1
|
Kierkegaard P, Su B, Wong R, Boffito M, Balendra S. Commentary: The North West London Clinical Trials Alliance: efficiency and innovation in clinical trial delivery. Trials 2024; 25:509. [PMID: 39069627 DOI: 10.1186/s13063-024-08344-x] [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: 04/15/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The set-up, activation, and delivery of clinical trials is pivotal for the advancement of medical science, serving as the primary mechanism through which new therapeutic interventions are validated for clinical use. Despite their critical role, the execution of these trials is often encumbered by a multitude of challenges. The North West London Clinical Trials Alliance (The Alliance) was established to address these complexities. It aims to bridge the gap between emerging scientific research and its clinical application through strategic collaborations among healthcare and research entities, thereby enhancing the regional ecosystem for clinical trials. MAIN TEXT This commentary aims to offer clarity on the fundamental insights that underlie The Alliance, providing a comprehensive understanding of its operational structure and the ecosystem it has fostered to optimise clinical trial delivery and revenue generation. The strategy employed by The Alliance centres on the cultivation of strategic partnerships across a broad spectrum of stakeholders. This approach addresses key operational challenges in clinical trial management, facilitating improvements in the development, setup, activation, and recruitment stages. Notably, The Alliance has reduced the average time to initiate trials to 19 days, compared to the standard 75 days typically observed for commercial setups in North West London. The effectiveness of The Alliance's framework was notably demonstrated during the COVID-19 pandemic, particularly with the expedited recruitment performance in the Janssen COVID-19 vaccine study conducted at Charing Cross Hospital. This instance highlighted the Alliance's capability to meet and exceed recruitment targets promptly while maintaining diversity within study cohorts. Additionally, The Alliance has effectively harnessed digital technology and infrastructure, enhancing its attractiveness to commercially funded studies and illustrating a sustainable model for clinical trial financing and execution. CONCLUSION The North West London Clinical Trials Alliance represents a strategic response to the conventional challenges faced in clinical trial management, emphasising the importance of cross-sectoral collaboration and resource optimisation. Its efforts, particularly highlighted by its response to the COVID-19 pandemic, provide a case study in enhancing trial delivery and efficiency with significant implications for both regional and global clinical trials research communities.
Collapse
Affiliation(s)
- Patrick Kierkegaard
- Cancer Research UK Convergence Science Centre, Imperial College London & The Institute of Cancer Research, London, UK.
| | - Bowen Su
- Cancer Research UK Convergence Science Centre, Imperial College London & The Institute of Cancer Research, London, UK
| | | | - Marta Boffito
- Imperial College Healthcare NHS Trust, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | |
Collapse
|
2
|
Mittal A, Moore S, Navani V, Jiang DM, Stewart DJ, Liu G, Wheatley-Price P. What Is Ailing Oncology Clinical Trials? Can We Fix Them? Curr Oncol 2024; 31:3738-3751. [PMID: 39057147 PMCID: PMC11276279 DOI: 10.3390/curroncol31070275] [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: 05/27/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Evidence from phase three clinical trials helps shape clinical practice. However, a very small minority of patients with cancer participate in clinical trials and many trials are not completed on time due to slow accrual. Issues with restrictive eligibility criteria can severely limit the patients who can access trials, without any convincing evidence that these restrictions impact patient safety. Similarly, regulatory, organizational, and institutional hurdles can delay trial activation, ultimately making some studies irrelevant. Additional issues during trial conduct (e.g., mandatory in-person visits, central confirmation of standard biomarkers, and inflexible drug dosage modification) contribute to making trials non-patient-centric. These real-life observations from experienced clinical trialists can seem nonsensical to investigators and patients alike, who are trying to bring effective drugs to patients with cancer. In this review, we delve into these issues in detail, and discuss potential solutions to make clinical trials more accessible to patients.
