1
|
Morton C, Sullivan R, Sarker D, Posner J, Spicer J. Revitalising cancer trials post-pandemic: time for reform. Br J Cancer 2023; 128:1409-1414. [PMID: 36959378 PMCID: PMC10035974 DOI: 10.1038/s41416-023-02224-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 03/25/2023] Open
Abstract
The COVID-19 pandemic posed significant risk to the health of cancer patients, compromised standard cancer care and interrupted clinical cancer trials, prompting dramatic streamlining of services. From this health crisis has emerged the opportunity to carry forward an unexpected legacy of positive reforms to clinical cancer research, where conventionally convoluted approvals processes, inefficient trial design, procedures and data gathering could benefit from the lessons in rationalisation learned during the pandemic.
Collapse
Affiliation(s)
- Cienne Morton
- Department of Medical Oncology, Guy's & St Thomas NHS Foundation Trust, London, UK.
| | | | - Debashis Sarker
- Department of Medical Oncology, Guy's & St Thomas NHS Foundation Trust, London, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - John Posner
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - James Spicer
- Department of Medical Oncology, Guy's & St Thomas NHS Foundation Trust, London, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| |
Collapse
|
2
|
Tsutsumi I, Tsutsumi Y, Yoshida C, Komeno T, Imanaka Y. Impact of the Clinical Trials Act on noncommercial clinical research in Japan: An interrupted time-series analysis. J Epidemiol 2021; 32:27-33. [PMID: 34690242 PMCID: PMC8666319 DOI: 10.2188/jea.je20210051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The number of new noncommercial clinical studies conducted in Japan declined within the first year of the implementation of the Clinical Trials Act (CTA) on April 1, 2018. This study aimed to examine the impact of the CTA's enforcement on the number of new noncommercial clinical studies registered in the Japanese Clinical Trial Registry. METHODS An interrupted time-series design was used in the analysis, which was conducted from April 2015 to March 2019. We collected data for studies registered in the Clinical Trial Registry, managed by the University Hospital Medical Information Network. RESULTS In total, 35,811 studies were registered; of these, 16,455 fulfilled the eligibility criteria. The difference in the trend of monthly number of new studies after CTA enforcement decreased significantly by 15.0 (95% CI, -18.7 to -11.3), and the level decreased by 40.8 (95% CI, -68.2 to -13.3) from the pre-enforcement to the post-enforcement period. Multigroup analyses indicated that the act exerted a significant effect on the trend of new clinical studies, particularly those with smaller sample sizes, interventional study designs, and nonprofit funding sponsors. CONCLUSIONS The number of Japanese noncommercial clinical studies declined significantly following implementation of the CTA. It is necessary to establish a system to promote clinical studies in Japan while ensuring transparency and safety.
Collapse
Affiliation(s)
- Ikuyo Tsutsumi
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine.,Department of Hematology, National Hospital Organization Mito Medical Center
| | - Yusuke Tsutsumi
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine
| | - Chikashi Yoshida
- Department of Hematology, National Hospital Organization Mito Medical Center
| | - Takuya Komeno
- Department of Hematology, National Hospital Organization Mito Medical Center
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine
| |
Collapse
|
3
|
Tridente A, Holloway PAH, Hutton P, Gordon AC, Mills GH, Clarke GM, Chiche JD, Stuber F, Garrard C, Hinds C, Bion J. Methodological challenges in European ethics approvals for a genetic epidemiology study in critically ill patients: the GenOSept experience. BMC Med Ethics 2019; 20:30. [PMID: 31064358 PMCID: PMC6503539 DOI: 10.1186/s12910-019-0370-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/22/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND During the set-up phase of an international study of genetic influences on outcomes from sepsis, we aimed to characterise potential differences in ethics approval processes and outcomes in participating European countries. METHODS Between 2005 and 2007 of the FP6-funded international Genetics Of Sepsis and Septic Shock (GenOSept) project, we asked national coordinators to complete a structured survey of research ethic committee (REC) approval structures and processes in their countries, and linked these data to outcomes. Survey findings were reconfirmed or modified in 2017. RESULTS Eighteen countries participated in the study, recruiting 2257 patients from 160 ICUs. National practices differed widely in terms of composition of RECs, procedures and duration of the ethics approval process. Eight (44.4%) countries used a single centralised process for approval, seven (38.9%) required approval by an ethics committee in each participating hospital, and three (16.7%) required both. Outcomes of the application process differed widely between countries because of differences in national legislation, and differed within countries because of interpretation of the ethics of conducting research in patients lacking capacity. The RECs in four countries had no lay representation. The median time from submission to final decision was 1.5 (interquartile range 1-7) months; in nine (50%) approval was received within 1 month; six took over 6 months, and in one 24 months; had all countries been able to match the most efficient approvals processes, an additional 74 months of country or institution-level recruitment would have been available. In three countries, rejection of the application by some local RECs resulted in loss of centres; and one country rejected the application outright. CONCLUSIONS The potential benefits of the single application portal offered by the European Clinical Trials Regulation will not be realised without harmonisation of research ethics committee practices as well as national legislation.
