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Pasmooij AMG, Mol PGM, Bot JC, Leufkens HGM. The Evolution of Drug Regulatory Sciences in the Netherlands: More than a Country Report. Clin Pharmacol Ther 2024; 116:64-71. [PMID: 38679943 DOI: 10.1002/cpt.3275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Abstract
In the Netherlands, drug regulatory science is a vibrant national and internationally oriented community. In this review, we present the factors that have contributed to this successful collaboration between relevant stakeholders and that led to a surge of activities around how regulatory science became embedded in the ecosystem of medicines research, clinical pharmacology, policymaking and regulation. We distinguished three pivotal episodes: (i) TI Pharma Escher-project, (ii) Dutch Medicines Evaluation Board as catalyst of the big jump, and (iii) Regulatory Science Network Netherlands and multistakeholder engagement. The research agenda has been influenced by the dynamic evolution of legal frameworks in Europe, such as the EU orphan medicines legislation of 2001 and the EU pharmacovigilance legislation of 2012. All these developments have inspired and have raised pertinent regulatory sciences questions. Furthermore, clinical pharmacology as a discipline has been very influential in shaping regulatory science, contributing to discussions on the level of clinical evidence that is necessary to justify marketing approval of a new medicine. With a growing interest of multiple parties such as academics, European Medicines Agency, national agencies, patient organizations and EFPIA, connecting regulatory science activities is key.
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Affiliation(s)
- Anna M G Pasmooij
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Regulatory Science Network Netherlands, Utrecht, The Netherlands
| | - Peter G M Mol
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
- Regulatory Science Network Netherlands, Utrecht, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacob Cornelis Bot
- Regulatory Science Network Netherlands, Utrecht, The Netherlands
- Janssen Biologics BV, Leiden, The Netherlands
- Lygature, Utrecht, The Netherlands
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Regulatory Science Network Netherlands, Utrecht, The Netherlands
- Lygature, Utrecht, The Netherlands
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Huneycutt BJ, Acha V. The ASAP Framework: A New Tool for Regulatory Agencies to Facilitate Adoption of Pandemic Approaches. Health Secur 2024; 22:249-262. [PMID: 38624265 DOI: 10.1089/hs.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Affiliation(s)
- Brenda J Huneycutt
- Brenda J. Huneycutt, PhD, JD, MPH, is Director, Global Regulatory Policy and Intelligence, Merck & Co., Inc., Rahway, NJ
| | - Virginia Acha
- Virginia Acha, DPhil, MPhil, is Associate Vice President, Global Regulatory Policy and Intelligence, MSD (UK) Limited, London, UK
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Schirinzi E, Bochicchio MA, Lochmüller H, Vissing J, Jordie-Diaz-Manerae, Evangelista T, Plançon JP, Fanucci L, Marini M, Tonacci A, Mancuso M, Segovia-Kueny S, Toscano A, Angelini C, Schoser B, Sacconi S, Siciliano G. E-Health & Innovation to Overcome Barriers in Neuromuscular Diseases. Report from the 3rd eNMD Congress: Pisa, Italy, 29-30 October 2021. J Neuromuscul Dis 2024:JND230091. [PMID: 38728200 DOI: 10.3233/jnd-230091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Neuromuscular diseases (NMDs), in their phenotypic heterogeneity, share quite invariably common issues that involve several clinical and socio-economical aspects, needing a deep critical analysis to develop better management strategies. From diagnosis to treatment and follow-up, the development of technological solutions can improve the detection of several critical aspects related to the diseases, addressing both the met and unmet needs of clinicians and patients. Among several aspects of the digital transformation of health and care, this congress expands what has been learned from previous congresses editions on applicability and usefulness of technological solutions in NMDs. In particular the focus on new solutions for remote monitoring provide valuable insights to increase disease-specific knowledge and trigger prompt decision-making. In doing that, several perspectives from different areas of expertise were shared and discussed, pointing out strengths and weaknesses on the current state of the art on topic, suggesting new research lines to advance technology in this specific clinical field.
