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Erdemli G, Grammatikopoulou M, Wagner B, Vairavan S, Curcic J, Aarsland D, Wittenberg G, Nikolopoulos S, Muurling M, Froehlich H, de Boer C, Shanbhag NM, Nies VJM, Coello N, Gove D, Diaz A, Foy S, Dartee W, Brem AK. Regulatory considerations for developing remote measurement technologies for Alzheimer's disease research. NPJ Digit Med 2024; 7:232. [PMID: 39232033 PMCID: PMC11375004 DOI: 10.1038/s41746-024-01211-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/01/2024] [Indexed: 09/06/2024] Open
Affiliation(s)
- Gül Erdemli
- Novartis Pharmaceuticals Corporation, Cambridge, MA, USA.
| | | | - Bertil Wagner
- Janssen Research & Development, LLC, a Johnson & Johnson company, Titusville, NJ, USA
| | - Srinivasan Vairavan
- Janssen Research & Development, LLC, a Johnson & Johnson company, Titusville, NJ, USA
| | | | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Centre for Healthy Brain Ageing, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gayle Wittenberg
- Janssen Research & Development, LLC, a Johnson & Johnson company, Titusville, NJ, USA
| | - Spiros Nikolopoulos
- Information Technologies Institute, Centre for Research & Technology Hellas, Thessaloniki, Greece
| | - Marijn Muurling
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Holger Froehlich
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Sankt Augustin, Germany
- Bonn-Aachen International Center for IT, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Casper de Boer
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | | | | | | | | | - Ana Diaz
- Alzheimer Europe, Luxembourg, Luxembourg
| | - Suzanne Foy
- Janssen Research & Development UK, a Johnson & Johnson company, High Wycombe, UK
| | | | - Anna-Katharine Brem
- Centre for Healthy Brain Ageing, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
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Welbourn M, Sheriff P, Tuttle PG, Adamowicz L, Psaltos D, Kelekar A, Selig J, Messere A, Mei W, Caouette D, Ghafoor S, Santamaria M, Zhang H, Demanuele C, Karahanoglu FI, Cai X. In-Clinic and Natural Gait Observations master protocol (I-CAN-GO) to validate gait using a lumbar accelerometer. Sci Rep 2024; 14:20128. [PMID: 39209869 PMCID: PMC11362325 DOI: 10.1038/s41598-024-67675-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 07/15/2024] [Indexed: 09/04/2024] Open
Abstract
Traditional measurements of gait are typically performed in clinical or laboratory settings where functional assessments are used to collect episodic data, which may not reflect naturalistic gait and activity patterns. The emergence of digital health technologies has enabled reliable and continuous representation of gait and activity in free-living environments. To provide further evidence for naturalistic gait characterization, we designed a master protocol to validate and evaluate the performance of a method for measuring gait derived from a single lumbar-worn accelerometer with respect to reference methods. This evaluation included distinguishing between participants' self-perceived different gait speed levels, and effects of different floor surfaces such as carpet and tile on walking performance, and performance under different bouts, speed, and duration of walking during a wide range of simulated daily activities. Using data from 20 healthy adult participants, we found different self-paced walking speeds and floor surface effects can be accurately characterized. Furthermore, we showed accurate representation of gait and activity during simulated daily living activities and longer bouts of outside walking. Participants in general found that the devices were comfortable. These results extend our previous validation of the method to more naturalistic setting and increases confidence of implementation at-home.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xuemei Cai
- Pfizer, Inc, Cambridge, MA, USA.
- Tufts Medical Center, Boston, MA, USA.
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Bakker JP, Izmailova ES, Clement A, Hoffmann S, Leptak C, Menetski JP, Wagner JA. Regulatory Pathways for Qualification and Acceptance of Digital Health Technology-Derived Clinical Trial Endpoints: Considerations for Sponsors. Clin Pharmacol Ther 2024. [PMID: 39148198 DOI: 10.1002/cpt.3398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/15/2024] [Indexed: 08/17/2024]
Abstract
Despite widespread interest and substantial investment in the adoption of sensor-based digital health technologies (sDHTs) for remote data capture in drug development trials, no drug has been approved based on an sDHT-derived primary endpoint in the United States (US). One reason for this lack of advancement is the complexity of obtaining regulatory endorsement for those endpoints within current US regulatory pathways. The goal of our review is to describe the two choices currently available to pharmaceutical study Sponsors: (i) they may navigate the traditional route of compiling the evidence to support the sDHT-derived endpoint in their investigational new drug (IND) application, requiring specific expertise and substantial resources; or (ii) they may navigate the drug development tool (DDT) pathway with the goal of qualifying their sDHT-derived endpoint as a biomarker or clinical outcome assessment applicable to a broader context of use (COU), either alone or as part of a partnership or consortium. We describe the nuances of each pathway; the evidentiary requirements for supporting an sDHT-derived endpoint and the technology used to capture it; and the impact that an sDHT's regulatory status may have on a Sponsor's decision to use it for data capture. By systematically comparing the IND and DDT pathways, our over-arching goals are to support the increasing deployment of sDHTs within the clinical research setting and help advance regulatory science in the field of digital medicine.