Collapse
Affiliation(s)
- Abhenil Mittal
- North East Cancer Center, Health Sciences North, Northern Ontario School of Medicine (NOSM U), Sudbury, ON P3E5J1, Canada;
| | - Sara Moore
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H8L6, Canada
| | - Vishal Navani
- Tom Baker Cancer Center, Alberta Health Services, Calgary, AB T2N4N2, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N4N2, Canada
| | - Di Maria Jiang
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G2M9, Canada (G.L.)
| | - David J. Stewart
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H8L6, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G2M9, Canada (G.L.)
| | - Paul Wheatley-Price
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H8L6, Canada
| |
Collapse
|
3
|
Iskander GM, Cavazos A, Ejezie CL, Cox V, Cheng H, Perez S, Koong AC, Nguyen J, Herman J, Beddar S, Liao Z, Yeboa DN. Protocol-in-a-Day Workshop: Expediting IRB Approval for Junior and Senior Faculty. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02460-7. [PMID: 38914893 DOI: 10.1007/s13187-024-02460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/26/2024]
Abstract
Delays in research protocol development may be a single factor that hinders the career progression of academic faculty. Structured educational guidance during this phase proves crucial in mitigating setbacks in Institutional Review Board (IRB) approval and expediting trial implementation. To address this, the Protocol-in-a-Day (PIAD) workshop, a comprehensive 1-day event involving members from six critical facets of RO clinical trial implementation, was established, offering significant input to individual protocols. Efficacy and satisfaction of the PIAD workshop were assessed through a 5-question survey and the average time from submission to IRB initial approval. The normality of the data was analyzed using the Shapiro-Wilk Test. Nonparametric data was analyzed using a Mann-Whitney U test for significance. A total of 18 protocols that went through the PIAD workshop were activated. The mean time to IRB approval for protocols that went through PIAD was 39.8 days compared to 58.4 days for those that did not go through the PIAD workshop. Based on survey results, 100% of PIAD participants said the PIAD workshop was useful and 94% of participants stated that the PIAD workshop improved the overall quality of their protocol. Participant surveys further highlighted substantial improvements in trial quality, language, and statistical design and revealed that all participants found the workshop helpful. Therefore, both junior and senior faculty benefitted from this educational program during protocol development, as both groups demonstrated shorter times to IRB approval than non-participants. This acceleration not only fosters efficient trial implementation but also supports academic faculty in their career development.
Collapse
Affiliation(s)
- Geina M Iskander
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Adriana Cavazos
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Chinenye Lynette Ejezie
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Victoria Cox
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Hunter Cheng
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Shelby Perez
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Albert C Koong
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Jonathan Nguyen
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Joseph Herman
- Northwell Health Cancer Institute Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Sam Beddar
- Department of Radiation Physics, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Debra Nana Yeboa
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA.
| |
Collapse
|
4
|
Cramer AE, King LS, Buckley MT, Casteleyn P, Ennis C, Hamidi M, Rodrigues GMC, Snyder DC, Vattikola A, Eisenstein EL. Improving eSource Site Start-Up Practices. RESEARCH SQUARE 2024:rs.3.rs-4414917. [PMID: 38826202 PMCID: PMC11142311 DOI: 10.21203/rs.3.rs-4414917/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Background eSource software that copies patient electronic health record data into a clinical trial electronic case report form holds promise for increasing data quality while reducing data collection, monitoring and source document verification costs. Integrating eSource into multicenter clinical trial start-up procedures could facilitate the use of eSource technologies in clinical trials. Methods We conducted a qualitative integrative analysis to identify eSource site start-up key steps, challenges that might occur in executing those steps, and potential solutions to those challenges. We then conducted a value analysis to determine the challenges and solutions with the greatest impacts for eSource implementation teams. Results There were 16 workshop participants: 10 pharmaceutical sponsor, 3 academic site, and 1 eSource vendor representatives. Participants identified 36 Site Start-Up Key Steps, 11 Site Start-Up Challenges, and 14 Site Start-Up Solutions for eSource-enabled studies. Participants also identified 77 potential impacts of the Challenges upon the Site Start-Up Key Steps and 70 ways in which the Solutions might impact Site Start-Up Challenges. The most important Challenges were: (1) not being able to identify a site eSource champion and (2) not agreeing on an eSource approach. The most important Solutions were: (1) vendors accepting electronic data in the FHIR standard, (2) creating standard content for eSource-related legal documents, and (3) creating a common eSource site readiness checklist. Conclusions Site start-up for eSource-enabled multi-center clinical trials is a complex socio-technical problem. This study's Start-Up Solutions provide a basic infrastructure for scalable eSource implementation.