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Affiliation(s)
- Erika Schirinzi
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | | | - Hanns Lochmüller
- Department of Medicine, Children's Hospital of Eastern Ontario Research Institute, Division of Neurology, The Ottawa Hospital, and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - John Vissing
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jordie-Diaz-Manerae
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Neurology Department, Neuromuscular Disorders Unit, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Teresinha Evangelista
- AP-HP, H. Pitié-Salpêtrière, Institut de Myologie, Unité de Morphologie Neuromusculaire, Paris, France
- AP-HP, H. Pitié-Salpêtrière, Centre de référence des maladies neuromusculaires Nord/Est/Ile de France, Paris, France
- Sorbonne Université, INSERM, Institut de Myologie, Centre de Recherche en Myologie, France
| | - Jean-Philippe Plançon
- European Patient Organisation for Dysimmune and Inflammatory Neuropathies (EPODIN) and EURO-NMD Educational board, Paris, France
| | - Luca Fanucci
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Marco Marini
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Alessandro Tonacci
- Institute of Clinical Physiology, National Research Council - CNR, Pisa, Italy
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | | | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Corrado Angelini
- Department Neurosciences, Padova University School of Medicine, Padova, Italy
| | - Benedikt Schoser
- Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sabrina Sacconi
- Peripheral Nervous System and Muscle Department, Université Cúte d'Azur (UCA), Centre Hospitalier Universitaire de Nice, Rare Neuromuscular Disease Reference Center, ERN-Euro-NMD, Nice, France
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
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Johnson EA, Hill G, Smith HA, Marsh L, Beer K. A global pilot comparative, cross-sectional study of clinical research nurses/research midwives: Definition, knowledge base, and communication skills related to the conduct of decentralized clinical trials. J Clin Transl Sci 2024; 8:e90. [PMID: 38836247 PMCID: PMC11148821 DOI: 10.1017/cts.2024.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/07/2024] [Accepted: 04/29/2024] [Indexed: 06/06/2024] Open
Abstract
Background A gap in the literature exists pertaining to a global research nurse/research midwife resources and communication skill set necessary to engage with participants of diverse populations and geographic regions in the community or home-based conduct of decentralized clinical trials. Aims An embedded mixed methods study was conducted to examine research nurse/research midwife knowledge base, experiences, and communication skill sets pertaining to decentralized trials across global regions engaged in remote research: the USA, Republic of Ireland, United Kingdom, and Australia. Methods An online survey was deployed across international research nurse/research midwife stakeholder groups, collecting demographics, decentralized trial experience, barriers and facilitators to optimal trial conduct, and the self-perceived communication competence (SPCC) and interpersonal communication competence (IPCC) instruments. Results 86 research nurses and research midwives completed the survey across all countries: The SPCC and IPCC results indicated increased clinical research experience significantly correlated with increased SPCC score (p < 0.05). Qualitative content analysis revealed five themes: (1) Implications for Role, (2) Safety and Wellbeing, (3) Training and Education, (4) Implications for Participants, and (5) Barriers and Facilitators. Conclusions Common trends and observations across the global sample can inform decentralized trial resource allocation and policy pertaining to the research nurse/research midwife workforce. This study demonstrates shared cultural norms of research nursing and midwifery across varied regional clinical trial ecosystems.
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Affiliation(s)
- Elizabeth A Johnson
- Mark & Robyn Jones College of Nursing, Montana State University, Bozeman, MT, USA
| | - Gordon Hill
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, SD, UK
| | - Hazel Ann Smith
- School of Health, Science, and Wellbeing, Staffordshire University, Stoke on Trent, UK
| | - Lisa Marsh
- Buntain College of Nursing, Northwest University, Kirkland, WA, USA
| | - Kelly Beer
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA, Australia
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Löfgren L, von Euler Chelpin M, Bhat M, Althage M, Hober A, Edfors F, Ruckh T, Challis B, Davidsson P, Miliotis T. Patient-Centric Quantitative Microsampling for Accurate Determination of Urine Albumin to Creatinine Ratio (UACR) in a Clinical Setting. J Appl Lab Med 2024; 9:329-341. [PMID: 38113397 DOI: 10.1093/jalm/jfad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/18/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Developing and implementing new patient-centric strategies for drug trials lowers the barrier to participation for some patients by reducing the need to travel to research sites. In early chronic kidney disease (CKD) trials, albuminuria is the key measure for determining treatment effect prior to pivotal kidney outcome trials. METHODS To facilitate albuminuria sample collection outside of a clinical research site, we developed 2 quantitative microsampling methods to determine the urinary albumin to creatinine ratio (UACR). Readout was performed by LC-MS/MS. RESULTS For the Mitra device the within-batch precision (CV%) was 2.8% to 4.6% and the between-batch precision was 5.3% to 6.1%. Corresponding data for the Capitainer device were 4.0% to 8.6% and 6.7% to 9.0%, respectively. The storage stability at room temperature for 3 weeks was 98% to 103% for both devices. The recovery for the Mitra and Capitainer devices was 104% (SD 7.0%) and 95 (SD 7.4%), respectively. The inter-assay comparison of UACR assessment generated results that were indistinguishable regardless of microsampling technique. The accuracy based on LC-MS/MS vs analysis of neat urine using a clinical chemistry analyzer was assessed in a clinical setting, resulting in 102 ± 8.0% for the Mitra device and 95 ± 10.0% for the Capitainer device. CONCLUSIONS Both UACR microsampling measurements exhibit excellent accuracy and precision compared to a clinical chemistry analyzer using neat urine. We applied our patient-centric sampling strategy to subjects with heart failure in a clinical setting. Precise UACR measurements using quantitative microsampling at home would be beneficial in clinical drug development for kidney therapies.
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Affiliation(s)
- Lars Löfgren
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Marianne von Euler Chelpin
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Maria Bhat
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Magnus Althage
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Andreas Hober
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
- Science for Life Laboratory, KTH Royal Institute of Technology, Solna, Sweden
- Division of Systems Biology, Department of Protein Science, School of Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm.Sweden
| | - Fredrik Edfors
- Science for Life Laboratory, KTH Royal Institute of Technology, Solna, Sweden
- Division of Systems Biology, Department of Protein Science, School of Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm.Sweden
| | - Tim Ruckh
- R&D Digital Health, AstraZeneca, Gothenburg, Sweden
| | - Benjamin Challis
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Pia Davidsson
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Tasso Miliotis
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
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de Jong AJ, Shahid N, Zuidgeest MGP, Santa-Ana-Tellez Y, Hogervorst M, Goettsch W, Traore H, de Boer A, Gardarsdottir H. Opportunities and Challenges for Decentralized Clinical Trial Approaches: European Health Technology Assessment Perspective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:294-300. [PMID: 38043711 DOI: 10.1016/j.jval.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/17/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Decentralized clinical trial (DCT) approaches are clinical trials in which some or all trial activities take place closer to participants' proximities instead of a traditional investigative site. Data from DCTs may be used for clinical and economic evaluations by health technology assessment (HTA) bodies to support reimbursement decision making. This study aimed to explore the opportunities and challenges for DCT approaches from an HTA perspective by interviewing representatives from European HTA bodies. METHODS We conducted semistructured interviews with 25 European HTA representatives between September 2022 and February 2023, and transcripts were analyzed after thematic analysis. RESULTS Two main themes were identified from the data relating to (1) DCT approaches in HTA and (2) trial-level acceptance and relevance. Experience with assessing DCTs was limited and a variety of knowledge about DCTs was observed. The respondents recognized the opportunity of DCTs to reduce recall bias when participant-reported outcome data can be collected more frequently and conveniently from home. Concerns were expressed about the data quality when participants become responsible for data collection. Despite this challenge, the respondents recognized the potential of DCTs to increase the generalizability of results because data can be collected in a setting reflective of the everyday situation potentially from a more diverse participant group. CONCLUSIONS DCTs could generate relevant results for HTA decision making when data are collected in a real-world setting from a diverse participant group. Increased awareness of the opportunities and challenges could help HTA assessors in their appraisal of DCT approaches.