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Affiliation(s)
| | | | | | - Steven Hoffmann
- Science Partnerships, Foundation for the National Institutes of Health, North Bethesda, Maryland, USA
| | | | - Joseph P Menetski
- Science Partnerships, Foundation for the National Institutes of Health, North Bethesda, Maryland, USA
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McGagh D, Song K, Yuan H, Creagh AP, Fenton S, Ng WF, Goldsack JC, Dixon WG, Doherty A, Coates LC. Digital health technologies to strengthen patient-centred outcome assessment in clinical trials in inflammatory arthritis. THE LANCET. RHEUMATOLOGY 2024:S2665-9913(24)00186-3. [PMID: 39089297 DOI: 10.1016/s2665-9913(24)00186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/22/2024] [Accepted: 06/18/2024] [Indexed: 08/03/2024]
Abstract
Common to all inflammatory arthritides, namely rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and juvenile idiopathic arthritis, is a potential for reduced mobility that manifests through joint pain, swelling, stiffness, and ultimately joint damage. Across these conditions, consensus has been reached on the need to capture outcomes related to mobility, such as functional capacity and physical activity, as core domains in randomised controlled trials. Existing endpoints within these core domains rely wholly on self-reported questionnaires that capture patients' perceptions of their symptoms and activities. These questionnaires are subjective, inherently vulnerable to recall bias, and do not capture the granularity of fluctuations over time. Several early adopters have integrated sensor-based digital health technology (DHT)-derived endpoints to measure physical function and activity in randomised controlled trials for conditions including Parkinson's disease, Duchenne's muscular dystrophy, chronic obstructive pulmonary disease, and heart failure. Despite these applications, there have been no sensor-based DHT-derived endpoints in clinical trials recruiting patients with inflammatory arthritis. Borrowing from case studies across medicine, we outline the opportunities and challenges in developing novel sensor-based DHT-derived endpoints that capture the symptoms and disease manifestations most relevant to patients with inflammatory arthritis.
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Affiliation(s)
- Dylan McGagh
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Kaiyang Song
- Oxford Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Hang Yuan
- Big Data Institute, University of Oxford, Oxford, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew P Creagh
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Sally Fenton
- School of Sport, Exercise, and Rehabilitation Science, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
| | - Wan-Fai Ng
- Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland; Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK; NIHR Newcastle Biomedical Research Centre and NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance, Salford, UK
| | - Aiden Doherty
- Big Data Institute, University of Oxford, Oxford, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Al Meslamani AZ. The long-term clinical impact of digital endpoints and biomarkers in data collection. Expert Rev Pharmacoecon Outcomes Res 2024; 24:697-699. [PMID: 38362754 DOI: 10.1080/14737167.2024.2320233] [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] [Received: 10/23/2023] [Accepted: 02/14/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Ahmad Z Al Meslamani
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- AAU Health and Biomedical Research quality of care Center, Al Ain University, Abu Dhabi, United Arab Emirates
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Podhaisky HP. Digital Health Technology (DHT) in European Clinical Trials, How to Improve the Status-Quo of the Regulatory Landscape? Ther Innov Regul Sci 2024; 58:610-613. [PMID: 38656468 DOI: 10.1007/s43441-024-00657-y] [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: 01/12/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
Digital health technology (DHT) is increasingly used to facilitate the conduct of clinical drug trials. The European regulatory environment would benefit from some adjustments to realize the full potential of DHTs. Considering current discussions such as the European Accelerating Clinical Trial Initiative (ACT EU), we propose four concrete adjustments to this regulatory landscape to introduce risk-based qualification approaches for DHTs. In our view, these changes would have the potential to facilitate the use of DHT in clinical research and thus provide access to innovative therapies in Europe.
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Affiliation(s)
- Hans-Peter Podhaisky
- Bayer AG, Research & Development, Pharmaceuticals, Regulatory Affairs, MD, Berlin, Germany.
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