A recent global review identified 11 leading candidates for the prevention and treatment of preeclampsia and eclampsia, according to a July 15 article in Communications Medicine. The study highlights significant gaps in evidence quality, disease models, and therapeutic diversity within the current preclinical pipeline.
The researchers analyzed and ranked 83 potential candidates developed between 2000 and 2025 for maternal health drug development. They excluded candidates lacking primary or publicly available data, those only reported in abstracts, or those associated with serious adverse effects such as fetal loss. Candidates already progressing to clinical trials were described separately.
Of the analyzed candidates, 11 were ranked as high-potential therapies. These included repurposed drugs like cyclosporin A, gefitinib, azathioprine, sufentanil; biologics such as etanercept; dietary supplements including puerarin, mangiferin, L-ergothioneine; and new chemical or biological entities like rhPlGF, MZe786, and SynB1-ELP-p50i. Nearly half of all identified candidates were novel compounds spanning 37 distinct molecular targets. However, many relied on similar biological pathways—particularly targeting soluble fms-like tyrosine kinase-1 (sFlt-1)—and most studies used animal models that may not fully represent human pregnancy physiology.
The assessment process incorporated criteria from existing evaluation tools such as the Quality Assessment Tool for In Vitro Studies (QUIN), Systematic Review Center for Laboratory Animal Experimentation (SYRCLE) frameworks for evidence quality questions, Technology Readiness Levels (TRL) tool for product maturity evaluation, and Target Product Profile criteria to assess implementability. Two reviewers independently scored each candidate, with disagreements resolved by a third reviewer.
The findings indicate that despite promising leads among high-potential therapies—including several previously overlooked compounds—development is hampered by limited target diversity and insufficiently representative animal models. Only delivery of the baby remains a definitive cure at present; current medications are few and originally designed for non-pregnant individuals.
Researchers say future efforts should address regulatory hurdles in drug development for preeclampsia by increasing industry engagement and improving trial design with better-matched animal models or organ-on-a-chip systems. Expanding research beyond sFlt-1-mediated disease could help address late-onset cases more effectively. The study concludes that multidisciplinary collaboration will be needed to accelerate suitable candidates toward clinical trials so that effective treatments can reach routine care.
