1
|
Bowman CJ, Becourt-Lhote N, Boulifard V, Cordts R, Corriol-Rohou S, Enright B, Erkman L, Harris J, Hartmann A, Hilpert J, Kervyn S, Mattson B, Morford L, Muller M, Powell M, Sobol Z, Srinivasan R, Stark C, Thompson KE, Turner KJ, Barrow P. Science-Based Approach to Harmonize Contraception Recommendations in Clinical Trials and Pharmaceutical Labels. Clin Pharmacol Ther 2023; 113:226-245. [PMID: 35388453 PMCID: PMC10083981 DOI: 10.1002/cpt.2602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 03/25/2022] [Indexed: 01/27/2023]
Abstract
This review presents a European Federation of Pharmaceutical Industries and Association/PreClinical Development Expert Group (EFPIA-PDEG) topic group consensus on a data-driven approach to harmonized contraception recommendations for clinical trial protocols and product labeling. There is no international agreement in pharmaceutical clinical trial protocols or product labeling on when/if female and/or male contraception is warranted and for how long after the last dose. This absence of consensus has resulted in different recommendations among regions. For most pharmaceuticals, contraception recommendations are generally based exclusively on nonclinical data and/or mechanism. For clinical trials, contraception is the default position and is maintained for women throughout clinical development, whereas appropriate information can justify removing male contraception. Conversely, contraception is only recommended in product labeling when warranted. A base case rationale is proposed for whether or not female and/or male contraception is/are warranted, using available genotoxicity and developmental toxicity data. Contraception is generally warranted for both male and female subjects treated with mutagenic pharmaceuticals. We propose as a starting point that contraception is not typically warranted when the margin is 10-fold or greater between clinical exposure at the maximum recommended human dose and exposure at the no observed adverse effect level (NOAEL) for purely aneugenic pharmaceuticals and for pharmaceuticals that induce fetal malformations or embryo-fetal lethality. Other factors are discussed, including contraception methods, pregnancy testing, drug clearance, options for managing the absence of a developmental toxicity NOAEL, drug-drug interactions, radiopharmaceuticals, and other drug modalities. Overall, we present a data-driven rationale that can serve as a basis for consistent contraception recommendations in clinical trials and in product labeling across regions.
Collapse
Affiliation(s)
- Christopher J Bowman
- Worldwide Research, Development, and Medical, Pfizer Inc, Groton, Connecticut, USA
| | | | | | - Rüdiger Cordts
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | - Brian Enright
- Preclinical Safety, AbbVie Inc., North Chicago, Illinois, USA
| | - Linda Erkman
- Preclinical Safety, Novartis Pharma, Basel, Switzerland
| | - Jayne Harris
- Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Cambridge, UK
| | | | - Jan Hilpert
- Translational Medicine, Pharma Research and Early Development, Bayer AG, Berlin, Germany
| | | | | | | | | | - Marcy Powell
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Zhanna Sobol
- Merck & Co., Inc., West Point, Pennsylvania, USA
| | | | - Claudia Stark
- Preclinical Development, Pharma Research and Early Development, Bayer AG, Berlin, Germany
| | - Kary E Thompson
- Nonclinical Safety, Janssen Pharmaceuticals, Spring House, Pennsylvania, USA
| | - Katie J Turner
- Nonclinical Safety, Janssen Pharmaceuticals, Spring House, Pennsylvania, USA
| | - Paul Barrow
- Pharma Research and Early Development, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| |
Collapse
|
2
|
da Silva WE, de Melo IMF, de Albuquerque YML, Mariano AFDS, Wanderley-Teixeira V, Teixeira ÁAC. Effect of metronidazole on placental and fetal development in albino rats. Anim Reprod 2019; 16:810-818. [PMID: 32368258 PMCID: PMC7189510 DOI: 10.21451/1984-3143-ar2018-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 06/11/2019] [Indexed: 11/08/2022] Open
Abstract
Metronidazole is an antiprotozoal and antibacterial used in gynecology and obstetrics for the treatment of parasitic infections. However, despite having clinical use for more than three decades, questions about the safety of its use during pregnancy is not well understood. Thus, the present study evaluated the effect of metronidazole on placental and fetal development in pregnant rats. Metronidazole was orally administered by gavage at a dosage of 130 mg/kg for 7 and 14 days. Morphological analysis, morphometry and immunohistochemistry were performed at the implantation sites and placentas with 14 days of development. The results showed that in the treated group there was a significant reduction in the number of implantation sites, total placental disc area and constituent elements of the labyrinth and spongiotrophoblast layers. Histochemical analysis revealed no significant changes in the content of collagen, elastic and reticular fibers. The TUNEL test showed apoptotic activity in the implantation sites and placentas with 14 days of development independent of the treatment. There was no evidence of malformation in the neonates. However, there was a significant reduction in the number and weight of neonates in the group treated with metronidazole when compared to the control group. Thus, it is concluded that the administration of 130 mg/kg of metronidazole during pregnancy in rats, in addition to interfering with the number of implanted embryos, promotes changes in placental structure and interferes with fetal development. This suggests that this drug should be used with caution during pregnancy.
Collapse
Affiliation(s)
- Welma Emídio da Silva
- Universidade Federal Rural de Pernambuco, Departamento de Morfologia e Fisiologia Animal, Recife, PE, Brasil
| | | | | | | | - Valéria Wanderley-Teixeira
- Universidade Federal Rural de Pernambuco, Departamento de Morfologia e Fisiologia Animal, Recife, PE, Brasil
| | | |
Collapse
|
4
|
Thompson KE, Rayhon SL, Bailey G, Delille P, McNerney ME. Assessment of cervical passage of vital dyes in pregnant, nonpregnant, and mated rats and mice. Reprod Toxicol 2015; 59:1-7. [PMID: 26546978 DOI: 10.1016/j.reprotox.2015.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/23/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022]
Abstract
Risk assessment for indirect exposure to small molecule pharmaceuticals in semen to the conceptus has traditionally been handled by calculations based on assumptions that any embryo-fetal exposure would be secondary to maternal absorption and redistribution. This study was designed to assess the potential for transcervical passage of drugs from semen. Reproductive tracts of rodents were examined following vaginal dosing with vital dyes during the estrous cycle, mating, and pregnancy. Toluidine Blue was not observed beyond the cervix after vaginal administration in pregnant rats; additionally, it did not pass the cervix in rats during any phase of estrous. In order to address the effects of semen, rats were dosed at receptivity and mated. Vital dyes were not visually evident in the uterus despite vaginal and sperm plug staining. This study provides evidence that direct transcervical passage is not a substantial route of direct embryo-fetal exposure for small molecule drugs in semen.
Collapse
Affiliation(s)
- Kary E Thompson
- Department of Reproductive Toxicology, Drug Safety Evaluation, Research & Development, Bristol-Myers Squibb Company, New Brunswick, NJ 08903, USA.
| | - Stephanie L Rayhon
- Department of Reproductive Toxicology, Drug Safety Evaluation, Research & Development, Bristol-Myers Squibb Company, New Brunswick, NJ 08903, USA
| | - Graham Bailey
- Preclinical Development & Safety, Janssen Research & Development, 2340 Beerse, Belgium
| | - Peter Delille
- Preclinical Development & Safety, Janssen Research & Development, 2340 Beerse, Belgium
| | - Mary Ellen McNerney
- Department of Reproductive Toxicology, Drug Safety Evaluation, Research & Development, Bristol-Myers Squibb Company, New Brunswick, NJ 08903, USA
| |
Collapse
|