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Affiliation(s)
- Amos J de Jong
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Nadi Shahid
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mira G P Zuidgeest
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yared Santa-Ana-Tellez
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Milou Hogervorst
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Wim Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; National Healthcare Institute, Diemen, The Netherlands
| | | | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; Division Laboratory and Pharmacy, Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands; Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland.
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van Rijssel TI, van Thiel GJMW, Gardarsdottir H, van Delden JJM. Which Benefits Can Justify Risks in Research? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024:1-11. [PMID: 38181217 DOI: 10.1080/15265161.2023.2296404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
Research ethics committees (RECs) evaluate whether the risk-benefit ratio of a study is acceptable. Decentralized clinical trials (DCTs) are a novel approach for conducting clinical trials that potentially bring important benefits for research, including several collateral benefits. The position of collateral benefits in risk-benefit assessments is currently unclear. DCTs raise therefore questions about how these benefits should be assessed. This paper aims to reconsider the different types of research benefits, and their position in risk-benefit assessments. We first propose a categorization of research benefits, based on the types of benefits that can be distinguished from the literature and ethical guidelines. Secondly, we will reconsider the position of collateral benefits. We argue that these benefits are not fundamentally different from other benefits of research and can therefore be included in risk-benefit assessments of DCTs.
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De Sutter E, Barbier L, Borry P, Geerts D, Ioannidis JP, Huys I. Personalized and longitudinal electronic informed consent in clinical trials: How to move the needle? Digit Health 2024; 10:20552076231222361. [PMID: 38269372 PMCID: PMC10807334 DOI: 10.1177/20552076231222361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/26/2024] Open
Abstract
Changes in the clinical trials landscape have been driven by advancements in digital technology. The use of electronic informed consent to inform research participants and to obtain their consent electronically has the potential to improve participant-researcher interactions over time, facilitate clinical trial participation, and increase efficiency in clinical trial conduct. A personalized electronic informed consent platform that enables long-term interactions with the research team could function as a tool to empower participant engagement in clinical trials. However, significant challenges persist impeding successful and widespread implementation. This Perspective provides insights into the opportunities and challenges for the implementation of electronic informed consent in clinical trials. It sets out key recommendations to promote the implementation of this innovative approach to the informed consent process, including the creation of uniform electronic informed consent platforms at regional and national level.
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Liese Barbier
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - David Geerts
- KU Leuven Digital Society Institute, KU Leuven, Leuven, Belgium
| | - John P.A. Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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von Itzstein MS, Gwin ME, Gupta A, Gerber DE. Telemedicine and Cancer Clinical Research: Opportunities for Transformation. Cancer J 2024; 30:22-26. [PMID: 38265922 PMCID: PMC10827351 DOI: 10.1097/ppo.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
ABSTRACT Telemedicine represents an established mode of patient care delivery that has and will continue to transform cancer clinical research. Through telemedicine, opportunities exist to improve patient care, enhance access to novel therapies, streamline data collection and monitoring, support communication, and increase trial efficiency. Potential challenges include disparities in technology access and literacy, physical examination performance, biospecimen collection, privacy and security concerns, coverage of services by insurance, and regulatory considerations. Coupled with artificial intelligence, telemedicine may offer ways to reach geographically dispersed candidates for narrowly focused cancer clinical trials, such as those targeting rare genomic subsets. Collaboration among clinical trial staff, clinicians, regulators, professional societies, patients, and their advocates is critical to optimize the benefits of telemedicine for clinical cancer research.
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Affiliation(s)
- Mitchell S. von Itzstein
- Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mary E. Gwin
- Department of Internal Medicine, University of Texas Southwestern Medical Center. Dallas, Texas, USA
| | - Arjun Gupta
- Department of Internal Medicine (Division of Hematology-Oncology), University of Minnesota, Minneapolis, Minnesota, USA
| | - David E. Gerber
- Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Chopra H, Annu, Shin DK, Munjal K, Priyanka, Dhama K, Emran TB. Revolutionizing clinical trials: the role of AI in accelerating medical breakthroughs. Int J Surg 2023; 109:4211-4220. [PMID: 38259001 PMCID: PMC10720846 DOI: 10.1097/js9.0000000000000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/13/2023] [Indexed: 01/24/2024]
Abstract
Clinical trials are the essential assessment for safe, reliable, and effective drug development. Data-related limitations, extensive manual efforts, remote patient monitoring, and the complexity of traditional clinical trials on patients drive the application of Artificial Intelligence (AI) in medical and healthcare organisations. For expeditious and streamlined clinical trials, a personalised AI solution is the best utilisation. AI provides broad utility options through structured, standardised, and digitally driven elements in medical research. The clinical trials are a time-consuming process with patient recruitment, enrolment, frequent monitoring, and medical adherence and retention. With an AI-powered tool, the automated data can be generated and managed for the trial lifecycle with all the records of the medical history of the patient as patient-centric AI. AI can intelligently interpret the data, feed downstream systems, and automatically fill out the required analysis report. This article explains how AI has revolutionised innovative ways of collecting data, biosimulation, and early disease diagnosis for clinical trials and overcomes the challenges more precisely through cost and time reduction, improved efficiency, and improved drug development research with less need for rework. The future implications of AI to accelerate clinical trials are important in medical research because of its fast output and overall utility.