Collapse
Affiliation(s)
- Ascanio Tridente
- Whiston Hospital, Prescot, Merseyside and Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | | | - Paula Hutton
- Intensive Care Unit, John Radcliffe Hospital, Oxford, UK
| | | | | | | | | | - Frank Stuber
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Charles Hinds
- Barts and the London Queen Mary School of Medicine, London, UK
| | - Julian Bion
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
4
|
Dombernowsky T, Hædersdal M, Lassen U, Thomsen SF. Development in the number of clinical trial applications in Western Europe from 2007 to 2015: retrospective study of data from national competent authorities. BMJ Open 2017; 7:e015579. [PMID: 28698332 PMCID: PMC5734571 DOI: 10.1136/bmjopen-2016-015579] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the development in the number of applications for authorisation of clinical trials of medicines (CTAs) submitted annually to national competent authorities in 10 Western European member states of the European Union from 2007 to 2015. DESIGN Registry study. SETTING Data from national competent authorities. PARTICIPANTS Germany, Italy, Spain, France, the UK, Belgium, the Netherlands, Austria, Denmark and Sweden. Inclusion criteria were Western European member states of the European Union, receiving more than 200 CTAs per year. OUTCOME MEASURES Summarised number of CTAs and distribution of CTAs by type of sponsor (commercial or non-commercial) and trial phase (I-IV). Average annual growth rates (AAGRs) based on linear regressions. Data were evaluated 2007-2011 and 2012-2015 to compare findings with the European Commission's statement of a 25% decrease in CTAs in the EU from 2007 to 2011. RESULTS From 2007 to 2011, the summarised number of CTAs decreased significantly (AAGR -3.9% (p=0.02)), primarily due to a decrease in commercially sponsored CTAs. From 2012 to 2015, the change was insignificant (AAGR 2.6% (p=0.27)), however with a 10% increase from 2014 to 2015 after stagnation from 2012 to 2014. Overall, the number of CTAs and distribution by type of sponsor varied considerably between countries. No distinct trends were observed when evaluating CTAs by type of trial phase. CONCLUSIONS This study found a significant decrease in the number of CTAs in Western Europe from 2007 to 2011 (AAGR -3.9%). This development is possibly attributable to several factors such as the European Clinical Trials Directive, national and local political decisions, and a potential global shift in clinical trial activity. From 2014 to 2015, the number of CTAs increased markedly (10%). However, it is yet too soon to determine if this constitutes a transient fluctuation or a new trend.
