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Nguyen QL, Hees K, Hernandez Penna S, König F, Posch M, Bofill Roig M, Meyer EL, Freitag MM, Parke T, Otte M, Dauben HP, Mielke T, Spiertz C, Mesenbrink P, Gidh-Jain M, Pierre S, Morello S, Hofner B. Regulatory Issues of Platform Trials: Learnings from EU-PEARL. Clin Pharmacol Ther 2024; 116:52-63. [PMID: 38529786 DOI: 10.1002/cpt.3244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
Although platform trials have many benefits, the complexity of these designs may result not only in increased methodological but also regulatory and ethical challenges. These aspects were addressed as part of the IMI project EU Patient-Centric Clinical Trial Platforms (EU-PEARL). We reviewed the available guidelines on platform trials in the European Union and the United States. This is supported and complemented by feedback received from regulatory interactions with the European Medicines Agency and the US Food and Drug Administration. Throughout the project we collected the needs of all relevant stakeholders including ethics committees, regulators, and health technology assessment bodies through active dialog and dedicated stakeholder workshops. Furthermore, we focused on methodological aspects and where applicable identified the corresponding guidance. Learnings from the guideline review, regulatory interactions, and workshops are provided. Based on these, a master protocol template was developed. Issues that still need harmonization or clarification in guidelines or where further methodological research is needed are also presented. These include questions around clinical trial submissions in Europe, the need for multiplicity control across the whole master protocol, the use of non-concurrent controls, and the impact of different randomization schemes. Master protocols are an efficient and patient-centered clinical trial design that can expedite drug development. However, they can also introduce additional operational and regulatory complexities. It is important to understand the different requirements of stakeholders upfront and address them in the trial. While relevant guidance is increasing, early dialog with relevant stakeholders can help to further support such designs.
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Affiliation(s)
- Quynh Lan Nguyen
- Section Data Science and Methods, Paul-Ehrlich-Institut, Langen, Germany
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Katharina Hees
- Section Data Science and Methods, Paul-Ehrlich-Institut, Langen, Germany
| | | | - Franz König
- Institute for Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Martin Posch
- Institute for Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Marta Bofill Roig
- Institute for Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Elias Laurin Meyer
- Institute for Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- Berry Consultants, Vienna, Austria
| | | | | | | | | | - Tobias Mielke
- Statistics and Decision Sciences, Janssen-Cilag GmbH, Neuss, Germany
| | | | - Peter Mesenbrink
- Analytics, Development, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | | | | | - Benjamin Hofner
- Section Data Science and Methods, Paul-Ehrlich-Institut, Langen, Germany
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Gidh-Jain M, Parke T, König F, Spiertz C, Mesenbrink P. Developing generic templates to shape the future for conducting integrated research platform trials. Trials 2024; 25:204. [PMID: 38515103 PMCID: PMC10956223 DOI: 10.1186/s13063-024-08034-8] [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: 09/24/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Interventional clinical studies conducted in the regulated drug research environment are designed using International Council for Harmonisation (ICH) regulatory guidance documents: ICH E6 (R2) Good Clinical Practice-scientific guideline, first published in 2002 and last updated in 2016. This document provides an international ethical and scientific quality standard for designing and conducting trials that involve the participation of human subjects. Recently, there has been heightened awareness of the importance of integrated research platform trials (IRPs) designed to evaluate multiple therapies simultaneously. The use of a single master protocol as a key source document to fulfill trial conduct obligations has resulted in a re-examination of the templates used to fulfill the dynamic regulatory and modern drug development environment challenges. METHODS Regulatory medical writing, biostatistical, and other members of EU Patient-cEntric clinicAl tRial pLatforms (EU-PEARL) developed the suite of templates for IRPs over a 3.5-year period. Stakeholders contributing expertise included academic hospitals, pharmaceutical companies, non-governmental organizations, patient representative groups, and small and medium-sized enterprises (SMEs). RESULTS The suite of templates for IRPs based on TransCelerate's Common Protocol Template (CPT) and statistical analysis plan (SAP) should help authors navigate relevant guidelines as they create study design content relevant for today's IRP studies. It offers practical suggestions for adaptive platform designs which offer flexible features such as dropping treatments for futility or adding new treatments to be tested during a trial. The EU-PEARL suite of templates for IRPs comprises a preface, followed by the actual resource. The preface clarifies the intended use and underlying principles that inform resource utility. The preface lists references contributing to the development of the resource. The resource includes TransCelerate CPT guidance text, and EU-PEARL-derived guidance text, distinguished from one another using shading. Rationale comments are used throughout for clarification purposes. In addition, a user-friendly, functional, and informative Platform Trials Best Practices tool to support the setup, design, planning, implementation, and conduct of complex and innovative trials to support multi-sourced/multi-company platform trials is also provided. Together, the EU-PEARL suite of templates and the Platform Trials Best Practices tool constitute the reference user manual. CONCLUSIONS This publication is intended to enhance the use, understanding, and dissemination of the EU-PEARL suite of templates for designing IRPs. The reference user manual and the associated website ( http://www.eu-pearl ) should facilitate the designing of IRP trials.