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Affiliation(s)
- Hitesh Chopra
- Department of Biosciences, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai - 602105, Tamil Nadu, India
| | - Annu
- Thin Film and Materials Laboratory, School of Mechanical Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea
| | - Dong K. Shin
- Thin Film and Materials Laboratory, School of Mechanical Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea
| | - Kavita Munjal
- Department of Pharmacy, Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh 201303, India
| | - Priyanka
- Department of Veterinary Microbiology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Rampura Phul, Bathinda, Punjab
| | - Kuldeep Dhama
- Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, Uttar Pradesh
| | - Talha B. Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International niversity, Dhaka, Bangladesh
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de Jong AJ, Santa-Ana-Tellez Y, Zuidgeest MGP, Grupstra RJ, Jami F, de Boer A, Gardarsdottir H. Direct-to-participant investigational medicinal product supply in clinical trials in Europe: Exploring the experiences of sponsors, site staff and couriers. Br J Clin Pharmacol 2023; 89:3512-3522. [PMID: 37438875 DOI: 10.1111/bcp.15850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023] Open
Abstract
AIMS Insights into the current practice of direct-to-participant (DtP) supply of investigational medicinal product (IMP) in the context of clinical trials conducted in Europe are needed, as regulations are unharmonized. This study is set out to explore how DtP IMP supply has been employed in Europe and what the advantages and disadvantages and barriers and facilitators of its implementation are. METHODS We conducted semi-structured interviews with representatives from sponsor companies, courier services and site study staff involved in the IMP dispensing and delivery process in Europe. Interviews were conducted between May and November 2021, and data were analysed following thematic analysis. RESULTS Sixteen respondents participated in one of the 12 interviews. Respondents had experience with different models of DtP IMP supply including shipment from the investigative site, a central pharmacy (a depot under the control of a pharmacist) and a local pharmacy-aiming to reduce trial participation burden. The respondents indicated that investigative site-to-participant shipment is not affected by regulatory barriers, but could burden site staff. Shipment from central locations was considered most efficient, but possible regulatory barriers related to maintaining participants' privacy and investigator oversight were identified. The respondents indicated that the involvement of local pharmacies to dispense IMP can be considered when the IMP is authorized. CONCLUSIONS Several DtP IMP supply models are implemented in clinical trials conducted in Europe. In this study, three main DtP IMP models were identified, which can be referenced when describing these approaches for regulatory approval.
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Affiliation(s)
- Amos J de Jong
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Yared Santa-Ana-Tellez
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mira G P Zuidgeest
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Renske J Grupstra
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Fatemeh Jami
- Strategic Advice R&D Quality Assurance, AstraZeneca, Cambridge, UK
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
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Cummins MR, Burr J, Young L, Yeatts SD, Ecklund DJ, Bunnell BE, Dwyer JP, VanBuren JM. Decentralized research technology use in multicenter clinical research studies based at U.S. academic research centers. J Clin Transl Sci 2023; 7:e250. [PMID: 38229901 PMCID: PMC10790101 DOI: 10.1017/cts.2023.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/06/2023] [Accepted: 11/02/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction During the COVID-19 pandemic, research organizations accelerated adoption of technologies that enable remote participation. Now, there's a pressing need to evaluate current decentralization practices and develop appropriate research, education, and operations infrastructure. The purpose of this study was to examine current adoption of decentralization technologies in a sample of clinical research studies conducted by academic research organizations (AROs). Methods The setting was three data coordinating centers in the U.S. These centers initiated coordination of 44 clinical research studies during or after 2020, with national recruitment and enrollment, and entailing coordination between one and one hundred sites. We determined the decentralization technologies used in these studies. Results We obtained data for 44/44 (100%) trials coordinated by the three centers. Three technologies have been adopted across nearly all studies (98-100%): eIRB, eSource, and Clinical Trial Management Systems. Commonly used technologies included e-Signature (32/44, 73%), Online Payments Portals (26/44, 59%), ePROs (23/44, 53%), Interactive Response Technology (22/44, 50%), Telemedicine (19/44, 43%), and eConsent (18/44, 41%). Wearables (7/44,16%) and Online Recruitment Portals (5/44,11%) were less common. Rarely utilized technologies included Direct-to-Patient Portals (1/44, 2%) and Home Health Nurse Portals (1/44, 2%). Conclusions All studies incorporated some type of decentralization technology, with more extensive adoption than found in previous research. However, adoption may be strongly influenced by institution-specific IT and informatics infrastructure and support. There are inherent needs, responsibilities, and challenges when incorporating decentralization technology into a research study, and AROs must ensure that infrastructure and informatics staff are adequate.