Collapse
Affiliation(s)
- Tilde Dombernowsky
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Merete Hædersdal
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Ulrik Lassen
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Langhof H, Lander J, Strech D. Input analysis for two public consultations on the EU Clinical Trials Regulation. Health Res Policy Syst 2016; 14:69. [PMID: 27639695 PMCID: PMC5027082 DOI: 10.1186/s12961-016-0141-0] [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: 04/13/2016] [Accepted: 08/31/2016] [Indexed: 11/10/2022] Open
Abstract
Background The European Union’s (EU) Clinical Trials Directive was replaced by an EU-Regulation as of 2016. The policy revision process was subject to a formal impact assessment exercised by the European Commission (EC) from 2008 to 2014. Following the EU principles of Good Governance, deliberation with stakeholders was an integral part of this impact assessment and the policy formulation process. Hence, two public consultations (PCs) were held by the EC in 2009 and 2011, respectively. Various stakeholders contributed and submitted their written input to the EC. Though often cited in the further revision process, the input gathered in the PC was not communicated with full transparency and it is unclear how and to what extent the input has been processed and used in the policy formulation. The objective of this study was an analysis of submissions to both PCs in order to systematically present what topics have been discussed and which possible policy options have been raised by the stakeholders. Methods All written submissions publicly available were downloaded from the EC’s homepage and assessed for stakeholder characteristics. Thematic text analysis was applied to assess the full text of a random sample of 33% of these submissions. Results A total of 198 different stakeholders from the EU and the United States of America contributed to one or both of the two PCs. In total, 44 various themes have been addressed that could be clustered under 24 main themes, including the articulation of problems as well as possible policy solutions to face these problems. Conclusion The two PCs on the Clinical Trials Directive were highly appreciated by the various stakeholders and their input allowed an in-depth view on their particular interests. This input provided a rich source of information for all stakeholders in the field of clinical trials as well as to the EC’s impact assessment. Although the EC obviously gathered a large quantity of expert knowledge on practical implications of trials legislation by consulting stakeholders, it remained unclear how this input was used in the development of the new regulation. For the sake of transparency, it is recommended that in future PCs the EC uses better standardized methods for a more transparent analysis and presentation of results. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0141-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Holger Langhof
- Institute for History, Ethics and Philosophy of Medicine, CELLS - Centre for Ethics and Law in the Life Sciences, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Jonas Lander
- Institute for History, Ethics and Philosophy of Medicine, CELLS - Centre for Ethics and Law in the Life Sciences, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Present Address: Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School (MHH), Hannover, Germany
| | - Daniel Strech
- Institute for History, Ethics and Philosophy of Medicine, CELLS - Centre for Ethics and Law in the Life Sciences, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| |
Collapse
|
6
|
Abou-El-Enein M, Schneider CK. Deciphering the EU clinical trials regulation. Nat Biotechnol 2016; 34:231-3. [DOI: 10.1038/nbt.3492] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
7
|
Ward DJ, Hammond E, Linden-Phillips L, Stevens AJ. Trends in clinical development timeframes for antiviral drugs launched in the UK, 1981-2014: a retrospective observational study. BMJ Open 2015; 5:e009333. [PMID: 26576812 PMCID: PMC4654359 DOI: 10.1136/bmjopen-2015-009333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Recent decades have witnessed the development of highly innovative new antiviral drug therapies. However, there are concerns that rising costs and lengthening development times could have implications for future patient access to innovative new drugs. We sought to establish whether the time taken for the clinical development of new antiviral drugs launched in the UK had increased since the 1980s. DESIGN AND SETTING Retrospective observational study of all new antiviral drugs licensed for use in the UK. PRIMARY AND SECONDARY OUTCOME MEASURES Duration of clinical development (from initiation of studies in humans to receipt of Marketing Authorisation), subdivided into clinical trial and regulatory approval periods by the date of Marketing Authorisation Application. RESULTS 48 new antiviral drugs were licensed for use in the UK between 1981 and 2014 (inclusive), over half (54%) initially for HIV infection. The overall mean duration of clinical development was 77.2 months, of which 64.6 months was spent in clinical trials before regulatory submission. The total time in clinical development increased from 41.7 months for drugs licensed 1981-1992 to 91.7 months for drugs licensed 2004-2014. This increase was accounted for by an increase in the clinical trials period and not the regulatory approval period, for which there was no observable trend. Drugs initially licensed to treat hepatitis C had a longer duration of clinical development than those indicated for other viral infections. However, the, initially shorter clinical development durations of drugs indicated for HIV infection increased more rapidly across the study period than those indicated for other viral infections. CONCLUSIONS The time spent by antiviral drugs in clinical development has increased markedly in recent decades despite many initiatives to speed access to innovative new drugs. However, this represents only one part of the translational research pathway, and a complete picture of development timeframes is lacking.
