1
|
Lim S, McDougall ARA, Goldstein M, Tuttle A, Hastie R, Tong S, Ammerdorffer A, Rushwan S, Ricci C, Gülmezoglu AM, Vogel JP. Analysis of a maternal health medicines pipeline database 2000-2021: New candidates for the prevention and treatment of fetal growth restriction. BJOG 2023; 130:653-663. [PMID: 36655375 DOI: 10.1111/1471-0528.17392] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The Accelerating Innovation for Mothers project established a new database of candidate medicines under development between 2000 and 2021 for five pregnancy-related conditions, including fetal growth restriction. The objective was to assess medicines for fetal growth restriction and their potential for clinical use globally. DESIGN Landscape analysis. SETTING Global (focus on low- and middle-income countries, LMICs). SAMPLE Drugs, dietary supplements and biologics under investigation for prevention or treatment of fetal growth restriction. METHODS A research pipeline database of medicines was created through searching AdisInsight, PubMed and various grant and clinical trial databases. Analysis of clinical and preclinical candidates were descriptive. MAIN OUTCOMES MEASURES Fetal growth restriction candidates in clinical development were identified and ranked as high, medium or low potential based on prespecified criteria, including efficacy, safety and accessibility. RESULTS Of the 444 unique candidates in the database across all five pregnancy-related conditions, 63 were for fetal growth restriction. Of these, 31 were in clinical development (phases I, II or III) and 32 were in preclinical development. Three candidates, aspirin, l-arginine and vitamin D, were ranked as having high potential as preventive agents. There were no high-potential candidates for treating fetal growth restriction, although five candidates were ranked as having medium potential: allylestrenol, dalteparin, omega-3 fatty acids, tadalafil, and United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP). CONCLUSIONS l-Arginine, aspirin and vitamin D are promising, high-potential preventative agents for fetal growth restriction. Based on the medicines pipeline, new pharmacological agents for fetal growth restriction are unlikely to emerge in the near future.
Collapse
Affiliation(s)
- Shao Lim
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Annie R A McDougall
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Maya Goldstein
- Policy Cures Research, Sydney, New South Wales, Australia
| | - Andrew Tuttle
- Policy Cures Research, Sydney, New South Wales, Australia
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
| | | | | | | | | | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Randomised controlled trials in women's health in the last two decades: A meta-review. Eur J Obstet Gynecol Reprod Biol 2022; 278:11-15. [PMID: 36108449 DOI: 10.1016/j.ejogrb.2022.09.001] [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: 07/07/2022] [Revised: 08/22/2022] [Accepted: 09/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Obstetric and gynaecological conditions represent a significant burden of disease, requiring clinical research. We aimed to study trends in the publication of randomised controlled trials (RCTs) in women's health over the last two decades. The primary objective was to describe longitudinal trends in the geographical distribution of RCTs in obstetrics and gynaecology. We also described trends in trial funding, publication sources and separately published trial protocols. STUDY DESIGN RCTs were identified by searching the Web of Science alone, due to the large number of results and descriptive nature of analyses. Using the filter tool, only studies labelled as "Clinical trial" or "Article" were included; all other document types were excluded. Trial protocols were identified and analysed separately. Indexing data were extracted using the Web of Science selection tools. As we aimed simply to describe research trends using a single platform, we did not check for duplicates. No process for data pooling was necessary. Correlation of GDP, funding and number of RCTs was calculated using Pearson's r test. RESULTS We identified 39,071 RCTs. The number of annual publications globally increased from 1,406 in 2001 to 1,979 in 2020. The US (n = 12,479) and the UK (n = 3,745) were responsible for the most RCTs, followed by Italy (n = 2,676) and China (n = 2,338). The largest percentage increase in annual publications was seen in Iran (n = 5 to n = 113, +2,160 %) and the Western Pacific Region (n = 16 to n = 171, +968.8 %). GDP was significantly correlated with the number of published RCTs in 2019 for the 25 most prolific countries (p < 0.001), but not with the proportion of RCTs funded. CONCLUSIONS Despite growing contributions from the Western Pacific and Eastern Mediterranean regions, most RCTs are still produced in a small nucleus of high-income countries. Increased international collaboration may benefit both high- and low-income countries.