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Affiliation(s)
- Mollie R. Cummins
- University of Utah, Salt Lake City, UT, USA
- Doxy.me Inc., Rochester, NY, USA
| | - Jeri Burr
- University of Utah, Salt Lake City, UT, USA
| | - Lisa Young
- University of Utah, Salt Lake City, UT, USA
| | | | | | - Brian E. Bunnell
- Doxy.me Inc., Rochester, NY, USA
- University of South Florida, Tampa, FL, USA
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13
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Huh KY, Chung WK, Park J, Lee S, Kim M, Oh J, Yu K. Feasibility study for a fully decentralized clinical trial in participants with functional constipation symptoms. Clin Transl Sci 2023; 16:2177-2188. [PMID: 37632169 PMCID: PMC10651644 DOI: 10.1111/cts.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Decentralized clinical trials (DCTs) leverage digital technologies to reduce dependency on study sites and intermediaries. DCT should be balanced with accessibility and data reliability while meeting regulatory requirements. Here, we conducted a pilot study for functional constipation symptoms to investigate the feasibility of DCT. The study was an open, fully remote, randomized clinical trial in participants who had functional constipation symptoms. Electronic consent was obtained remotely, and study volunteers were screened through web-based questionnaires. Subjects were randomized to either receive Lactobacillus and vitamin C supplements or vitamin C alone in a 1:1 ratio, which were delivered directly to subjects. Subjects kept track of bowel diaries daily during the 1-week baseline and 2-week treatment period using mobile applications. Bowel symptoms and the validity of the records were descriptively evaluated. A total of 30 subjects were randomized and completed the study. A total of 26.7% of subjects resided outside of the metropolitan area. Two-week Lactobacillus treatments increased the number of defecations (+0.80 vs. +0.46 times per week) and decreased the defecation time (-3.94 h vs. -1.62 h) compared to the comparator group. Overall, 67.1% of bowel diary records were completed in accordance with the schedule whereas 32.9% were not. Implementation of DCTs can facilitate geographic accessibility but should be guaranteed for data reliability. Prompt detection of errors and response using objective metrics would be required.
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Affiliation(s)
- Ki Young Huh
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulKorea
| | - Woo Kyung Chung
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulKorea
| | - Jiyeon Park
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulKorea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulKorea
| | - Min‐Gul Kim
- Nanum Space Co., LtdJeonjuKorea
- Department of Pharmacology, Medical SchoolJeonbuk National UniversityJeonjuKorea
| | - Jaeseong Oh
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulKorea
- Present address:
Department of PharmacologyJeju National University School of MedicineJejuRepublic of Korea
| | - Kyung‐Sang Yu
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulKorea
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14
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Huml RA, Collyar D, Antonijevic Z, Beckman RA, Quek RGW, Ye J. Aiding the Adoption of Master Protocols by Optimizing Patient Engagement. Ther Innov Regul Sci 2023; 57:1136-1147. [PMID: 37615880 DOI: 10.1007/s43441-023-00570-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
Master protocols (MPs) are an important addition to the clinical trial repertoire. As defined by the U.S. Food and Drug Administration (FDA), this term means "a protocol designed with multiple sub-studies, which may have different objectives (goals) and involve coordinated efforts to evaluate one or more investigational drugs in one or more disease subtypes within the overall trial structure." This means we now have a unique, scientifically based MP that describes how a clinical trial will be conducted using one or more potential candidate therapies to treat patients in one or more diseases. Patient engagement (PE) is also a critical factor that has been recognized by FDA through its Patient-Focused Drug Development (PFDD) initiative, and by the European Medicines Agency (EMA), which states on its website that it has been actively interacting with patients since the creation of the Agency in 1995. We propose that utilizing these PE principles in MPs can make them more successful for sponsors, providers, and patients. Potential benefits of MPs for patients awaiting treatment can include treatments that better fit a patient's needs; availability of more treatments; and faster access to treatments. These make it possible to develop innovative therapies (especially for rare diseases and/or unique subpopulations, e.g., pediatrics), to minimize untoward side effects through careful dose escalation practices and, by sharing a control arm, to lower the probability of being assigned to a placebo arm for clinical trial participants. This paper is authored by select members of the American Statistical Association (ASA)/DahShu Master Protocol Working Group (MPWG) People and Patient Engagement (PE) Subteam. DahShu is a 501(c)(3) non-profit organization, founded to promote research and education in data science. This manuscript does not include direct feedback from US or non-US regulators, though multiple regulatory-related references are cited to confirm our observation that improving patient engagement is supported by regulators. This manuscript represents the authors' independent perspective on the Master Protocol; it does not represent the official policy or viewpoint of FDA or any other regulatory organization or the views of the authors' employers. The objective of this manuscript is to provide drug developers, contract research organizations (CROs), third party capital investors, patient advocacy groups (PAGs), and biopharmaceutical executives with a better understanding of how including the patient voice throughout MP development and conduct creates more efficient clinical trials. The PE Subteam also plans to publish a Plain Language Summary (PLS) of this publication for clinical trial participants, patients, caregivers, and the public as they seek to understand the risks and benefits of MP clinical trial participation.