Collapse
Affiliation(s)
| | | | | | | | - Cory Ennis
- Duke University School of Medicine, Vice Dean's Office
| | | | | | - Denise C Snyder
- Duke University School of Medicine, Duke Office of Clinical Research
| | | | | |
Collapse
|
5
|
Ratnayake IP, Do AT, Gajewski D, Pepper S, Ige O, Streeter N, Lin TL, McGuirk M, Gajewski B, Mudaranthakam DP. Evaluating the impact of delayed study startup on accrual in cancer studies. RESEARCH SQUARE 2024:rs.3.rs-3660904. [PMID: 38699379 PMCID: PMC11065059 DOI: 10.21203/rs.3.rs-3660904/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background : Drug development in cancer medicine depends on high-quality clinical trials, but these require large investments of time to design, operationalize, and complete; for oncology drugs, this can take 8-10 years. Long timelines are expensive and delay innovative therapies from reaching patients. Delays often arise from study startup, a process that can take 6 months or more. We assessed how study-specific factors affected the study startup duration and the resulting overall success of the study. Method: Data from The University of Kansas Cancer Center (KUCC) were used to analyze studies initiated from 2018 to 2022. Accrual percentage was computed based on the number of enrolled participants and the desired enrollment goal. Accrual success was determined by comparing the percentage of enrollments to predetermined threshold values (50%, 70%, or 90%). Results : Studies that achieve or surpass the 70% activation threshold typically exhibit a median activation time of 140.5 days. In contrast, studies that fall short of the accrual goal tend to have a median activation time of 187 days, demonstrating the shorter median activation times associated with successful studies. Wilcoxon rank-sum test conducted for the study phase (W=13607, p-value=0.001) indicates that late-phase projects took longer to activate compared to early-stage projects. We also conducted the study with 50% and 90% accrual thresholds; our findings remained consistent. Conclusions: Longer activation times are linked to reduced project success, and early-phase studies tend to have higher success than late-phase studies. Therefore, by reducing impediments to the approval process, we can facilitate quicker approvals, increasing the success of studies regardless of phase.
Collapse
|
6
|
Gumber L, Agbeleye O, Inskip A, Fairbairn R, Still M, Ouma L, Lozano-Kuehne J, Bardgett M, Isaacs JD, Wason JM, Craig D, Pratt AG. Operational complexities in international clinical trials: a systematic review of challenges and proposed solutions. BMJ Open 2024; 14:e077132. [PMID: 38626966 PMCID: PMC11029458 DOI: 10.1136/bmjopen-2023-077132] [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: 06/26/2023] [Accepted: 02/27/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE International trials can be challenging to operationalise due to incompatibilities between country-specific policies and infrastructures. The aim of this systematic review was to identify the operational complexities of conducting international trials and identify potential solutions for overcoming them. DESIGN Systematic review. DATA SOURCES Medline, Embase and Health Management Information Consortium were searched from 2006 to 30 January 2023. ELIGIBILITY CRITERIA All studies reporting operational challenges (eg, site selection, trial management, intervention management, data management) of conducting international trials were included. DATA EXTRACTION AND SYNTHESIS Search results were independently screened by at least two reviewers and data were extracted into a proforma. RESULTS 38 studies (35 RCTs, 2 reports and 1 qualitative study) fulfilled the inclusion criteria. The median sample size was 1202 (IQR 332-4056) and median number of sites was 40 (IQR 13-78). 88.6% of studies had an academic sponsor and 80% were funded through government sources. Operational complexities were particularly reported during trial set-up due to lack of harmonisation in regulatory approvals and in relation to sponsorship structure, with associated budgetary impacts. Additional challenges included site selection, staff training, lengthy contract negotiations, site monitoring, communication, trial oversight, recruitment, data management, drug procurement and distribution, pharmacy involvement and biospecimen processing and transport. CONCLUSIONS International collaborative trials are valuable in cases where recruitment may be difficult, diversifying participation and applicability. However, multiple operational and regulatory challenges are encountered when implementing a trial in multiple countries. Careful planning and communication between trials units and investigators, with an emphasis on establishing adequately resourced cross-border sponsorship structures and regulatory approvals, may help to overcome these barriers and realise the benefits of the approach. OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER: osf-registrations-yvtjb-v1.
