EU-PEARL: Changing the paradigm of clinical trials in Europe

Issue

Recently, innovative clinical trial designs have been proposed, which have the potential to revolutionize clinical research. Whereas classical trials mostly evaluate only one investigational drug, platform trials embed various trials under a shared master protocol to enable the evaluation of multiple interventions for a disease or condition. Platform trials have mostly been used to evaluate cancer therapies, but also recently for COVID-19. The EU Patient-cEntric clinicAl tRial pLatforms (EU-PEARL) project aims to expand the use of platform trials as the backbone of drug development.

Description of Issue

EU-PEARL is a Innovative Medicines Initiative 2 Joint Undertaking funded project (2019-2023), and a strategic public and private sector alliance, which aims to support the transformation of the classical trial approach into a cross-company collaborative, multi-compound platform, centred around patients, not diseases. How to operationalize and sustain this? A multi-stakeholder, mixed-methods approach is taken, focused around the concept of an integrated research platform (IRP), i.e., a common enabling framework for platform trials. The IRP will be established as a sustainable and scalable global solution, consisting of an infrastructure, workflows, and guidance on how to meet complex regulatory, ethical, legal, statistical and data requirements. Lessons from COVID-19 trials will be incorporated.

Results

A disease-agnostic IRP is being developed, as well as four disease specific IRPs in four areas of high public health relevance, i.e. major depressive disorder, tuberculosis, non-alcoholic steatohepatitis, and neurofibromatosis.

Lessons

Multi-stakeholder, multi-sector and multi-disciplinary collaborations are challenging in practice, but rewarding in outcomes. Given the complexity of setting-up these novel trials, clear communication and standardized terminology must be established, as well as continual awareness building of their components, challenges and benefits.

Key messages

EU-PEARL intends to stage the clinical trials of the future, which will be more adaptive, efficient and patient-centred by design and outcome. EU-PEARĹs efforts aim to contribute to timely societal access to affordable medicines and address unmet health needs.

Different competition of thyroxine binding to transthyretin and thyroxine-binding globulin by hydroxy-PCBs, PCDDs and PCDFs

In an earlier study several hydroxylated polychlorinated biphenyls (PCBs), dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) competitively displaced [125I]thyroxine (T4) from transthyretin with different potencies. Transthyretin is the major T4 transport protein in plasma of rodents. In man, however, thyroxine-binding globulin transports most of the T4 in blood. In this study, hydroxylated PCBs, PCDDs and PCDFs were tested in an in vitro competitive binding assay, using purified human thyroxine-binding globulin and [125I]T4 as the displaceable radioligand. None of the tested hydroxylated PCBs, PCDDs and PCDFs inhibited [125I]T4 binding to thyroxine-binding globulin. In addition, some T4 derived compounds, e.g., tyrosine, mono-iodotyrosine, di-iodotyrosine and tri-iodophenol were tested on both transthyretin and thyroxine-binding globulin to investigate possible differences in structural characteristics determining T4 binding to thyroxine-binding globulin and transthyretin. The T4 derived compounds also did not inhibit [125I]T4 binding to thyroxine-binding globulin as tested in the in vitro assay. However, tri-iodophenol and to a lesser extent di-iodotyrosine inhibited [125I]T4-transthyretin binding. These results indicate a marked difference in T4 binding to thyroxine-binding globulin or transthyretin. The hydroxylated PCBs, PCDDs and PCDFs can inhibit T4 binding to transthyretin, but not to thyroxine-binding globulin, and thus may cause different effects in rodents and man.