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Affiliation(s)
| | | | | | - Robert A Beckman
- Departments of Oncology and of Biostatistics, Bioinformatics, & Biomathematics, Lombardi Comprehensive Cancer Center and Innovation Center for Biomedical Informatics, Georgetown University Medical Center, District of Columbia (DC), Washington, USA
| | - Ruben G W Quek
- Health Economics & Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Jingjing Ye
- Data Science and Operational Excellent, Global Statistics and Data Sciences, BeiGene, Ltd., Washington, DC, USA
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15
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Singh P, Burden AM, Natanegara F, Beckman RA. Design and Execution of Sustainable Decentralized Clinical Trials. Clin Pharmacol Ther 2023; 114:802-809. [PMID: 37489911 DOI: 10.1002/cpt.3009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/01/2023] [Indexed: 07/26/2023]
Abstract
The decentralized clinical trial (DCT) approach is increasingly recognized as a means to accelerate the development of potential therapeutic interventions. DCTs have a crucial advantage over traditional clinical trials: patients are monitored in their environment using technology (e.g., wearables), that capture data as they continue in daily life. This narrative review outlines a gap analysis focused on the frameworks and guidance from expert working groups and regulatory agencies for the design and execution of DCTs. Eight DCT elements guided the analysis and summarized the frameworks and guidance: (1) suitability, (2) protocol, (3) investigational medicinal product (IMP) supply, (4) investigators and health care providers, (5) safety, (6) regulatory and ethics, (7) data and technology, and (8) engagement, communication, and advocacy. Based on the gap analysis, two key takeaways were identified: (1) a need for a comprehensive sustainability assessment of each DCT element; and (2) current frameworks and guidance provide recommendations on social sustainability and some on economic sustainability. DCTs are an essential evolution in healthcare research; however, more guidance related to a comprehensive assessment of designing and executing sustainable DCTs is needed. This is especially the case for environmental sustainability, including, for example, carbon footprint and disposal of IMPs and sensors.
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Affiliation(s)
- Pritibha Singh
- Novartis Pharma AG, Basel, Switzerland
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Andrea M Burden
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | | | - Robert A Beckman
- Departments of Oncology and of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center and Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA
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16
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Nebie EI, Sawadogo HN, van Eeuwijk P, Signorell A, Reus E, Utzinger J, Burri C. Opportunities and challenges for decentralised clinical trials in sub-Saharan Africa: a qualitative study. BMJ Open 2023; 13:e075903. [PMID: 37739467 PMCID: PMC10533674 DOI: 10.1136/bmjopen-2023-075903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Digital health has gained traction in research and development, and clinical decision support systems. The COVID-19 pandemic accelerated the adoption of decentralised clinical trials (DCTs) as a mitigation and efficiency improvement strategy. We assessed the opportunities and challenges of a digital transformation in clinical research in sub-Saharan Africa from different stakeholders' perspectives. METHODS A qualitative study, including 40 in-depth semi structured interviews, was conducted with investigators of three leading research institutions in sub-Saharan Africa and Switzerland, contract research organisations and sponsors managing clinical trials in sub-Saharan Africa. A thematic approach was used for the analysis. RESULTS Interviewees perceived DCTs as an opportunity for trial efficiency improvement, quality improvement and reducing the burden of people participating in clinical trials. However, to gain and maintain an optimal quality of clinical trials, a transition period is necessary to tackle contextual challenges before DCTs are being implemented. The main challenges are categorised into four themes: (1) usability and practicability of the technology; (2) paradigm shift and trial data quality; (3) ethical and regulatory hurdles and (4) contextual factors (site-specific research environment and sociocultural aspects). CONCLUSION The transformation from a site to a patient-centric model with an increased responsibility of participants should be context adapted. The transformation requires substantial investment, training of the various stakeholders and an efficient communication. Additionally, commitment of sponsors, investigators, ethics and regulatory authorities and the buy-in of the communities are essential for this change.
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Affiliation(s)
- Eric I Nebie
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Peter van Eeuwijk
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Aita Signorell
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Elisabeth Reus
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Juerg Utzinger
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Christian Burri
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
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17
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Zawada SJ, Ruff KC, Sklar T, Demaerschalk BM. Towards a conceptual framework for addressing state-level barriers to decentralized clinical trials in the U.S. J Clin Transl Sci 2023; 7:e162. [PMID: 37528942 PMCID: PMC10388410 DOI: 10.1017/cts.2023.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
| | - Kevin C. Ruff
- Mayo Clinic Center for Digital Health, Phoenix, AZ, USA
| | - Tara Sklar
- University of Arizona James E. Rogers College of Law, Tucson, AZ, USA
- Arizona Telemedicine Program, Phoenix, AZ, USA
| | - Bart M. Demaerschalk
- Mayo Clinic College of Medicine and Science, Scottsdale, AZ, USA
- Mayo Clinic Center for Digital Health, Phoenix, AZ, USA
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18
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Cooper L, Jose N. Despite negative perceptions of clinical trial conduct during the coronavirus disease 2019 (COVID-19) pandemic, are decentralized clinical trial methods here to stay? ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:159. [PMID: 36923074 PMCID: PMC10009564 DOI: 10.21037/atm-23-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Affiliation(s)
- Lisa Cooper
- Department of Health Informatics, School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Nadina Jose
- Department of Health Informatics, School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
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19
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De Sutter E, Borry P, Huys I, Barbier L. Informing a European guidance framework on electronic informed consent in clinical research: a qualitative study. BMC Health Serv Res 2023; 23:181. [PMID: 36810088 PMCID: PMC9942635 DOI: 10.1186/s12913-023-09173-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Electronic informed consent (eIC) may offer various advantages compared to paper-based informed consent. However, the regulatory and legal landscape related to eIC provides a diffuse image. By drawing from the perspectives of key stakeholders in the field, this study aims to inform the creation of a European guidance framework on eIC in clinical research. METHODS Focus group discussions and semi-structured interviews were conducted with 20 participants from six stakeholder groups. The stakeholder groups included representatives of ethics committees, data infrastructure organizations, patient organizations, and the pharmaceutical industry as well as investigators and regulators. All were involved in or knowledgeable about clinical research and were active in one of the European Union Member States or at a pan-European or global level. The framework method was used for data analysis. RESULTS Stakeholders underwrote the need for a multi-stakeholder guidance framework addressing practical elements related to eIC. According to the stakeholders, a European guidance framework should describe consistent requirements and procedures for implementing eIC on a pan-European level. Generally, stakeholders agreed with the definitions of eIC issued by the European Medicines Agency and the US Food and Drug Administration. Nevertheless, it was raised that, in a European guidance framework, it should be emphasized that eIC aims to support rather than replace the personal interaction between research participants and the research team. In addition, it was believed that a European guidance framework should include details on the legality of eIC across European Union Member States and the responsibilities of an ethics committee in the eIC assessment process. Although stakeholders supported the idea to include detailed information on the type of eIC-related materials to be submitted to an ethics committee, opinions varied on this regard. CONCLUSION The creation of a European guidance framework is a much needed factor to advance eIC implementation in clinical research. By collecting the views of multiple stakeholder groups, this study advances recommendations that may facilitate the development of such a framework. Particular consideration should go to harmonizing requirements and providing practical details related to eIC implementation on a European Union-wide level.