Collapse
Affiliation(s)
- Derek J Ward
- NIHR Horizon Scanning Research & Intelligence Centre, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Edward Hammond
- NIHR Horizon Scanning Research & Intelligence Centre, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Luan Linden-Phillips
- NIHR Horizon Scanning Research & Intelligence Centre, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Andrew J Stevens
- Department of Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
8
|
Bordet R, Lang M, Dieu C, Billon N, Duffet JP. Early results from a multi-component French public-private partnership initiative to improve participation in clinical research - CeNGEPS: a prospective before-after study. BMC Med Res Methodol 2015; 15:67. [PMID: 26286263 PMCID: PMC4541748 DOI: 10.1186/s12874-015-0044-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 07/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A public-private (51/49 %) partnership was initiated in 2007 in France to improve the attractiveness of French sites in industry-sponsored international clinical trials. This initiative developed and implemented a combination of structuring actions and support actions. Here we report the assessment of the impact after 6 years on participation of French study sites in industry-sponsored clinical trials. METHODS We performed a prospective before-after study of clinical research activities in French public hospitals to assess the impact of actions developed and implemented by CeNGEPS. The programme involved a combination of structuring actions (establishment of sites of excellence, national networks and dedicated clinical research assistants (CRAs)), support actions (tools, templates and training) and competitive budget allocation for sites or networks based on performance. The impact was assessed using the following performance criteria: 1) reduction of the delay to contract signature to ≤ 60 days for 80 % of the trial sites; 2) inclusion of ≥80 % of the planned number of patients by at least 80 % of trial sites; 3) closure of <15 % of trials sites without patients enrolled. RESULTS In 2013, the median delay to contract signature was: 55 days, compared with 76 days in 2008 (27.6 % reduction), 50.5 % of all sites and 58 % of sites with a dedicated CRA included ≥80 % of the planned number of patients compared with 44.8 % in 2008 (12.7 % increase) and 21.3 % of all sites and 9 % of sites with a dedicated CRA closed with no patients included, compared with 26.4 % in 2008 (19.3 and 65.9 %, respectively). CONCLUSIONS These results provide evidence that it is possible to improve a country's attractiveness for industry-sponsored clinical research. The two main actions, i.e. establishing sites of excellence throughout the country with well-trained, dedicated staff and establishing a national network of clinical investigators, could be adapted to other countries in Western Europe to improve Europe's attractiveness to industry-funded trials.
Collapse
Affiliation(s)
- Régis Bordet
- Centre National de Gestion des Essais de Produits de Santé, 3 quai des Célestins, BP2251, 69229, Lyon, Cedex 02, France.
| | - Marie Lang
- Centre National de Gestion des Essais de Produits de Santé, 3 quai des Célestins, BP2251, 69229, Lyon, Cedex 02, France.
| | - Christelle Dieu
- Centre National de Gestion des Essais de Produits de Santé, 3 quai des Célestins, BP2251, 69229, Lyon, Cedex 02, France.
| | - Nathalie Billon
- Centre National de Gestion des Essais de Produits de Santé, 3 quai des Célestins, BP2251, 69229, Lyon, Cedex 02, France.
| | - Jean-Pierre Duffet
- Centre National de Gestion des Essais de Produits de Santé, 3 quai des Célestins, BP2251, 69229, Lyon, Cedex 02, France.
| |
Collapse
|
9
|
Cevallos M, Züllig S, Christen A, Meier BE, Goetz M, Coslovsky M, Trelle S. A pilot test of the new Swiss regulatory procedure for categorizing clinical trials by risk: A randomized controlled trial. Clin Trials 2015; 12:677-87. [PMID: 26122923 PMCID: PMC4648234 DOI: 10.1177/1740774515591983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background/Aims: Several countries are working to adapt clinical trial regulations to align the approval process to the level of risk for trial participants. The optimal framework to categorize clinical trials according to risk remains unclear, however. Switzerland is the first European country to adopt a risk-based categorization procedure in January 2014. We assessed how accurately and consistently clinical trials are categorized using two different approaches: an approach using criteria set forth in the new law (concept) or an intuitive approach (ad hoc). Methods: This was a randomized controlled trial with a method-comparison study nested in each arm. We used clinical trial protocols from eight Swiss ethics committees approved between 2010 and 2011. Protocols were randomly assigned to be categorized in one of three risk categories using the concept or the ad hoc approach. Each protocol was independently categorized by the trial’s sponsor, a group of experts and the approving ethics committee. The primary outcome was the difference in categorization agreement between the expert group and sponsors across arms. Linear weighted kappa was used to quantify agreements, with the difference between kappas being the primary effect measure. Results: We included 142 of 231 protocols in the final analysis (concept = 78; ad hoc = 64). Raw agreement between the expert group and sponsors was 0.74 in the concept and 0.78 in the ad hoc arm. Chance-corrected agreement was higher in the ad hoc (kappa: 0.34 (95% confidence interval = 0.10–0.58)) than in the concept arm (0.27 (0.06–0.50)), but the difference was not significant (p = 0.67). Limitations: The main limitation was the large number of protocols excluded from the analysis mostly because they did not fit with the clinical trial definition of the new law. Conclusion: A structured risk categorization approach was not better than an ad hoc approach. Laws introducing risk-based approaches should provide guidelines, examples and templates to ensure correct application.
