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Schreiber K, Graversgaard C, Hunt BJ, Wason JMS, Costedoat-Chalumeau N, Aguilera S, Guerra MM, Salmon JE. Challenges of designing and conducting cohort studies and clinical trials in populations of pregnant people. THE LANCET. RHEUMATOLOGY 2024; 6:e560-e572. [PMID: 38876128 DOI: 10.1016/s2665-9913(24)00118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 06/16/2024]
Abstract
Rheumatic and musculoskeletal diseases often affect individuals of childbearing age. The incidence and prevalence of rheumatic and musculoskeletal diseases is rising. More pregnancies in patients with rheumatic and musculoskeletal diseases are anticipated and some rheumatic and musculoskeletal diseases are associated with pregnancy complications (eg, miscarriages, fetal deaths, preterm births, and hypertensive disorders in pregnancy). Despite the need to understand the use of drugs to treat rheumatic and musculoskeletal diseases in pregnancy, clinical trials in pregnancy are rare, therapeutics in pregnancy are understudied, and pregnant individuals are routinely excluded as premarketing trial participants. Data on the effectiveness and safety of disease-modifying antirheumatic drugs are most often based on post-marketing observational data. Observational studies assessing the bidirectional relationship between rheumatic and musculoskeletal diseases and pregnancy, as well as interventional studies of treatments during pregnancy, are scarce. Historical reluctance to perform studies in what was deemed an at-risk group persists in pharmaceutical companies, regulatory bodies, and ethics boards. Additionally, patients must be engaged partners, which requires trust that the research respects the needs and interests of the patient and complies with the rules intended to protect the pregnant person and the fetus from harm. In this Series paper, we share challenges we have encountered in conducting prospective cohort studies and interventional trials of postmarketing approved medications, assessing pregnancy specific outcomes in pregnant women with rheumatic and musculoskeletal diseases in the EU, the UK, and the USA. We discuss the changing landscape around trials in pregnancy and present possible solutions to our challenges.
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Affiliation(s)
- Karen Schreiber
- Danish Centre for Expertise in Rheumatology (CeViG), Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Christine Graversgaard
- Danish Centre for Expertise in Rheumatology (CeViG), Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark; Department of Rheumatology, Århus University Hospital, Århus, Denmark
| | - Beverley J Hunt
- Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James M S Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nathalie Costedoat-Chalumeau
- Centre de référence maladies auto-immunes et systémiques rares de l'île de France, Cochin Hospital, Paris, France; Université Paris Cité, Paris, France; Center Of Research In Epidemiology And Statistics, Inserm University, Paris, France
| | - Silvia Aguilera
- Spanish Association for Antiphospholipid Syndrome, Elche, Spain
| | | | - Jane E Salmon
- Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medicine, New York, NY, USA
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Ługowski F, Babińska J. Haptens in preparations marketed as dedicated for pregnant women: Analysis of product composition. Contact Dermatitis 2024; 91:152-153. [PMID: 38567875 DOI: 10.1111/cod.14559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 07/12/2024]
Affiliation(s)
| | - Julia Babińska
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
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Vannappagari V, McCallister S, Romach B, Bush M, Stanislaus D, Root C, Lampkin C, Nwokolo N, Puga A, Moreira S, Salem F, DeMasi R, Payvandi N, Smith K, Garges H, de Ruiter A. Responding to the Call to Action: Framework to Accelerate Clinical Data Generation for Antiretroviral Use in Pregnant Individuals with HIV. Infect Dis Ther 2024; 13:1391-1398. [PMID: 38772986 PMCID: PMC11219686 DOI: 10.1007/s40121-024-00993-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/08/2024] [Indexed: 05/23/2024] Open
Affiliation(s)
- Vani Vannappagari
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA.
- VP, Global Head of Epidemiology & Real World Evidence, ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA.
| | | | - Beth Romach
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Mark Bush
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | | | - Charlotte Root
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Christine Lampkin
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Nneka Nwokolo
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Ana Puga
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | | | | | - Ralph DeMasi
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Nassrin Payvandi
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Kimberly Smith
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Harmony Garges
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
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Le Merdy M, Szeto KX, Perrier J, Bolger MB, Lukacova V. PBPK Modeling Approach to Predict the Behavior of Drugs Cleared by Metabolism in Pregnant Subjects and Fetuses. Pharmaceutics 2024; 16:96. [PMID: 38258106 PMCID: PMC10820132 DOI: 10.3390/pharmaceutics16010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
This study aimed to develop a physiologically based pharmacokinetic (PBPK) model that simulates metabolically cleared compounds' pharmacokinetics (PK) in pregnant subjects and fetuses. This model accounts for the differences in tissue sizes, blood flow rates, enzyme expression levels, plasma protein binding, and other physiological factors affecting the drugs' PK in both the pregnant woman and the fetus. The PBPKPlus™ module in GastroPlus® was used to model the PK of metoprolol, midazolam, and metronidazole for both non-pregnant and pregnant groups. For each of the three compounds, the model was first developed and validated against PK data in healthy non-pregnant volunteers and then applied to predict the PK in the pregnant groups. The model accurately described the PK in both the non-pregnant and pregnant groups and explained well the differences in the plasma concentration due to pregnancy. When available, the fetal plasma concentration, placenta, and fetal tissue concentrations were also predicted reasonably well at different stages of pregnancy. The work described the use of a PBPK approach for drug development and demonstrates the ability to predict differences in PK in pregnant subjects and fetal exposure for metabolically cleared compounds.
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Affiliation(s)
- Maxime Le Merdy
- Simulations Plus, Inc., 42505 10th Street West, Lancaster, CA 93534, USA
| | - Ke Xu Szeto
- Simulations Plus, Inc., 42505 10th Street West, Lancaster, CA 93534, USA
| | - Jeremy Perrier
- PhinC Development, 36 Rue Victor Basch, 91300 Massy, France
| | - Michael B Bolger
- Simulations Plus, Inc., 42505 10th Street West, Lancaster, CA 93534, USA
| | - Viera Lukacova
- Simulations Plus, Inc., 42505 10th Street West, Lancaster, CA 93534, USA
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Verma A, Chauhan A, Awasthi A. Transcending Molecules: Paving the Way from Lab to Life in Drug Transport Innovation. Curr Drug Targets 2024; 25:445-448. [PMID: 38639289 DOI: 10.2174/0113894501305312240414073623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Abhishek Verma
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab, 142001, India
| | - Abhishek Chauhan
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab, 142001, India
| | - Ankit Awasthi
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab, 142001, India
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