Introduction to clinical trials
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Introduction to clinical trials. Definition of a clinical trial. A research activity that involves administration of a test treatment to some experimental unit in order to evaluate the treatment. Key words. Treament. Pharmaceutical, diet, procedure, diagnostic, device, program, placebo.

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Introduction to clinical trials

Introduction to clinical trials

Stefan Franzén


Definition of a clinical trial

Definition of a clinical trial

A research activity that involves administration of a test treatment to some experimental unit in order to evaluate the treatment.


Key words

Key words

Treament

Pharmaceutical, diet, procedure, diagnostic, device, program, placebo.

Experimental unit

Subject from a target population.

Evaluate

Assessment of (clinical) effect, but also adverse events, lab variables, vital signs, quality of life, health economy.


The first study

The first study

I have found two treats that makes a letcure seem more interesting.

How do I find out which one is best?


The wheel of science

The Wheel of Science

Experiment

Research

question

Data

Conlusion


Drug discovery development process

Drug discovery/development process

discovery; refinement; chemical & biological characterisation

safety & toxicity in animals; formulation development

volunteer studies; patient studies

regulatory process

marketing

Lessons &

development

post registration

monitoring

Discovery=find new active structure : Development=convert it to a useful drug


The path to a new medicine

The path to a new medicine

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

Years

First patent

application

Clinical trial

application

Product licenceapplication

Drug Discovery

Drug Development

Target and leadidentification

Leadoptimisation

Developmentfor launch

Product lifecycle support

Concept testing

Launch

Clinical Development

Phase I12-150people

Phase II50-1000people

Phase III500-5,000people

Phase IV studies continue

Toxicology and pharmacokinetic studies

(absorption, distribution, metabolism, excretion)

Pharmaceutical and analytical development

Process chemistry and manufacturing

Registration and regulatory affairs

Sales and marketing (preparation, promotion, advertising and selling)

No. of compounds

Up to 10,000

10-15

1-8

1-3

1


Phase i

Phase I

The drug seems reasonably safe in animal study, but has never been tested on humans

What do we want to know?

How can we find that out?


Phase i trials

Phase I trials

Phase I50-150people

Phase III500-15000people

Phase II100-200people

Phase IV studies continue

  • Focused on tolerability and safety

  • 12-30 (150) healthy people (often males)

  • Efficacy on biomarkers if possible

  • Single and repeated doses

  • Increase dose levels

  • Interaction with other drugs

  • Pharmacokinetics

  • Explorative’

  • ADME (Absorption, Distribution, Metabolism Excretion)

  • Through QT study

  • Bridging , PK in other populations


Phase ii

Phase II

The drug seems to be resonably safe in humans and there is some sign of an effect on something.

What do we want to know next?

How can we find that out?


Phase 2 trials

Phase 2 trials

Phase II50-1000people

Phase I50-150people

Phase III500-5,000people

Phase IV studies continue

  • 50-1000 patients

  • Extensive monitoring

  • Safety and tolerability in patients

  • Often complicated design, explorative

  • Selection of optimal dose

  • Pharmacokinetics in patients

  • Effect in special populations

  • Explorative


Phase iii

Phase III

The drug seems resonable safe to give to patients and we have and idea of which dose to use.

What do we want to know now?

How can we find that out?


Phase 3 trials

Phase 3 trials

Phase III500-15000people

Phase I50-150people

Phase II100-200people

Phase IV studies continue

  • 500-20000 patients

  • Effect is verified in the target population

  • Forms the basis of the NDA, New Drug Application

  • Interactions between drugs start to become measurable in the larger population

  • sub-groups start to be established

  • special features and problems show up

  • Confirmative


Phase iv

Phase IV

Our drug is approved for use on patients.

What’s next?


Phase iv trials

Phase IV trials

Phase I50-150people

Phase II100-200people

Phase III500-5,000people

Phase IV studies continue

  • Often large 500-30000 patients

  • Further investigation of efficacy and safety post approval

  • Special populations

  • New indications

  • Marketing


Observational studies

data collection

analysis

interpretation

time

now

Observational studies

Data is collected for a set of patients without any randomisation

Prospective: Data is collected after the objectives are set

data collection

analysis

interpretation

time

now

Retrospective: Data is collected before the objectives are set


Where to look for information

Where to look for information

ICH (international Conference on Harmonisation)

http://www.ich.org/products/guidelines.html

FDA (Food and Drug Agency)

http://www.fda.gov/

EMEA (European Medicines Agency)

http://www.emea.europa.eu/

Cochrane Collaboration

http://www.cochrane.org/index.htm


Introduction to clinical trials

ICH

  • Quality

  • Efficacy

  • Safety

  • Multidiciplinary


Ich quality guidelines

ICH Quality guidelines

Harmonisation achievements in the Quality area include pivotal milestones such as the conduct of stability studies, defining relevant thresholds for impurities testing and a more flexible approach to pharmaceutical quality based on Good Manufacturing Practice (GMP) risk management.


Ich safety guidelines

ICH safety guidelines

ICH has produced a comprehensive set of safety Guidelines to uncover potential risks like carcinogenicity, genotoxicity and reprotoxicity. A recent breakthrough has been a non-clinical testing strategy for assessing the QT interval prolongation liability: the single most important cause of drug withdrawals in recent years.

  • S7A: Safety Pharmacology Studies for Human Pharmaceutical

  • S7B: The Non-Clinical Evaluation of the Potential for Delayed Ventricular Repolarization (QT prolongation) by Human Pharmaceutical


Ich efficacy guidelines

ICH efficacy guidelines

The work carried out by ICH under the Efficacy heading is concerned with the design, conduct, safety and reporting of clinical trials. It also covers novel types of medicines derived from biotechnological processes and the use of pharmacogenetics/genomics techniques to produce better targeted medicines.


Ich efficacy guidelines1

ICH Efficacy Guidelines

  • Clinical Safety E1-E2F

  • Clinical Study Reports E3

  • Dose Reponse Studies E4

  • Ethnic Factors E5

  • Good Clinical Practise E6

  • Clinical Trials E7-E11

  • Clincal Evaluation of a Therapeutic Category E12

  • Clincal Evaluation E14

  • Pharmacogenomics E15-E16

  • Cross Cutting Topics E17


Ich efficacy guidelines2

ICH Efficacy Guidelines

  • E7: Studies in Support of Special Populations, Geriatrics

  • E8: General Considerations for Clinical Trials

  • E9: Statistical Principles for Clincal Trials

  • E10: Choice of Control Group and Related Issues

  • E11: Clinical Investigation of Medicinal Products in the Pediatric Population


The clinical study process

The Clinical Study Process

Preparation of statisticalanalysis

StatisticalAnalysis

Outline

Clinical StudyProtocol

StudyConduct

Clinical Study Report

StudySetup

Data Capture

Publications

StatisticalAnalysis Plan

Clean File

Data base lock

T i m e


Chapter 1 reading instructions

Chapter 1 Reading instructions

  • 1.1 What are clinical trials: Read

  • 1.2 History of clinical trials: Less important

  • 1.3 Regulatory process and requirements: Read page 14

  • 1.4 Investigational new drug application: Read page 17–20

  • 1.5 New drug application: Less important

  • 1.6 Clinical development plan and practise: Read

  • 1.7 Aims and structure of this book: Skip


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