Collapse
Affiliation(s)
- Myriam Cevallos
- CTU Bern, Department of Clinical Research, University of Bern, Bern, Switzerland Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Stephanie Züllig
- Section Research on Human Beings and Ethics, Federal Office of Public Health, Bern, Switzerland
| | - Andri Christen
- Section Research on Human Beings and Ethics, Federal Office of Public Health, Bern, Switzerland
| | - Brigitte E Meier
- Section Research on Human Beings and Ethics, Federal Office of Public Health, Bern, Switzerland
| | - Martin Goetz
- Section Research on Human Beings and Ethics, Federal Office of Public Health, Bern, Switzerland
| | - Michael Coslovsky
- CTU Bern, Department of Clinical Research, University of Bern, Bern, Switzerland Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sven Trelle
- CTU Bern, Department of Clinical Research, University of Bern, Bern, Switzerland Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| |
Collapse
|
10
|
Veerus P, Lexchin J, Hemminki E. Legislative regulation and ethical governance of medical research in different European Union countries. JOURNAL OF MEDICAL ETHICS 2014; 40:409-413. [PMID: 23665856 DOI: 10.1136/medethics-2012-101282] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To obtain information about the similarities and differences in regulating different types of medical research in the European Union (EU). METHODS Web searches were performed from September 2009 to January 2011. Notes on pre-determined topics were systematically taken down from the web pages. The analysis relied only on documents and reports available on the web, reflecting the situation at the end of 2010. RESULTS In several countries, regulatory legislation applied only to clinical trials on drugs and medical devices, in other states various types of research were also regulated but by laws different from those concerning trials, and in many countries, some research areas were not controlled by legislation at all. In very few countries was all medical research handled similarly from a legal point of view. The number of research ethics committees (RECs) in a single country varied from one to 264. Their areas of responsibility, working principles and length of time to grant research permission varied as well as the rules for obtaining informed consent from vulnerable groups. In 10 EU countries, there was no appeal mechanism after a negative decision by an REC. The RECs were not accountable to any organisation in five EU countries. CONCLUSIONS There is a need for a fundamental debate regarding whether and which kinds of changes are needed for the further harmonisation of medical research governance in the EU and how cross-country medical research could be facilitated in the future.
Collapse
Affiliation(s)
- Piret Veerus
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Joel Lexchin
- Faculty of Health, York University, Toronto, Canada
| | | |
Collapse
|
11
|
Gehring M, Taylor RS, Mellody M, Casteels B, Piazzi A, Gensini G, Ambrosio G. Factors influencing clinical trial site selection in Europe: the Survey of Attitudes towards Trial sites in Europe (the SAT-EU Study). BMJ Open 2013; 3:e002957. [PMID: 24240138 PMCID: PMC3831096 DOI: 10.1136/bmjopen-2013-002957] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Applications to run clinical trials in Europe fell 25% between 2007 and 2011. Costs, speed of approvals and shortcomings of European Clinical Trial Directive are commonly invoked to explain this unsatisfactory performance. However, no hard evidence is available on the actual weight of these factors or has it been previously investigated whether other criteria may also impact clinical trial site selection. DESIGN The Survey of Attitudes towards Trial sites in Europe (SAT-EU Study) was an anonymous, cross-sectional web-based survey that systematically assessed factors impacting European clinical trial site selection. It explored 19 factors across investigator-driven, hospital-driven and environment-driven criteria, and costs. It also surveyed perceptions of the European trial environment. SETTING AND PARTICIPANTS Clinical research organisations (CROs), academic clinical trial units (CTUs) and industry invited to respond. OUTCOME MEASURES PRIMARY OUTCOME weight assigned to each factor hypothesised to impact trial site selection and trial incidence. Secondary outcome: desirability of European countries to run clinical trials. RESULTS Responses were obtained from 485 professionals in 34 countries: 49% from BioPharma, 40% from CTUs or CROs. Investigator-dependent, environment-dependent and hospital-dependent factors were rated highly important, costs being less important (p<0.0001). Within environment-driven criteria, pool of eligible patients, speed of approvals and presence of disease-management networks were significantly more important than costs or government financial incentives (p<0.0001). The pattern of response was consistent across respondent groupings (CTU vs CRO vs industry). Considerable variability was demonstrated in the perceived receptivity of countries to undertake clinical trials, with Germany, the UK and the Netherlands rated the best trial markets (p<0.0001). CONCLUSIONS Investigator-dependent factors and ease of approval dominate trial site selection, while costs appear less important. Fostering competitiveness of European clinical research may not require additional government spending/incentives. Rather, harmonisation of approval processes, greater visibility of centres of excellence and reduction of 'hidden' indirect costs, may bring significantly more clinical trials to Europe.
