Conducting a clinical trial is a complex and challenging task and involves robust scientific understanding and logistics planning. Although there are international guidelines for good clinical practices, the standard approach may not work for all clinical trials especially in the case of trials that use orphan drugs, terminally ill patients, epidemiological trials, and so on.
Factors that plague clinical trials
It has been reported that approximately 50% of phase III clinical trials do not achieve their objective or fail to demonstrate the desired results. Some of the major issues that pharmaceutical companies face while conducting large-scale trials are:
Meeting regulatory deadlines: Inadequate or poor patient recruitment, poor execution, or complicated study design are some reasons that contributed to the inability of a company to meet timelines. Approximately, 80% of trials are behind schedule. Analysis shows patient recruitment to be one of the prime reasons for study delay.
Data quality: A flawed study design and complacency in following the patient eligibility criteria required for enrolment also affect the data quality and ethics of a trial. In addition, lack of patient informed consent or breach of confidentiality are other serious unethical practices that affect final data quality.
Infrastructure and resources: While accounting for infrastructure and resources, sponsor companies sometimes underestimate the requirement of trained staff at each step of a trial. A sponsor may need to recruit more number of clinical trial associates, study coordinators as well as other trained personnel depending upon the number of trial sites and targeted cohort size. At times, the importance of site inspection is also overlooked. Site inspections help in evaluating the technical capability of the staff and confirm if the site is well equipped to handle additional responsibilities.
Unexpected challenges: Sponsor companies are sometimes caught unawares by challenges that crop up during execution of a trial. Without a risk management plan (RMP), it is impossible to identify warning signs and can also bring the trial to an abrupt halt.
All the above factors require the sponsor to look for remediation measures and this is where rescue trials come into picture.
There are different approaches that pharmaceutical companies employ for rescue support. For specific issues, the company may choose to bring on board a third party with expertise in a specific function or completely outsource study management and control to a contract research organization (CRO).
Integrating into an ongoing study requires the on boarding team to have the flexibility as well as the insight to identify problem areas that have led to the failure of the Sponsor’s trial. Therefore, it is necessary for the CRO to have demonstrated expertise in handling a particular therapeutic area or to have the technical knowhow of running rescue studies. This will help in seamless knowledge transition and identification of bottlenecks that have caused the trial to fail.
In case the trial is being transferred from another CRO, there should be a clear communication and handover plan from the outgoing CRO to the on boarding CRO and the Sponsor Company. This communication should include strategic details such as current study status, vendors involved, database migration, documentation and quality control, current risk management plan, to name some of them.
For a successful rescue study, there should be document compliance and effective documented communication between the sponsor and CRO. Corrective action and preventive action (CAPA) at each stage of the trial is necessary, especially in the case of rescue studies, to meet study milestones and to avoid any further delay in trial execution
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