Collapse
|
3
|
Kazma JM, Saleeb M, Potarazu S, Stringer E, Ahmadzia HK, Gimovsky AC. Low- and middle-income country abstract representation at the Society for Maternal Fetal Medicine Annual Pregnancy Meeting. Int J Gynaecol Obstet 2021; 154:568-569. [PMID: 34077560 DOI: 10.1002/ijgo.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/03/2021] [Accepted: 06/01/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Jamil M Kazma
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Monica Saleeb
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Savita Potarazu
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Elizabeth Stringer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Homa K Ahmadzia
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Alexis C Gimovsky
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
4
|
Ramaswami R, Paulino E, Barrichello A, Nogueira-Rodrigues A, Bukowski A, St Louis J, Goss PE. Disparities in Breast, Lung, and Cervical Cancer Trials Worldwide. J Glob Oncol 2019; 4:1-11. [PMID: 30241268 PMCID: PMC6223472 DOI: 10.1200/jgo.17.00226] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose As cancer burden has risen worldwide, physicians, patients, and their advocates have become aware that the clinical cancer trial research paradigm is not ubiquitous. Furthermore, the number and characteristics of trials that are registered in low- and middle-income countries (LMICs) compared with that in high-income countries (HICs) are unknown. Methods We collected retrospective data on trials for breast, lung, and cervical cancer registered in ClinicalTrials.gov or with the WHO International Clinical Trial Registry Platform between 2010 and 2017. The data were then classified as trials within LMICs or HICs using definitions from the World Bank. Results Included in these analyses were 6,710 trials, of which 3,164 (47%) were breast cancer trials, 3,283 (49%) were lung cancer trials, and 263 (4%) were cervical cancer trials. There were 1,951 (29%) trials from LMICs and 4,759 (71%) trials from HICs (P < .001). Although the proportion of phase III trials in HICs versus LMICs was similar (18% v 17%; P = .66), the number of phase I trials in LMICs was significantly lower than that of HICs (20% v 2%; P < .001). For several LMICs with the highest mortality-to-incidence ratios for breast, lung, or cervical cancer, there were no cancer trials registered in the registration data bases searched for this work. Conclusion There are differences in access to cancer clinical trials in LMICs compared with HICs. Several factors, such as excessive cost and a lack of infrastructure and expertise, may explain these differences.
Collapse
Affiliation(s)
- Ramya Ramaswami
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Eduardo Paulino
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Adriana Barrichello
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Angelica Nogueira-Rodrigues
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Alexandra Bukowski
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Jessica St Louis
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Paul E Goss
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| |
Collapse
|
5
|
Ramaswami R, Paulino E, Barrichello A, Nogueira-Rodrigues A, Bukowski A, St Louis J, Goss PE. Disparities in Breast, Lung, and Cervical Cancer Trials Worldwide. J Glob Oncol 2018. [PMID: 30241268 DOI: 10.1200/jgo.17.00226.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE As cancer burden has risen worldwide, physicians, patients, and their advocates have become aware that the clinical cancer trial research paradigm is not ubiquitous. Furthermore, the number and characteristics of trials that are registered in low- and middle-income countries (LMICs) compared with that in high-income countries (HICs) are unknown. METHODS We collected retrospective data on trials for breast, lung, and cervical cancer registered in ClinicalTrials.gov or with the WHO International Clinical Trial Registry Platform between 2010 and 2017. The data were then classified as trials within LMICs or HICs using definitions from the World Bank. RESULTS Included in these analyses were 6,710 trials, of which 3,164 (47%) were breast cancer trials, 3,283 (49%) were lung cancer trials, and 263 (4%) were cervical cancer trials. There were 1,951 (29%) trials from LMICs and 4,759 (71%) trials from HICs ( P < .001). Although the proportion of phase III trials in HICs versus LMICs was similar (18% v 17%; P = .66), the number of phase I trials in LMICs was significantly lower than that of HICs (20% v 2%; P < .001). For several LMICs with the highest mortality-to-incidence ratios for breast, lung, or cervical cancer, there were no cancer trials registered in the registration data bases searched for this work. CONCLUSION There are differences in access to cancer clinical trials in LMICs compared with HICs. Several factors, such as excessive cost and a lack of infrastructure and expertise, may explain these differences.