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Affiliation(s)
| | - Tom Parke
- Berry Consultants, Suite3, 5 East Saint Helen Street, Abingdon, OX14 5EG, UK
| | - Franz König
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Peter Mesenbrink
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936, USA.
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Koenig F, Spiertz C, Millar D, Rodríguez-Navarro S, Machín N, Van Dessel A, Genescà J, Pericàs JM, Posch M. Current state-of-the-art and gaps in platform trials: 10 things you should know, insights from EU-PEARL. EClinicalMedicine 2024; 67:102384. [PMID: 38226342 PMCID: PMC10788209 DOI: 10.1016/j.eclinm.2023.102384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/22/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024] Open
Abstract
Platform trials bring the promise of making clinical research more efficient and more patient centric. While their use has become more widespread, including their prominent role during the COVID-19 pandemic response, broader adoption of platform trials has been limited by the lack of experience and tools to navigate the critical upfront planning required to launch such collaborative studies. The European Union-Patient-cEntric clinicAl tRial pLatform (EU-PEARL) initiative has produced new methodologies to expand the use of platform trials with an overarching infrastructure and services embedded into Integrated Research Platforms (IRPs), in collaboration with patient representatives and through consultation with U.S. Food and Drug Administration and European Medicines Agency stakeholders. In this narrative review, we discuss the outlook for platform trials in Europe, including challenges related to infrastructure, design, adaptations, data sharing and regulation. Documents derived from the EU-PEARL project, alongside a literature search including PubMed and relevant grey literature (e.g., guidance from regulatory agencies and health technology agencies) were used as sources for a multi-stage collaborative process through which the 10 more important points based on lessons drawn from the EU-PEARL project were developed and summarised as guidance for the setup of platform trials. We conclude that early involvement of critical stakeholder such as regulatory agencies or patients are critical steps in the implementation and later acceptance of platform trials. Addressing these gaps will be critical for attaining the full potential of platform trials for patients. Funding Innovative Medicines Initiative 2 Joint Undertaking with support from the European Union's Horizon 2020 research and innovation programme and EFPIA.
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Affiliation(s)
- Franz Koenig
- Medical University of Vienna, Center for Medical Data Science, Vienna, Austria
| | | | - Daniel Millar
- Former Employee, Janssen Research & Development, LLC, Raritan, NJ, USA
| | | | | | | | - Joan Genescà
- Vall d’Hebron Institute for Research, Barcelona, Spain
- Liver Unit, Vall d’Hebron University Hospital, Barcelona, Spain
- Spanish Network of Biomedical Research Centers, Digestive and Liver Diseases (CIBERehd), Madrid, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Juan M. Pericàs
- Vall d’Hebron Institute for Research, Barcelona, Spain
- Liver Unit, Vall d’Hebron University Hospital, Barcelona, Spain
- Spanish Network of Biomedical Research Centers, Digestive and Liver Diseases (CIBERehd), Madrid, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Martin Posch
- Medical University of Vienna, Center for Medical Data Science, Vienna, Austria
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Di Stefano F, Rodrigues C, Galtier S, Guilleminot S, Robert V, Gasparini M, Saint-Hilary G. Incorporation of healthy volunteers data on receptor occupancy into a phase II proof-of-concept trial using a Bayesian dynamic borrowing design. Biom J 2023; 65:e2200305. [PMID: 37888795 DOI: 10.1002/bimj.202200305] [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: 11/04/2022] [Revised: 07/09/2023] [Accepted: 07/23/2023] [Indexed: 10/28/2023]
Abstract
Receptor occupancy in targeted tissues measures the proportion of receptors occupied by a drug at equilibrium and is sometimes used as a surrogate of drug efficacy to inform dose selection in clinical trials. We propose to incorporate data on receptor occupancy from a phase I study in healthy volunteers into a phase II proof-of-concept study in patients, with the objective of using all the available evidence to make informed decisions. A minimal physiologically based pharmacokinetic modeling is used to model receptor occupancy in healthy volunteers and to predict it in the patients of a phase II proof-of-concept study, taking into account the variability of the population parameters and the specific differences arising from the pathological condition compared to healthy volunteers. Then, given an estimated relationship between receptor occupancy and the clinical endpoint, an informative prior distribution is derived for the clinical endpoint in both the treatment and control arms of the phase II study. These distributions are incorporated into a Bayesian dynamic borrowing design to supplement concurrent phase II trial data. A simulation study in immuno-inflammation demonstrates that the proposed design increases the power of the study while maintaining a type I error at acceptable levels for realistic values of the clinical endpoint.