Collapse
Affiliation(s)
- Leher Gumber
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, Northumbria, UK
| | - Opeyemi Agbeleye
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Inskip
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ross Fairbairn
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Madeleine Still
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Ouma
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jingky Lozano-Kuehne
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michelle Bardgett
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - James Ms Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Arthur G Pratt
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| |
Collapse
|
7
|
Al Sukhun SA, Vanderpuye V, Taylor C, Ibraheem AF, Wiernik Rodriguez A, Asirwa FC, Francisco M, Moushey A. Global Equity in Clinical Trials: An ASCO Policy Statement. JCO Glob Oncol 2024; 10:e2400015. [PMID: 38484198 PMCID: PMC10954071 DOI: 10.1200/go.24.00015] [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: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 03/19/2024] Open
Abstract
ASCO is a global professional society representing more than 50,000 physicians, other health care professionals, and advocates in over 100 countries specializing in cancer treatment, diagnosis, prevention, and advocacy. ASCO strives, through research, education, and promotion of the highest quality of patient care, to create a world where cancer is prevented or cured, and every survivor is healthy. In this pursuit, health equity remains the guiding institutional principle that applies to all its activities across the cancer care continuum. This ASCO policy statement emphasizes the urgent need for global equity in clinical trials, aiming to enhance access and representation in cancer research as it not only improves cancer outcomes but also upholds principles of fairness and justice in health care.
Collapse
Affiliation(s)
| | - Verna Vanderpuye
- National Center for Radiotherapy Ghana, Korle Bu Teaching Hospital, Accra, Ghana
| | | | | | - Andres Wiernik Rodriguez
- Grupo Montecristo Healthcare Division, San José, Escazu, Costa Rica
- Hospital Metropolitano, San José, Costa Rica
- Metropolitano Research Institute, San José, Costa Rica
| | - Fredrick Chite Asirwa
- International Cancer Institute, Kenya International Cancer Institute | ICI, Eldoret, Kenya
| | | | | |
Collapse
|
8
|
Allen L, O'Toole RV, Bosse MJ, Obremskey WT, Archer KR, Cannada LK, Shores J, Reider LM, Frey KP, Carlini AR, Staguhn ED, Castillo RC. How many sites should an orthopedic trauma prospective multicenter trial have? A marginal analysis of the Major Extremity Trauma Research Consortium completed trials. Trials 2024; 25:107. [PMID: 38317256 PMCID: PMC10840249 DOI: 10.1186/s13063-024-07917-0] [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: 08/11/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Multicenter trials in orthopedic trauma are costly, yet crucial to advance the science behind clinical care. The number of sites is a key cost determinant. Each site has a fixed overhead cost, so more sites cost more to the study. However, more sites can reduce total costs by shortening the study duration. We propose to determine the optimal number of sites based on known costs and predictable site enrollment. METHODS This retrospective marginal analysis utilized administrative and financial data from 12 trials completed by the Major Extremity Trauma Research Consortium. The studies varied in size, design, and clinical focus. Enrollment across the studies ranged from 1054 to 33 patients. Design ranged from an observational study with light data collection to a placebo-controlled, double-blinded, randomized controlled trial. Initial modeling identified the optimal number of sites for each study and sensitivity analyses determined the sensitivity of the model to variation in fixed overhead costs. RESULTS No study was optimized in terms of the number of participating sites. Excess sites ranged from 2 to 39. Excess costs associated with extra sites ranged from $17K to $330K with a median excess cost of $96K. Excess costs were, on average, 7% of the total study budget. Sensitivity analyses demonstrated that studies with higher overhead costs require more sites to complete the study as quickly as possible. CONCLUSIONS Our data support that this model may be used by clinical researchers to achieve future study goals in a more cost-effective manner. TRIAL REGISTRATION Please see Table 1 for individual trial registration numbers and dates of registration.
Collapse
Affiliation(s)
- Lauren Allen
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21205, USA.
