Repurposing existing drugs for preterm birth prevention

Preterm birth is a significant contributor to neonatal morbidity and mortality worldwide, yet current therapies offer limited efficacy in delaying birth and improving outcomes. Current management strategies addressing premature birth focus on optimizing neonatal outcomes by administering tocolytic drugs to suppress uterine contractions – allowing time for transfer to appropriate facilities and antenatal corticosteroids administration for fetal lung maturation. However, existing tocolytics have significant limitations, associated with adverse effects on both maternal and fetal health, and only provide a short delay in delivery. Repurposing drugs offers the potential to expedite pharmaceutical development by utilizing compounds with established safety profiles.

A recent review examined the potential of repurposing drugs with established safety profiles to address uterine contractions and inflammation––identifying promising candidates for future clinical trials. This review explored the evidence for repurposing proton pump inhibitors (PPIs), tumor necrosis factor inhibitors (TNFis), prostaglandin receptor antagonists, aspirin, and statins as preventative or therapeutic options for preterm birth. 

Evidence suggests that many of these approaches are safe for use during pregnancy. The authors also discussed strategies for drug delivery enhancement, for instance, with targeted delivery systems or combination therapies––to optimize effectiveness. As these innovative strategies address multiple aspects of the complex pathophysiology underlying preterm birth, they hold promise for improving neonatal outcomes. 

Repurposing existing drugs provides promise, as it reduces time and costs associated with the new drug development process. Comprehensive research is imperative to uncover the mechanisms underlying preterm birth, facilitating the development of predictive, screening, and therapeutic tools. While medical interventions are crucial, preventative public health measures also play a significant role in addressing the underlying causes and risk factors of preterm birth.

Source: Arman BM, Binder NK, de Alwis N, Tu’uhevaha J, Hannan NJ. Repurposing existing drugs as a therapeutic approach for the prevention of preterm birth. Reproduction. 2023 Jan 1;165(1):R9-23.