Predicting the safety of medicines in pregnancy: A workshop report

• Published in: Reproductive toxicology (Elmsford, N.Y.) Vol. 93; pp. 199 - 210
• Main Authors: Clements, J.M., Hawkes, R.G., Jones, D., Adjei, A., Chambers, T., Simon, L., Stemplewski, H., Berry, N., Price, S., Pirmohamed, M., Piersma, A.H., Waxenecker, G., Barrow, P., Beekhuijzen, M.E.W., Fowkes, A., Prior, H., Sewell, F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2020
• Subjects: Adverse outcome pathway; Adverse Outcome Pathways; Alternative assay; Animal Testing Alternatives; Animals; Data sharing; Drug and Narcotic Control; Drug Evaluation, Preclinical; Drug-Related Side Effects and Adverse Reactions; Embryo-fetal development; Female; Humans; In silico; Maternal-Fetal Exchange; Medicines regulation; Predictive models; Pregnancy; Quantitative Structure-Activity Relationship; Toxicity Tests; Pregnancy; Data sharing; Medicines regulation; Alternative assay; Predictive models; In silico; Embryo-fetal development; Adverse outcome pathway
• ISSN: 0890-6238; 1873-1708; 1873-1708
• DOI: 10.1016/j.reprotox.2020.02.011

•The current testing strategy can be improved by utilising alternative methods.•A better understanding of adverse developmental outcome pathways is required.•Alternative methods should be qualified with harmonised regulatory guidance.•Multidisciplinary cross-sector interactions and data sharing are required.•A ‘Safe Harbour’ approach should be identified to promote data sharing. The framework for developmental toxicity testing has remained largely unchanged for over 50 years and although it remains invaluable in assessing potential risks in pregnancy, knowledge gaps exist, and some outcomes do not necessarily correlate with clinical experience. Advances in omics, in silico approaches and alternative assays are providing opportunities to enhance our understanding of embryo-fetal development and the prediction of potential risks associated with the use of medicines in pregnancy. A workshop organised by the Medicines and Healthcare products Regulatory Agency (MHRA), “Predicting the Safety of Medicines in Pregnancy – a New Era?”, was attended by delegates representing regulatory authorities, academia, industry, patients, funding bodies and software developers to consider how to improve the quality of and access to nonclinical developmental toxicity data and how to use this data to better predict the safety of medicines in human pregnancy. The workshop delegates concluded that based on comparative data to date alternative methodologies are currently no more predictive than conventional methods and not qualified for use in regulatory submissions. To advance the development and qualification of alternative methodologies, there is a requirement for better coordinated multidisciplinary cross-sector interactions coupled with data sharing. Furthermore, a better understanding of human developmental biology and the incorporation of this knowledge into the development of alternative methodologies is essential to enhance the prediction of adverse outcomes for human development. The output of the workshop was a series of recommendations aimed at supporting multidisciplinary efforts to develop and validate these alternative methodologies.