An Israeli startup is leveraging artificial intelligence to help women personalize their medication more effectively and is on track to take its program to wider public use in August, the Tazpit Press Service (TPS) reported on July 23, 2023.
The startup, Levana, is the inspiration of a woman who suffered from attention deficit hyperactivity disorder and discovered that problematic patterns in the effectiveness of her medication were shared by other women.
The story of Levana began when Dr. Ilana Kwartin’s four-year-old son was diagnosed with ADHD. After being told that the condition was very likely inherited, the mother of four got herself tested.
It was back in 2018. Kwartin, a lawyer with a PhD in gender studies, was diagnosed and given her first prescription of Focalin.
The dosage was 30 milligrams each day, Kwartin recalled.
The medicine is a strong central nervous system stimulant that affects a person’s attention and behavior by increasing norepinephrine and dopamine activity in the brain.
However, she said, “I noticed throughout the month that there were fluctuations in the way the medicine was working on me. There were days in which it was working fine and days as if I didn’t take it at all.”
She would eventually discover that the variations in the Focalin’s effectiveness were caused by her monthly hormonal cycle.
“I noticed that the fluctuations correlated with another app on my phone for hormonal cycle tracking. So my hormonal cycle and the effectiveness of the medication on my symptoms were late. That’s what I saw in me. It wasn’t research, just data collection that I did out of curiosity,” Kwartin said.
She went back to her physician who instructed Kwartin to vary the doses between 10 and 40 mg.
“He said, ‘Play around with it and see what the effects are,’” Kwartin said. “I learned in hindsight after months in this profession that they know little about the brain. Much of psychiatric medicine works by trial and error and lots of attempts to make a break. But it’s really not accurate or data-based. It’s very individual and very subjective.”
She went on to meet hundreds of other women taking psychiatric medicine and experiencing the same fluctuations in the effectiveness of their medication.
“That was when I learned that it wasn’t my ‘Ilana problem’ but a women’s problem,” Kwartin said.
Hormonal cycles impact medication
Why does a woman’s hormonal cycle impact the effectiveness of common psychiatric medications such as Focalin, Ritalin, Adderall or Prozac?
The answer begins with estrogen. This hormone, Kwartin explained, “enhances” the release of the medicine in the brain.
“You know how there are a lot of medicines that you’re told not to take with food, or yes to take with food, not take with vitamin C, or yes to take with vitamin C? There are certain substances that influence the way medication works on the body,” Kwartin said.
A woman’s estrogen levels change over the course of her monthly cycle, with higher levels during ovulation and lower levels during menstruation. But despite the fluctuating hormone levels, the dosage of prescribed psychiatric medicine remains constant.
“So the treatment the woman is receiving is not the best treatment for her if it works half of the time and the other half not at all,” Kwartin said, adding that this also applies to medication women take for depression and anxiety, thyroid conditions, epilepsy and migraines.
“There’s a whole world where we can implement solutions,” she said.
‘Reaching for the moon’
Kwartin founded Levana in November 2022 and is CEO of the startup.
Women who join Levana track their symptoms in correlation with data about their medication. Levana provides women with a report showing the effect of the medication.
Using artificial intelligence to analyze the woman’s data, “We can see how the medicine works throughout a week, throughout a month, throughout a year. It paints a picture of a wave and is used as a tool for recommending the best course of treatment for you,” Kwartin said.
On this point, Kwartin stresses that Levana is not using artificial intelligence to replace doctors.
“Doctors are the ones prescribing the medication and treatment, but they are lacking the data and tools to do so because they rely on yearly visits and trial and error, which can last up to three years,” she said. “To replace this lengthy and not really productive way, that’s what Levana is trying to replace and improve for women.”
She adds that Levana will eventually get access to the digital files at their clients’ HMOs/health funds, creating a pool of data for the AI to analyze.
For now, the service is only available to women in Israel, “but as the platform develops, we will bring this journey to other countries,” Kwartin said. Hundreds of women have signed up, but Kwartin says Levana is “focusing on a focus group of 50, examining their daily reports.”
Levana has a “founding team” of 10 people working in Israel and California.
She anticipates getting regulatory approval from Israel’s Health Ministry and the U.S. Food and Drug Administration. Kwartin also hopes to have her AI platform ready for wider use in August.
Levana’s platform might also be adapted for men down the road. While men’s hormone levels don’t follow a monthly cycle, studies have found that men typically have 24-hour testosterone cycles that can impact mood and behavior. Research also suggests that testosterone levels are highest in the fall and lowest in the spring.
“From interviews, we learned that men sometimes change the dose of their medication by themselves if they feel that it’s messing with their sleep or their energy,” Kwartin said.
“We were interviewing a physician from Canada who was treating patients with depression. And he said throughout the year—because Canada is super cold in the winter—they see that they need to up the dose of the medication during the winter because the symptoms are more severe. So those fluctuations, or cycles, are there in every human.”
But Kwartin stresses that Levana is firmly in the femtech movement, which she describes as “a subindustry of technological solutions for women’s needs.”
There are thousands of startups in that space that are interesting and fabulous and are making the world better,” citing fertility and breast cancer as examples.
Asked about her startup’s name, Kwartin said that Levana is a Hebrew word for the moon.
“It’s a cycle which is full, anti-full, and is ever-changing every month,” she explained.
“And also, someone said it to me in hindsight—I didn’t think of it at the time—it’s because you’re reaching for the moon because you’re trying to change a paradigm in the medical world of how we can view medical treatment for women. I’ll take that.”