| | - Robert V O'Toole
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Michael J Bosse
- Atrium Health Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - William T Obremskey
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Lisa K Cannada
- Novant Health Orthopedic Fracture Clinic, Charlotte, NC, 28211, USA
| | - Jaimie Shores
- School of Medicine, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Lisa M Reider
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21205, USA
| | - Katherine P Frey
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21205, USA
| | - Anthony R Carlini
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21205, USA
| | - Elena D Staguhn
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21205, USA
| | - Renan C Castillo
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21205, USA
| |
Collapse
|
9
|
Bieske L, Zinner M, Dahlhausen F, Truebel H. Critical path activities in clinical trial setup and conduct: How to avoid bottlenecks and accelerate clinical trials. Drug Discov Today 2023; 28:103733. [PMID: 37544639 DOI: 10.1016/j.drudis.2023.103733] [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: 03/10/2022] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Most clinical trials are delayed due to scientific and/or operational challenges. Any effort to minimize delays can generate value for patients and sponsors. This article reviews critical path process steps commonly identified by practitioners, such as during protocol development, site contracting, or patient recruitment. Commonly considered measures, such as adding more trial sites or countries, were contrasted with less frequented measures, such as evidence-based feasibility or real-world evidence analysis, to help validate assumptions before clinical trial initiation. In a broad analysis, we integrated a literature review with a practitioner survey into a framework to help decision makers on the most critical process steps when setting up or conducting clinical trials in order to bring critical treatments to patients faster.
Collapse
Affiliation(s)
- Linn Bieske
- Witten/Herdecke University, Alfred Herrhausen Str. 45, D-58455 Witten, Germany
| | - Maximillian Zinner
- Witten/Herdecke University, Alfred Herrhausen Str. 45, D-58455 Witten, Germany
| | - Florian Dahlhausen
- Witten/Herdecke University, Alfred Herrhausen Str. 45, D-58455 Witten, Germany
| | - Hubert Truebel
- Witten/Herdecke University, Alfred Herrhausen Str. 45, D-58455 Witten, Germany; The Knowledge House GmbH, Breite Str. 22, D40213 Duesseldorf, Germany.
| |
Collapse
|
10
|
Lawrence CE, Bruce V(NM, Salberg LD, Edwards T, Morales C, Palm M, Bernard GR. Quantitative assessment of the impact of standard agreement templates on multisite clinical trial start up time. J Clin Transl Sci 2023; 7:e204. [PMID: 37830004 PMCID: PMC10565190 DOI: 10.1017/cts.2023.622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 10/14/2023] Open
Abstract
Contracting delays remain a challenge to the successful initiation of multisite clinical research in the US. The Clinical and Translational Science Awards (CTSA) Contracts Processing Study showed average contract negotiation duration of > 100 days for industry-sponsored or investigator-initiated contracts. Such delays create enormous costs to sponsors and to patients waiting to use new evidence-based treatments. With support from the National Institutes of Health's National Center for Advancing Translational Sciences, the Accelerated Clinical Trial Agreement (ACTA) was developed by 25 major academic institutions and medical centers engaged in clinical research in collaboration with the University-Industry Demonstration Partnership and with input from pharmaceutical companies. The ACTA also informed the development of subsequent agreements, including the Federal Demonstration Partnership Clinical Trial Subaward Agreement (FDP-CTSA); both ACTA and the FDP-CTSA are largely non-negotiable agreements that represent pre-negotiated compromises in contract terms agreed upon by industry and/or medical center stakeholders. When the involved parties agree to use the CTSA-developed and supported standard agreement templates as a starting point for negotiations, there can be significant time savings for trials. Use of the ACTA resulted in an average savings of 48 days and use of the FDP-CTSA saved an average of 57 days of negotiation duration.
Collapse
Affiliation(s)
- Colleen E. Lawrence
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Libby D. Salberg
- Office of Contracts Management, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Terri Edwards
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Casi Morales
- Pediatrics, Clinical Trials Office, University of Utah, Salt Lake City, UT, USA
| | - Marisha Palm
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Gordon R. Bernard
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
11
|
Mullen CG, Houlihan JY, Stroo M, Deeter CE, Freel SA, Padget AM, Snyder DC. Leveraging retooled clinical research infrastructure for Clinical Research Management System implementation at a large Academic Medical Center. J Clin Transl Sci 2023; 7:e127. [PMID: 37313387 PMCID: PMC10260330 DOI: 10.1017/cts.2023.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 06/15/2023] Open
Abstract
Quality clinical research is essential for health care progress and is the mission of academic health centers. Yet ensuring quality depends on an institution's ability to measure, control, and respond to metrics of trial performance. Uninformed clinical research provides little benefit to health care, drains institutional resources, and may waste participants' time and commitment. Opportunities for ensuring high-quality research are multifactorial, including training, evaluation, and retention of research workforces; operational efficiencies; and standardizing policies and procedures. Duke University School of Medicine has committed to improving the quality and informativeness of our clinical research enterprise through investments in infrastructure with significant focus on optimizing research management system integration as a foundational element for quality management. To address prior technology limitations, Duke has optimized Advarra's OnCore for this purpose by seamlessly integrating with the IRB system, electronic health record, and general ledger. Our goal was to create a standardized clinical research experience to manage research from inception to closeout. Key drivers of implementation include transparency of research process data and generating metrics aligned with institutional goals. Since implementation, Duke has leveraged OnCore data to measure, track, and report metrics resulting in improvements in clinical research conduct and quality.