Collapse
Affiliation(s)
| | - Rod S Taylor
- Exeter Medical School, Institute of Health Services Research, University of Exeter, UK
| | | | | | | | | | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| |
Collapse
|
12
|
Lejeune S, Lacombe D. Towards personalized medicine in the EU: what is needed to facilitate the complex international clinical research? Per Med 2013; 10:849-857. [PMID: 29776285 DOI: 10.2217/pme.13.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cancer is a major health problem in developed countries. Despite important progress, cancer remains a fatal disease. In Europe, cancer care is becoming less and less sustainable because it is not cost effective. Better treatments should be made available to patients. The biology of the disease should be known. Drug development should be based on methodologically robust clinical trials testing drugs selected on the grounds of convincing preclinical evidence. Personalized medicine will be established only if sophisticated clinical research is conducted, maximizing the use of recent technologies. Modern clinical research will request a strong partnership between industry and academics, with close contact with regulators and payers. European legal framework should be streamlined and simplified in order to become researcher friendly.
Collapse
Affiliation(s)
- Stéphane Lejeune
- European Organisation for Research & Cancer, 83 Avenue Emmanuel Mounier, 1200 Brussels, Belgium.
| | - Denis Lacombe
- European Organisation for Research & Cancer, 83 Avenue Emmanuel Mounier, 1200 Brussels, Belgium
| |
Collapse
|
13
|
Ihrig K, Fath B, Fuchs M, Hallek M, Marschner N, Naumann R, Röllig C, Saussele S, Tesch H, Gökbuget N. [Focus on academic multicenter trials: impact of the German drug law on hematological/oncological therapy optimization trials]. ONKOLOGIE 2013; 36 Suppl 2:23-8. [PMID: 23549033 DOI: 10.1159/000348254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of legal regulations for clinical trials on study centers participating in investigator-initiated trials (IITs) in the field of hematology/oncology. METHOD Questionnaires were sent out to the heads of hematology-oncology study centers. RESULTS Medical units participating in IITs have a good infrastructure and extensive experience in clinical trials. Depending on indication, a high proportion of patients have been treated in studies with the purpose to improve outcome. However, 35% of the responders will reduce their participation in IITs in the future due to a lack of financial support for staff involved in the extensive organizational tasks. CONCLUSIONS The widely recognized research field in therapy optimization trials in hematology and oncology in Germany is at risk. This will have negative effects on the patients as highly sophisticated protocols will no longer be initiated in several study centers, resulting in the loss of valuable data for the improvement of patient therapy and outcome. To stop this development, legislators as well as regulatory authorities and health insurances need to make the necessary changes in the legal framework.
Collapse
Affiliation(s)
- Kristina Ihrig
- Kompetenznetz Leukämien, Medizinische Klinik II, Hämatologie und Onkologie, Studienzentrale, Klinikum der Goethe-Universität, Frankfurt a.M., Deutschland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Gökbuget N, Naumann R. [Application for academic multicenter studies at German ethical review boards]. Oncol Res Treat 2013; 36 Suppl 2:29-35. [PMID: 23549034 DOI: 10.1159/000348270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Before the start of a clinical trial, approval by the responsible institutional ethical review board (IRB) is required. In Germany, nearly 50 independent IRBs may be responsible for the different participating sites of a multicenter study. In trials for rare diseases, the participation of many centers is required. Therefore, the application procedure for academic multicenter trials in malignant hematologic diseases is often a bureaucratic nightmare. Different aspects of IRB application and possible approaches for improvement are presented.
