The Global Preclinical Research and Development Landscape for Pre-Eclampsia and Eclampsia Therapies.

Surprisingly few medicines are available to prevent or manage pre-eclampsia, all of which are repurposed from non-pregnant populations and conditions. Analyses of clinical research and development (R&D) pipelines for pre-eclampsia medicines has identified high-potential candidates, however the preclinical pipeline has not been interrogated. We analysed and ranked the potential of 53 preclinical candidates for pre-eclampsia and eclampsia identified in a novel Maternal Health Pipeline spanning 2000 to 2021. Candidates were assessed across three domains – quality of preclinical evidence, product development stage and implementability. Each question in the prioritisation matrix was assigned a numerical value based on importance. The sum of these values was used to rank the potential of each candidate for future research. Among the 53 candidates analysed, 56.6% of which are novel medicines, 27 different binding targets were identified; the purported mechanism of action for 21 candidates was a reduction in sFlt-1. We identified eight high-potential candidates, three of which were novel, that should be prioritised for further development.