Collapse
Affiliation(s)
- Catherine G. Mullen
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Jessica Y. Houlihan
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Marissa Stroo
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Christine E. Deeter
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Stephanie A. Freel
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Angela M. Padget
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Denise C. Snyder
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| |
Collapse
|
12
|
McClure J, Asghar A, Krajec A, Johnson MR, Subramanian S, Caroff K, McBurney C, Perusich S, Garcia A, Beck DJ, Huang GD. Clinical trial facilitators: A novel approach to support the execution of clinical research at the study site level. Contemp Clin Trials Commun 2023; 33:101106. [PMID: 37063166 PMCID: PMC10028341 DOI: 10.1016/j.conctc.2023.101106] [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: 05/23/2022] [Revised: 02/21/2023] [Accepted: 03/10/2023] [Indexed: 03/24/2023] Open
Abstract
In the summer of 2020, multiple efforts were undertaken to establish safe and effective vaccines to combat the spread of the coronavirus disease (COVID-19). In the United States (U.S.), Operation Warp Speed (OWS) was the program designated to coordinate such efforts. OWS was a partnership between the Department of Health and Human Services (HHS), the Department of Defense (DOD), and the private sector, that aimed to help accelerate control of the COVID-19 pandemic by advancing development, manufacturing, and distribution of vaccines, therapeutics, and diagnostics. The U.S. Department of Veterans Affairs’ (VA) was identified as a potential collaborator in several large-scale OWS Phase III clinical trial efforts designed to evaluate the safety and efficacy of various vaccines that were in development. Given the global importance of these trials, it was recognized that there would be a need for a coordinated, centralized effort within VA to ensure that its medical centers (sites) would be ready and able to efficiently initiate, recruit, and enroll into these trials. The manuscript outlines the partnership and start-up activities led by two key divisions of the VA's Office of Research and Development's clinical research enterprise. These efforts focused on site and enterprise-level requirements for multiple trials, with one trial serving as the most prominently featured of these studies within the VA. As a result, several best practices arose that included designating clinical trial facilitators to study sites to support study initiation activities and successful study enrollment at these locations in an efficient and timely fashion.
Collapse
Affiliation(s)
| | | | | | - Marcus R. Johnson
- Durham VA Health Care System, USA
- Corresponding author. 508 Fulton Street (152), Durham, NC 27705, USA.
| | | | - Krissa Caroff
- Office of Research and Development, USA
- U.S. Department of Veterans Affairs, USA
| | | | | | - Amanda Garcia
- U.S. Department of Veterans Affairs, USA
- VA Cooperative Studies Program Central Office, USA
| | | | - Grant D. Huang
- Office of Research and Development, USA
- U.S. Department of Veterans Affairs, USA
- VA Cooperative Studies Program Central Office, USA
| |
Collapse
|
13
|
Boutzoukas AE, Olson R, Sellers MA, Fischer G, Hornik CD, Alibrahim O, Iheagwara K, Abulebda K, Bass AL, Irby K, Subbaswamy A, Zivick EE, Sweney J, Stormorken AG, Barker EE, Lutfi R, McCrory MC, Costello JM, Ackerman KG, Munoz Pareja JC, Dean JM, Abdelsamad N, Hanley DF, Mould WA, Lane K, Stroud M, Feger BJ, Greenberg RG, Smith PB, Benjamin DK, Hornik CP, Zimmerman KO, Becker ML. Mechanisms to expedite pediatric clinical trial site activation: The DOSE trial experience. Contemp Clin Trials 2023; 125:107067. [PMID: 36577492 PMCID: PMC9918704 DOI: 10.1016/j.cct.2022.107067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/17/2022] [Accepted: 12/22/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Timely trial start-up is a key determinant of trial success; however, delays during start-up are common and costly. Moreover, data on start-up metrics in pediatric clinical trials are sparse. To expedite trial start-up, the Trial Innovation Network piloted three novel mechanisms in the trial titled Dexmedetomidine Opioid Sparing Effect in Mechanically Ventilated Children (DOSE), a multi-site, randomized, double-blind, placebo-controlled trial in the pediatric intensive care setting. METHODS The three novel start-up mechanisms included: 1) competitive activation; 2) use of trial start-up experts, called site navigators; and 3) supplemental funds earned for achieving pre-determined milestones. After sites were activated, they received a web-based survey to report perceptions of the DOSE start-up process. In addition to perceptions, metrics analyzed included milestones met, time to start-up, and subsequent enrollment of subjects. RESULTS Twenty sites were selected for participation, with 19 sites being fully activated. Across activated sites, the median (quartile 1, quartile 3) time from receipt of regulatory documents to site activation was 82 days (68, 113). Sites reported that of the three novel mechanisms, the most motivating factor for expeditious activation was additional funding available for achieving start-up milestones, followed by site navigator assistance and then competitive site activation. CONCLUSION Study start-up is a critical time for the success of clinical trials, and innovative methods to minimize delays during start-up are needed. Milestone-based funds and site navigators were preferred mechanisms by sites participating in the DOSE study and may have contributed to the expeditious start-up timeline achieved. CLINICALTRIALS gov #: NCT03938857.