Collapse
Affiliation(s)
- Ramya Ramaswami
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Eduardo Paulino
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Adriana Barrichello
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Angelica Nogueira-Rodrigues
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Alexandra Bukowski
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Jessica St Louis
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Paul E Goss
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| |
Collapse
|
6
|
Maaløe N, Housseine N, van Roosmalen J, Bygbjerg IC, Tersbøl BP, Khamis RS, Nielsen BB, Meguid T. Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants' perceptions. BMC Pregnancy Childbirth 2017; 17:175. [PMID: 28592237 PMCID: PMC5463375 DOI: 10.1186/s12884-017-1360-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While international guidelines for intrapartum care appear to have increased rapidly since 2000, literature suggests that it has only in few instances been matched with reviews of local modifications, use, and impact at the targeted low resource facilities. At a Tanzanian referral hospital, this paper describes the development process of locally achievable, partograph-associated, and peer-reviewed labour management guidelines, and it presents an assessment of professional birth attendants' perceptions. METHODS Part 1: Modification of evidence-based international guidelines through repeated evaluation cycles by local staff and seven external specialists in midwifery/obstetrics. Part 2: Questionnaire evaluation 12 months post-implementation of perceptions and use among professional birth attendants. RESULTS Part 1: After the development process, including three rounds of evaluation by staff and two external peer-review cycles, there were no major concerns with the guidelines internally nor externally. Thereby, international recommendations were condensed to the eight-paged 'PartoMa guidelines ©'. This pocket booklet includes routine assessments, supportive care, and management of common abnormalities in foetal heart rate, labour progress, and maternal condition. It uses colour codes indicating urgency. Compared to international guidelines, reductions were made in frequency of assessments, information load, and ambiguity. Part 2: Response rate of 84% (n = 84). The majority of staff (93%) agreed that the guidelines helped to improve care. They found the guidelines achievable (89%), and the graphics worked well (90%). Doctors more often than nurse-midwives (89% versus 74%) responded to use the guidelines daily. CONCLUSIONS The PartoMa guidelines ensure readily available, locally achievable, and acceptable support for intrapartum surveillance, triage, and management. This is a crucial example of adapting evidence-based international recommendations to local reality. TRIAL REGISTRATION This paper describes the intervention of the PartoMa trial, which is registered on ClinicalTrials.org ( NCT02318420 , 4th November 2014).
Collapse
Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Natasha Housseine
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
| | - Jos van Roosmalen
- Athena Institute, VU University of Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Rashid Saleh Khamis
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Birgitte Bruun Nielsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Tarek Meguid
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- School of Health & Medical Sciences, State University of Zanzibar, P.O.Box:146, Zanzibar, Tanzania
| |
Collapse
|
7
|
Firoz T, Ateka-Barrutia O, Rojas-Suarez JA, Wijeyaratne C, Castillo E, Lombaard H, Magee LA. Global obstetric medicine: Collaborating towards global progress in maternal health. Obstet Med 2015; 8:138-45. [PMID: 27512469 PMCID: PMC4935022 DOI: 10.1177/1753495x15595308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Globally, the nature of maternal mortality and morbidity is shifting from direct obstetric causes to an increasing proportion of indirect causes due to chronic conditions and ageing of the maternal population. Obstetric medicine can address an important gap in the care of women by broadening its scope to include colleagues, communities and countries that do not yet have established obstetric medicine training, education and resources. We present the concept of global obstetric medicine by highlighting three low- and middle-income country experiences as well as an example of successful collaboration. The article also discusses ideas and initiatives to build future partnerships within the global obstetric medicine community.
Collapse
Affiliation(s)
- Tabassum Firoz
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | | | - Eliana Castillo
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Hennie Lombaard
- Maternal and Fetal Medicine, University of Pretoria, Pretoria, South Africa
- Obstetrics Unit, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Laura A Magee
- Maternal Medicine, St. George's Hospital, University of London, London, UK
| |
Collapse
|