Collapse
Affiliation(s)
- Nicola Gökbuget
- Universitäres Centrum für Tumorerkrankungen, Medizinische Klinik II, Hämatologie/Onkologie, Klinikum der Goethe-Universität, Frankfurt a.M., Deutschland.
| | | |
Collapse
|
15
|
Hartmann M. Impact assessment of the European Clinical Trials Directive: a longitudinal, prospective, observational study analyzing patterns and trends in clinical drug trial applications submitted since 2001 to regulatory agencies in six EU countries. Trials 2012; 13:53. [PMID: 22540886 PMCID: PMC3349611 DOI: 10.1186/1745-6215-13-53] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 04/29/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Shifts in clinical trial application rates over time indicate if the attractiveness of a country or region for the conduct of clinical trials is growing or decreasing. The purpose of this observational study was to track changes in drug trial application patterns across several EU countries in order to analyze the medium-term impact of the EU Clinical Trials Directive 2001/20/EC on the conduct of drug trials. METHODS Rates of Clinical Trial Applications (CTA) for studies with medicinal products in those six countries in the EU, which authorize on average more than 500 trials per year, were analyzed. Publicly available figures on the number of annually submitted CTA, the distribution of trials per phase and the type of sponsorship were tracked; missing data were provided by national drug agencies. RESULTS Since 2001, the number of CTA in Italy and Spain increased significantly (5.0 and 2.5% average annual growth). For Italy, the gain was driven by a strong increase of applications from academic trial sponsors; Spain's growth was due to a rise in trials run by commercial sponsors. The Netherlands, Germany, France and the UK saw a decline (1.9, 2.3, 3.0 and 5.3% average annual diminution; significant (P < 0.05) except for Germany) in clinical drug trials. The decrease in the UK was caused by a sharp fall in academic trial activities. Across the six analyzed countries, no EU-wide trial-phase-specific patterns or trends were observed. CONCLUSIONS The EU Clinical Trials Directive 2001/20/EC did not achieve the harmonization of clinical trial requirements across Europe. Rather, it resulted in the leveling of clinical trial activities caused by a continuing decrease in CTA rates in the Netherlands, Germany, France and the UK. Southern European countries, Italy and Spain, benefited to some extent from policy changes introduced by the Directive. In Italy's case, national funding measures helped to considerably promote the conduct of non-commercial trials. On the other hand, the EU Directive-driven transition from liberal policy environments, based on non-explicit trial approval through notifications, towards red-taped processes of trial authorization, contributed to the decreases in trial numbers in Germany and the UK. In the latter case, national research governance concerns had a share in the country's marked decline. However, different EU member states successfully developed best practices, which a new European legislation should take into consideration to resume Europe's attractiveness and international competitiveness for the conduct of clinical trials.
Collapse
Affiliation(s)
- Markus Hartmann
- European Consulting & Contracting in Oncology, St, Annastrasse 3, D-54295 Trier, Germany.
| |
Collapse
|
16
|
Frewer LJ, Coles D, van der Lans IA, Schroeder D, Champion K, Apperley JF. Impact of the European clinical trials directive on prospective academic clinical trials associated with BMT. Bone Marrow Transplant 2011; 46:443-7. [PMID: 20531283 PMCID: PMC3252796 DOI: 10.1038/bmt.2010.139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/29/2010] [Accepted: 04/21/2010] [Indexed: 11/08/2022]
Abstract
The European Clinical Trials Directive (EU 2001; 2001/20/EC) was introduced to improve the efficiency of commercial and academic clinical trials. Concerns have been raised by interested organizations and institutions regarding the potential for negative impact of the Directive on non-commercial European clinical research. Interested researchers within the European Group for Blood and Marrow Transplantation (EBMT) were surveyed to determine whether researcher experiences confirmed this view. Following a pilot study, an internet-based questionnaire was distributed to individuals in key research positions in the European haemopoietic SCT community. Seventy-one usable questionnaires were returned from participants in different EU member states. The results indicate that the perceived impact of the European Clinical Trials Directive has been negative, at least in the research areas of interest to the EBMT.
Collapse
Affiliation(s)
- L J Frewer
- MCB Group, Wageningen University, Wageningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|