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Affiliation(s)
- Fulvio Di Stefano
- Dipartimento di Scienze Matematiche (DISMA) "Giuseppe Luigi Lagrange,", Politecnico di Torino, Torino, Italy
| | - Christelle Rodrigues
- Department of Quantitative Pharmacology, Institut de Recherches Internationales Servier, Suresnes, France
| | - Stephanie Galtier
- Department of Clinical Statistics, Institut de Recherches Internationales Servier, Suresnes, France
| | - Sandrine Guilleminot
- Department of Quantitative Pharmacology, Institut de Recherches Internationales Servier, Suresnes, France
| | - Veronique Robert
- Department of Clinical Statistics, Institut de Recherches Internationales Servier, Suresnes, France
| | - Mauro Gasparini
- Dipartimento di Scienze Matematiche (DISMA) "Giuseppe Luigi Lagrange,", Politecnico di Torino, Torino, Italy
| | - Gaelle Saint-Hilary
- Dipartimento di Scienze Matematiche (DISMA) "Giuseppe Luigi Lagrange,", Politecnico di Torino, Torino, Italy
- Department of Statistical Methodology, Saryga, Tournus, France
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Meyer EL, Mesenbrink P, Di Prospero NA, Pericàs JM, Glimm E, Ratziu V, Sena E, König F. Designing an exploratory phase 2b platform trial in NASH with correlated, co-primary binary endpoints. PLoS One 2023; 18:e0281674. [PMID: 36893087 PMCID: PMC9997886 DOI: 10.1371/journal.pone.0281674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/28/2023] [Indexed: 03/10/2023] Open
Abstract
Non-alcoholic steatohepatitis (NASH) is the progressive form of nonalcoholic fatty liver disease (NAFLD) and a disease with high unmet medical need. Platform trials provide great benefits for sponsors and trial participants in terms of accelerating drug development programs. In this article, we describe some of the activities of the EU-PEARL consortium (EU Patient-cEntric clinicAl tRial pLatforms) regarding the use of platform trials in NASH, in particular the proposed trial design, decision rules and simulation results. For a set of assumptions, we present the results of a simulation study recently discussed with two health authorities and the learnings from these meetings from a trial design perspective. Since the proposed design uses co-primary binary endpoints, we furthermore discuss the different options and practical considerations for simulating correlated binary endpoints.
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Affiliation(s)
- Elias Laurin Meyer
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Peter Mesenbrink
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, United States of America
| | | | - Juan M. Pericàs
- Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research (VHIR), Barcelona, Spain
- Centros de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), ISCIII, Madrid, Spain
| | - Ekkehard Glimm
- Novartis Pharma AG, Basel, Switzerland
- Institute of Biometry and Medical Informatics, University of Magdeburg, Magdeburg, Germany
| | - Vlad Ratziu
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitie-Salpetriere, University of Paris, Paris, France
| | - Elena Sena
- Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research (VHIR), Barcelona, Spain
| | - Franz König
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Ianevski A, Giri AK, Aittokallio T. SynergyFinder 3.0: an interactive analysis and consensus interpretation of multi-drug synergies across multiple samples. Nucleic Acids Res 2022; 50:W739-W743. [PMID: 35580060 PMCID: PMC9252834 DOI: 10.1093/nar/gkac382] [Citation(s) in RCA: 176] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/16/2022] [Accepted: 04/29/2022] [Indexed: 11/26/2022] Open
Abstract
SynergyFinder (https://synergyfinder.fimm.fi) is a free web-application for interactive analysis and visualization of multi-drug combination response data. Since its first release in 2017, SynergyFinder has become a popular tool for multi-dose combination data analytics, partly because the development of its functionality and graphical interface has been driven by a diverse user community, including both chemical biologists and computational scientists. Here, we describe the latest upgrade of this community-effort, SynergyFinder release 3.0, introducing a number of novel features that support interactive multi-sample analysis of combination synergy, a novel consensus synergy score that combines multiple synergy scoring models, and an improved outlier detection functionality that eliminates false positive results, along with many other post-analysis options such as weighting of synergy by drug concentrations and distinguishing between different modes of synergy (potency and efficacy). Based on user requests, several additional improvements were also implemented, including new data visualizations and export options for multi-drug combinations. With these improvements, SynergyFinder 3.0 supports robust identification of consistent combinatorial synergies for multi-drug combinatorial discovery and clinical translation.
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Affiliation(s)
- Aleksandr Ianevski
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Finland.,Helsinki Institute for Information Technology (HIIT), Aalto University, Finland
| | - Anil K Giri
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Finland.,Foundation for the Finnish Cancer Institute (FCI), University of Helsinki, Finland
| | - Tero Aittokallio
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Finland.,Helsinki Institute for Information Technology (HIIT), Aalto University, Finland.,Institute for Cancer Research, Department of Cancer Genetics, Oslo University Hospital, Norway.,Centre for Biostatistics and Epidemiology (OCBE), Faculty of Medicine, University of Oslo, Norway
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