Clinical pharmacology: a discipline called to action for maternal and child health

Pharmacokinetic studies in pregnancy

The effects of the many biochemical and physiologic changes of pregnancy on the dose-response relationship of drugs administered to pregnant women are poorly understood. The dose-response relationship is affected by pharmacokinetics, or what the body does to a drug, and pharmacodynamics, or what a drug does to the body. Insights into the potential effects of the changes of pregnancy on one aspect of the dose-response relationship of a drug can be obtained by studying the pharmacokinetics of the drug in the various stages of pregnancy and the postpartum period. There are several available approaches to studying pharmacokinetic changes in pregnancy. Single trough screening studies can provide qualitative estimates of elimination clearance, which with the dosing rate determines the steady-state drug concentration, throughout pregnancy and into the postpartum period. Population pharmacokinetic studies such as two stage pharmacokinetic studies and studies using a nonlinear mixed effects pharmacokinetic modeling approach can characterize pharmacokinetic changes more rigorously.

Pharmacogenetics in reproductive and perinatal medicine

The clinical application of pharmacogenetics has been well accepted by some medical specialties, but not all. The aim of this review is to discuss the current use of pharmacogenetics in reproductive and perinatal medicine and to highlight areas where pharmacogenetics may be able to help in the future to predict response to medicines in terms of efficacy and safety. This applies to drugs that are specific to pregnancy and reproduction, as well as drugs prescribed for the treatment of medical disorders in pregnancy. Our review points out the need for well-designed clinical studies on the efficacy and safety of medicines used in women of childbearing age in order to define the additional utility provided by pharmacogenetic testing.

The global alliance for pediatric pharmacology: the future is here and now

The vast majority of drugs prescribed for children have not been approved by regulatory agencies for the pediatric age group and, in many cases, have not been studied appropriately. In July 2008, at a meeting of pediatric pharmacologists from over 30 countries and 5 continents in Toronto, ON, Canada, it became apparent that numerous pediatric drug studies are being conducted, often duplicating studies done elsewhere. This is also true for pharmacokinetic and pharmacodynamic studies, as well as for the development of pediatric formulations. Finding simple ways to inform the world about existing data may save time and facilitate efforts.

The National Institutes of Health and the Best Pharmaceuticals for Children Act

The majority of drugs used to treat children are not labeled for use in children. The Best Pharmaceuticals for Children Act of 2002, re-authorized as the US FDA Amendments Act of 2007, directs the National Institutes of Health (NIH) to sponsor pediatric clinical trials of drugs lacking patent protection, if the FDA request for studies has been declined. The NIH is currently sponsoring 17 clinical studies. Challenges encountered include a paucity of investigators who are trained in pediatric clinical pharmacology; inadequate knowledge of the mechanisms of drug action in a growing child; and lack of pediatric formulations.

An independent contribution to the growth of paediatric clinical pharmacology in Italy

OBJECTIVE

Providing young researchers with an education is one of the priorities of the Mario Negri Institute, the main, private, non-profit Italian research foundation.

INTRODUCTION

Between 1994 and 2006, 21 research fellows from different health-care areas were selected for a problem-oriented fellowship in paediatric clinical pharmacology in the Laboratory of Mother and Child Health. Of these, 18 received at least 2 years of training and 12 completed a formal pharmacology research course focused on paediatrics. One research fellow received a PhD degree, and another is currently working towards a PhD. The majority of these research fellows are currently employed in the private health sector, four work in the public National Health Service, and four continue to work as senior scientists at the Mario Negri Institute.

DISCUSSION

To guarantee a safer and more effective use of medicines in children, more post-doctoral fellows should receive training in paediatric clinical pharmacology. Financial resources must be raised to support an adequate education, training, and research programme in this field. A possible challenge could be a European network of interested, expert institutions collaborating in a joint initiative in the interest of paediatric clinical pharmacology, and, more importantly, in the interest of rational therapies for children.