Pharmacokinetics of Monoclonal Antibodies Throughout Pregnancy: A Systematic Literature Review

BACKGROUND AND OBJECTIVE

Although little information is available on the pharmacokinetics (PK) of monoclonal antibodies (mAbs) during pregnancy, multiple mAbs are being used during pregnancy for various indications. The aim of this systematic literature review was to characterize the PK of mAbs throughout pregnancy.

METHODS

A systematic literature search was carried out in PubMed and Embase on 21 April 2023. Articles were included when information on PK or exposure parameters of mAbs in pregnant women was available.

RESULTS

A total of 42 relevant articles were included, of which eight discussed adalimumab, three certolizumab pegol, five eculizumab, one golimumab, 12 infliximab (IFX), two natalizumab, one canakinumab, one omalizumab, five tocilizumab, eight ustekinumab, and five vedolizumab. One of the 42 studies reported information on clearance (CL) and volume of distribution (VD) of IFX; all other studies only reported on serum concentrations in the pre-pregnancy state, different trimesters, and the postpartum period. For all of the assessed mAbs except IFX, serum concentrations were similar to concentrations in the pre-pregnancy state or modestly decreased. In contrast, IFX trough concentrations generally increased in the second and third trimesters in comparison to the non-pregnant state.

CONCLUSION

Available information suggests that the anatomical and physiological changes throughout pregnancy may have meaningful effects on the PK of mAbs. For most mAbs (not IFX), modestly higher dosing (per mg) maybe needed during pregnancy to sustain a similar serum exposure compared to pre-pregnancy.

Probing the tricritical endpoint of QCD phase diagram at NICAFAIR energies

In this contributions we discuss the novel version of hadron resonance gas model which is based on the induced surface tension concept. Also we present new arguments in favor of a hypothesis that the chiral symmetry restoration transition in central nuclear collisions may occur at the center of mass energies 4.3-4.9 GeV and that the deconfinement phase transition may occur at the center of mass energies 8.8-9.2 GeV. These arguments are based on the unique thermostatic properties of the mixed phase and the ones of an exponential mass spectrum of hadrons.

Possible functions of short-chain and medium-chain carnitine acyltransferases

Several mammalian tissue contain water-soluble, branched chain acylcarnitines and other short-chain aliphatic acylcarnitines and also contain a broad spectrum of short-chain and medium-chain carnitine acyltransferase (CAT) activities. Although carnitine can stimulate the oxidation of branched chain alpha-ketoacids, it has not been established that carnitine is required for the oxidation of the alpha-ketoacids in the matrix of mitochondria. Rather it probably acts as a reversible sink for acyl residues, thereby generating CoASH, which can be used to maintain normal metabolism; thus carnitine would have a facilitative rather than an obligatory role. Microsomes and peroxisomes contain medium- and short-chain CATs. This occurrence is short- and medium-chain CATs in peroxisomes is consistent with carnitine's being involved in shuttling the chain-shortened products of beta-oxidation out of peroxisomes. Human urine contains a spectrum of short-chain acylcarnitines and data are presented that show a large amount of propionylcarnitine in the urine of the individual with a metabolic problem. The cumulative data are consistent with the conclusion that carnitine has multiple roles in mammalian metabolism, including the shuttling of beta-oxidation chain-shortened products out of peroxisomes in liver, the modulation of the acyl-CoA/CoASH ratio in mammalian cells, and the translocation of acetyl units for selective synthesis in a yeast.