Pravastatin, proton pump inhibitors, metformin, micronutrients and biologics: new horizons for the prevention or treatment of preeclampsia.

Abstract There has been increasing research momentum to identify new therapeutic agents for preeclampsia. Most have adopted the pragmatic strategy of repurposing drugs. Pravastatin has been the most studied and there is significant preclinical and early phase trial evidence suggesting it may have therapeutic activity. Further large clinical trials evaluating whether pravastatin can prevent preeclampsia are planned, or ongoing. Other drugs or treatment approaches that have transitioned to human trials (ranging from single arm to phase III trials) includes esomeprazole, metformin, sulfasalazine, folate, nitric oxide donors (such as L-Arginine), apheresis, recombinant antithrombin III, digoxin immune Fab; and antioxidants such as melatonin. Recent preclinical studies have proposed novel molecular targeted strategies such neutralizing antibodies, or short interfering RNA technologies targeting soluble fms-like tyrosine kinase-1 (sFlt-1) or angiotensinogen. If new agents were discovered that are effective in preventing or treating preeclampsia the potential to improve global maternal and perinatal health is significant.