Collapse
Affiliation(s)
- Angelique E Boutzoukas
- Duke Clinical Research Institute, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - Rachel Olson
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Gwenyth Fischer
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Chi D Hornik
- Duke Clinical Research Institute, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | | | | | - Kamal Abulebda
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Andora L Bass
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Jill Sweney
- Primary Children's Medical Center, University of Utah, Salt Lake City, UT, USA
| | | | | | - Riad Lutfi
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | | | | | | | | | | | | | - Daniel F Hanley
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - W Andrew Mould
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Lane
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Stroud
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | | | - Rachel G Greenberg
- Duke Clinical Research Institute, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - P Brian Smith
- Duke Clinical Research Institute, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - Christoph P Hornik
- Duke Clinical Research Institute, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - Kanecia O Zimmerman
- Duke Clinical Research Institute, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - Mara L Becker
- Duke Clinical Research Institute, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA.
| |
Collapse
|
14
|
Michaeli DT, Yagmur HB, Achmadeev T, Michaeli T. Value drivers of development stage biopharma companies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1287-1296. [PMID: 35038054 PMCID: PMC9550717 DOI: 10.1007/s10198-021-01427-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/23/2021] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Scholars previously estimated research and development (R&D) costs of the internal drug development process. However, little is known about the costs and value arising from externally acquired therapeutics. This study identifies and estimates the magnitude of factors associated with Biopharma acquisition value. METHODS SDC Thomson Reuter and S&P Capital IQ were screened for majority acquisitions of US and EU Biopharma companies developing new molecular entities for prescription use (SIC code: 2834) from 2005 to 2020. Financial acquisition data were complemented with variables characterizing the target's product portfolio extracted from clinicaltrials.gov, Drugs@FDA database, US SEC filings, and transaction announcements. A multivariate regression assesses the association of firm value with extracted variables. RESULTS 311 acquisitions of companies developing prescription drugs were identified over the study period. Acquirers paid 37% (p < 0.05) more for companies with biologics and gene therapeutics than small-molecule lead drugs. Multi-indication products were acquired for a 12% premium per additional indication (p < 0.01). No significant valuation difference between companies developing orphan and non-orphan designated lead products was observed (18%, p = 0.223). Acquisition value positively correlated with the total number of further products, headquarter location in the US, underlying market conditions, and acquirer market capitalization (p < 0.05). CONCLUSIONS Internal and external drug development consumes many financial and human resources, yet it is important for entrepreneurs, regulators, and payers to understand their precise magnitude and value drivers. This information permits the design of targeted pricing and industrial policies that incentivize the development of novel drugs in areas with high unmet needs.
Collapse
Affiliation(s)
- Daniel Tobias Michaeli
- Fifth Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
- Division of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
- TUM School of Management, Technical University of Munich, Munich, Germany.
| | - Hasan Basri Yagmur
- TUM School of Management, Technical University of Munich, Munich, Germany
| | - Timur Achmadeev
- TUM School of Management, Technical University of Munich, Munich, Germany
| | - Thomas Michaeli
- Fifth Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
- Division of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|