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Pascal Borry
- grid.5596.f0000 0001 0668 7884Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- grid.5596.f0000 0001 0668 7884Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Liese Barbier
- grid.5596.f0000 0001 0668 7884Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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20
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Chen J, Lu Y, Kummar S. Increasing patient participation in oncology clinical trials. Cancer Med 2023; 12:2219-2226. [PMID: 36043431 PMCID: PMC9939168 DOI: 10.1002/cam4.5150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022] Open
Abstract
AIM Timely recruitment of eligible participants is essential for the success of clinical trials, with insufficient accrual being the leading cause for premature termination of both oncology and non-oncology trials. METHODS In this paper we further elaborate on the challenges for patient participation in oncology trials from physician, patient, healthcare system, and some trial-related perspectives. RESULTS We present strategies such as use of digital healthcare technologies, real-world data and real-world evidence, decentralized clinical trials, pragmatic trial designs, and supportive services to increase patient participation. CONCLUSIONS Multifaceted measures are necessary to increase patient participation, especially for those who are under-represented in cancer trials.
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Affiliation(s)
- Jie Chen
- Department of Biometrics, Overland Pharmaceuticals, Dover, Delaware, USA
| | - Ying Lu
- Department of Biomedical Data Science and Stanford Cancer Institute, Stanford University, Palo Alto, California, USA
| | - Shivaani Kummar
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
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21
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Faulkner SD, Somers F, Boudes M, Nafria B, Robinson P. Using Patient Perspectives to Inform Better Clinical Trial Design and Conduct: Current Trends and Future Directions. Pharmaceut Med 2023; 37:129-138. [PMID: 36653601 PMCID: PMC9848715 DOI: 10.1007/s40290-022-00458-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/20/2023]
Abstract
The approach to patient engagement (PE) in drug development has changed rapidly due to many factors, including the complexity of innovative drugs and the need to demonstrate outcomes of relevance to patients, the desire to show 'value add' of PE, and the pandemic-related changes to how clinical trials are run, e.g., decentralised studies. In parallel, there have been changes in technology-assisted ways of running clinical trials, capturing patient health outcomes and preferences, an increasing societal demand for diversity and inclusion, and efforts to improve clinical trial efficiency, transparency, and accountability. Organisations are beginning to monitor PE activities and outcomes more effectively to learn and inform future PE strategies. As a result, these factors are facilitating the incorporation of patients' lived experience, preferences and needs into the design and running of clinical trials more than ever before. In this paper, the authors reflect upon these last few years, the emerging trends and their drivers, and where we may expect PE in clinical research to progress in the near future.
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Affiliation(s)
- Stuart D. Faulkner
- grid.4991.50000 0004 1936 8948Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG UK
| | - Fabian Somers
- UCB Biopharma SRL, Allee de la Recherche 60, 1070 Brussels, Belgium
| | - Mathieu Boudes
- European Patients’ Forum, Chaussée d’Etterbeek 180, Brussels, Belgium
| | - Begõna Nafria
- grid.411160.30000 0001 0663 8628Patient Engagement in Research Department, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain ,grid.411160.30000 0001 0663 8628Innovation Department Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Paul Robinson
- grid.419737.f0000 0004 6047 9949Merck Sharp & Dohme (UK) Ltd., Moorgate, London, UK
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22
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Huh KY, Yu KS, Song I. Analysis of the distribution of trial sites in South Korea using social network analysis. Transl Clin Pharmacol 2023; 31:1-12. [PMID: 37034125 PMCID: PMC10079509 DOI: 10.12793/tcp.2023.31.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/05/2023] [Accepted: 03/12/2023] [Indexed: 04/03/2023] Open
Abstract
Location of trial sites can be a potential source of study bias. Considering that clinical trials have been mostly conducted in urban areas, the distribution of trial sites need to be evaluated. We analyzed clinical trial approval data using social network analysis to quantitatively assess the site-by-site connections. The approval list of clinical trials from the Ministry of Food and Drug Safety database between 2014 and 2021 was analyzed. The number of clinical trials per trial site was counted according to the approval year and study phase and evaluated for distribution using empirical cumulative distribution function plots. Trial sites and conducts of a clinical trial were mapped into nodes and edges in the social network analysis, and basic network parameters were obtained. The clinical trials were concentrated at several trial sites. Forty-nine to 60.6% of phase 1 and up to 30% of the other study phases of clinical trials were at the top 5 trial sites. The annual distribution of the number of clinical trials per site was comparable across the study period. Connections among the trial sites in the metropolitan area were prominent. Graph size and density were higher in phase 3 trials than in the other phases. We demonstrated that the conduct of clinical trials was concentrated in the Seoul Metropolitan Area in both number of trials and connections using social network analysis.
