Roly Gosling, James B. Cutrell, Michelle S. Hsiang

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


Low- and middle-income countries (LMICs) face significant challenges in the control of COVID-19, given limited resources, especially for inpatient care. In a parallel effort to that for vaccines, the identification of therapeutics that have near-term potential to be available and easily administered is critical. Using the United States (US), European Union (EU), and World Health Organization (WHO) clinical trial registries, we reviewed COVID-19 therapeutic agents currently under investigation. The search was limited to oral or potentially oral agents, with at least a putative anti-SARS-CoV-2 virus mechanism and with at least five registered trials. The search yielded 1,001, 203, and 1,128 trials, in the US, EU, and WHO trial registers, respectively. These trials covered 13 oral or potentially oral repurposed agents that are currently used as antimicrobials and immunomodulatory therapeutics with established safety profiles. The available evidence regarding proposed mechanisms of action, potential limitations, and trial status is summarized. The results of the search demonstrate few published studies of high quality, a low proportion of trials completed, and the vast majority with negative results. These findings reflect limited investment in COVID-19 therapeutics development compared with vaccines. We also identified the need for better coordination of trials of accessible agents and their combinations in LMICs. To prevent COVID-19 from becoming a neglected tropical disease, there is a critical need for rapid and coordinated efforts in the evaluation and deployment of those agents found to be efficacious.

Original languageEnglish (US)
Pages (from-to)584-595
Number of pages12
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number3
StatePublished - Sep 2021

ASJC Scopus subject areas

  • Infectious Diseases
  • Virology
  • Parasitology


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