Reducing Events of Noncompliance in Neurology Human Subjects Research: the Effect of Human Subjects Research Protection Training and Site Initiation Visits

Rethinking the clinical research protocol: Lessons learned from the COVID-19 pandemic and recommendations for reducing noncompliance

BACKGROUND/AIMS

Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, 103.4 million cases and 1.1 million deaths have occurred nationally as of November 2023. Despite the benefit of mitigating measures, the pandemic's effect on participant safety is rarely documented.

METHODS

This study assessed noncompliance occurring from July 2019 to August 2021 that were stratified by the date of noncompliance (before or after restrictions). Events were described by size, site, noncompliance type, primary category, subcategory, and cause. In addition, noncompliance associated with COVID-19 was analyzed to determine characteristics.

RESULTS

In total, 323 noncompliance events occurred across 21,146 participants at risk in 35 protocols. The overall rate of noncompliance increased from 0.008 events per participant to 0.022 events per participant after the COVID-19 restrictions (p < 0.001). For onsite protocols, the median within protocol change in rates was 0.001 (interquartile range = 0.141) after the onset of COVID-19 restrictions (p = 0.54). For large-sized protocols (n ≥ 100), the median within protocol change in rates was also 0.001 (interquartile range = 0.017) after COVID-19 restrictions (p = 0.15). For events related to COVID-19 restrictions, 160/162 (99%) were minor deviations, 161/162 (99%) were procedural noncompliance, and 124/162 (77%) were an incomplete study visit.

CONCLUSION

These noncompliance events have implications for clinical trial methodology because nonadherence to trial design can lead to participant safety concerns and loss of trial data validity. Protocols should be written to better facilitate the capture of all safety and efficacy data. This recommendation should be considered when changes occur to the protocol environment that are outside of the study team's control.

Limits of ethical non-human subjects research in an applied setting

Ethical research follows numerous rules and regulations to ensure that all human subjects are protected during the collection and dissemination of research outcomes. Nevertheless, there is often a critical distinction drawn between human subjects research and non-human subjects research (NHSR). The latter can also be described as non-research activities, which typically reduces any oversight even if human subjects are involved. Despite the need to conduct ethical NHSR or non-research activities in an applied setting, there are several ways this determination can be used to circumvent regulatory oversight. In particular, the problem arises because one or more of several key functions become conflated in an applied setting, whereas they would be compartmentalized and independent in controlled or experimental settings. These functions include: 1) ethical oversight; 2) funding; 3) execution; and 4) peer review. The current discussion outlines how NHSR in an applied setting can allow these functions to overlap, and how personnel might stretch the boundaries of ethical conduct even while following existing regulations. As such, the goal is to guide future practices when conducting or reviewing NHSR in an applied setting so that unethical practices do not bias the results.

The Practice of Experimental Neurotherapeutics in Neuromuscular Disease

PURPOSE OF REVIEW

The discipline of experimental neurotherapeutics targets the process and operation of translating scientific discoveries into new treatments for neurologic diseases and has been instrumental in the progression of many areas of neurology.

RECENT FINDINGS

From the US Food and Drug Administration (FDA) market approval of the first systemic in vivo gene therapy in neurology to multiple current gene-targeting therapeutics, monoclonal antibodies, and new drugs under development or approved in the last several years, the field of experimental neurotherapeutics has a presence in every neuromuscular clinic in the United States.

SUMMARY

This article provides an overview of experimental neurotherapeutics with guidance on the clinical trials landscape, using examples in the field of neuromuscular disease. It covers the regulatory framework, clinical trial methodology, and offers advice on common pitfalls encountered when embarking on a clinical trials program in the clinic.