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Affiliation(s)
- Ki Young Huh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - Ildae Song
- Department of Pharmaceutical Science and Technology, Kyungsung University, Busan 48434, Korea
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23
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Petrini C, Mannelli C, Riva L, Gainotti S, Gussoni G. Decentralized clinical trials (DCTs): A few ethical considerations. Front Public Health 2022; 10:1081150. [PMID: 36590004 PMCID: PMC9797802 DOI: 10.3389/fpubh.2022.1081150] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Decentralized clinical trials (DCTs) are studies in which the need for patients to physically access hospital-based trial sites is reduced or eliminated. The CoViD-19 pandemic has caused a significant increase in DCT: a survey shows that 76% of pharmaceutical companies, device manufacturers, and Contract Research Organizations adopted decentralized techniques during the early phase of the pandemic. The implementation of DCTs relies on the use of digital tools such as e-consent, apps, wearable devices, Electronic Patient-Reported Outcomes (ePRO), telemedicine, as well as on moving trial activities to the patient's home (e.g., drug delivery) or to local healthcare settings (i.e., community-based diagnosis and care facilities). DCTs adapt to patients' routines, allow patients to participate regardless of where they live by removing logistical barriers, offer better access to the study and the investigational product, and permit the inclusion of more diverse and more representative populations. The feasibility and quality of DCTs depends on several requirements including dedicated infrastructures and staff, an adequate regulatory framework, and partnerships between research sites, patients and sponsors. The evaluation of Ethics Committees (ECs) is crucial to the process of innovating and digitalizing clinical trials: adequate assessment tools and a suitable regulatory framework are needed for evaluation by ECs. DCTs also raise issues, many of which are of considerable ethical significance. These include the implications for the relationship between patients and healthcare staff, for the social dimension of the patient, for data integrity (at the source, during transmission, in the analysis phase), for personal data protection, and for the possible risks to health and safety. Despite their considerable growth, DCTs have only received little attention from bioethicists. This paper offers a review on some ethical implications and requirements of DCTs in order to encourage further ethical reflection on this rapidly emerging field.
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Affiliation(s)
- Carlo Petrini
- Bioethics Unit, Istituto Superiore di Sanità, Rome, Italy,*Correspondence: Carlo Petrini
| | | | - Luciana Riva
- Bioethics Unit, Istituto Superiore di Sanità, Rome, Italy
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Thomas KA, Kidziński Ł. Artificial intelligence can improve patients' experience in decentralized clinical trials. Nat Med 2022; 28:2462-2463. [PMID: 36266513 DOI: 10.1038/s41591-022-02034-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Kevin A Thomas
- Clario, San Mateo, CA, USA. .,School of Engineering and School of Medicine, Stanford University, Stanford, USA.
| | - Łukasz Kidziński
- Clario, San Mateo, CA, USA.,School of Engineering and School of Medicine, Stanford University, Stanford, USA
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25
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Do W, Russell R, Wheeler C, Lockwood M, De Vos M, Pavord I, Bafadhel M. Performance of Contactless Respiratory Rate Monitoring by Albus Home TM, an Automated System for Nocturnal Monitoring at Home: A Validation Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22197142. [PMID: 36236241 PMCID: PMC9573065 DOI: 10.3390/s22197142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 06/12/2023]
Abstract
Respiratory rate (RR) is a clinically important predictor of cardio-respiratory deteriorations. The mainstay of clinical measurement comprises the manual counting of chest movements, which is variable between clinicians and limited to sporadic readings. Emerging solutions are limited by poor adherence and acceptability or are not clinically validated. Albus HomeTM is a contactless and automated bedside system for nocturnal respiratory monitoring that overcomes these limitations. This study aimed to validate the accuracy of Albus Home compared to gold standards in real-world sleeping environments. Participants undertook overnight monitoring simultaneously using Albus Home and gold-standard polygraphy with thoraco-abdominal respiratory effort belts (SomnomedicsEU). Reference RR readings were obtained by clinician-count of polygraphy data. For both the Albus system and reference, RRs were measured in 30-s segments, reported as breaths/minute, and compared. Accuracy was defined as the percentage of RRs from the Albus system within ±2 breaths/minute of reference counts. Across a diverse validation set of 32 participants, the mean accuracy exceeded 98% and was maintained across different participant characteristics. In a Bland-Altman analysis, Albus RRs had strong agreement with reference mean differences and the limits of agreement of -0.4 and ±1.2 breaths/minute, respectively. Albus Home is a contactless yet accurate system for automated respiratory monitoring. Validated against gold -standard methods, it enables long-term, reliable nocturnal monitoring without patient burden.
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Affiliation(s)
| | - Richard Russell
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | | | | | - Maarten De Vos
- Department of Electrical Engineering and Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Ian Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Mona Bafadhel
- King’s Centre for Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 1UL, UK
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