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2016 ; 214
(6
): 720.e1-720.e17
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Safety and pharmacokinetics of pravastatin used for the prevention of
preeclampsia in high-risk pregnant women: a pilot randomized controlled trial
#MMPMID26723196
Costantine MM
; Cleary K
; Hebert MF
; Ahmed MS
; Brown LM
; Ren Z
; Easterling TR
; Haas DM
; Haneline LS
; Caritis SN
; Venkataramanan R
; West H
; D'Alton M
; Hankins G
Am J Obstet Gynecol
2016[Jun]; 214
(6
): 720.e1-720.e17
PMID26723196
show ga
BACKGROUND: Preeclampsia complicates approximately 3-5% of pregnancies and
remains a major cause of maternal and neonatal morbidity and mortality. It shares
pathogenic similarities with adult cardiovascular disease as well as many risk
factors. Pravastatin, a hydrophilic, 3-hydroxy-3-methyl-glutaryl-coenzyme A
reductase inhibitor, has been shown in preclinical studies to reverse various
pathophysiological pathways associated with preeclampsia, providing biological
plausibility for its use for preeclampsia prevention. However, human trials are
lacking. OBJECTIVE: As an initial step in evaluating the utility of pravastatin
in preventing preeclampsia and after consultation with the US Food and Drug
Administration, we undertook a pilot randomized controlled trial with the
objective to determine pravastatin safety and pharmacokinetic parameters when
used in pregnant women at high risk of preeclampsia. STUDY DESIGN: We conducted a
pilot, multicenter, double-blind, placebo-controlled, randomized trial of women
with singleton, nonanomalous pregnancies at high risk for preeclampsia. Women
between 12(0/7) and 16(6/7) weeks' gestation were assigned to daily pravastatin
10 mg or placebo orally until delivery. Primary outcomes were maternal-fetal
safety and pharmacokinetic parameters of pravastatin during pregnancy. Secondary
outcomes included rates of preeclampsia and preterm delivery, gestational age at
delivery, birthweight, and maternal and cord blood lipid profile
(clinicaltrials.gov identifier NCT01717586). RESULTS: Ten women assigned to
pravastatin and 10 to placebo completed the trial. There were no differences
between the 2 groups in rates of study drug side effects, congenital anomalies,
or other adverse or serious adverse events. There was no maternal, fetal, or
neonatal death. Pravastatin renal clearance was significantly higher in pregnancy
compared with postpartum. Four subjects in the placebo group developed
preeclampsia compared with none in the pravastatin group. Although pravastatin
reduced maternal cholesterol concentrations, umbilical cord cholesterol
concentrations and infant birthweight were not different between the groups. The
majority of umbilical cord and maternal pravastatin plasma concentrations at the
time of delivery were below the lower limit of quantification of the assay.
Pravastatin use was associated with a more favorable pregnancy angiogenic
profile. CONCLUSION: This study provides preliminary safety and pharmacokinetic
data regarding the use of pravastatin for preventing preeclampsia in high-risk
pregnant women. Although the data are preliminary, no identifiable safety risks
were associated with pravastatin use in this cohort. This favorable risk-benefit
analysis justifies using pravastatin in a larger clinical trial with dose
escalation.
|*Pregnancy, High-Risk
[MESH]
|Adult
[MESH]
|Birth Weight
[MESH]
|Cholesterol/blood
[MESH]
|Double-Blind Method
[MESH]
|Female
[MESH]
|Fetal Blood/chemistry
[MESH]
|Humans
[MESH]
|Hydroxymethylglutaryl-CoA Reductase
Inhibitors/blood/*pharmacokinetics/*therapeutic use
[MESH]
|Infant, Newborn
[MESH]
|Pilot Projects
[MESH]
|Pravastatin/blood/*pharmacokinetics/*therapeutic use
[MESH]