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Should I Participate in a Clinical Trial?

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This talk will review the importance of ongoing medical research and how it helps advance medical knowledge and promote the development of new treatments. We will discuss the research process, the protection of study participants, and how individuals may find and choose research studies to volunteer in at SMG or elsewhere.

Veröffentlicht in: Gesundheit & Medizin, Business
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Should I Participate in a Clinical Trial?

  1. 1. SHOULD I PARTICIPATE IN A CLINICAL TRIAL? GARY C. PIEN, MD/PhD Allergist/Immunologist SMG Research Director June 5, 2013
  2. 2. OBJECTIVES • Understand what is a clinical trial • Examine the role of medical research and clinical trials in developing new therapies • Review the drug development process • Discuss ethical and scientific safeguards to protect research participants • Highlight ways to participate in medical research
  3. 3. WHAT IS A CLINICAL TRIAL? • medical research • novel methods to diagnose, prevent, or treat diseases  new drugs  new combinations of drugs  new indications of an existing drug  new surgical techniques or medical devices  new test for diagnosing disease or risk of disease  establishing new guidelines or recommendations • goal is to determine if new intervention is safe and effective http://www.nih.gov/health/clinicaltrials/basics.htm
  4. 4. TYPES OF CLINICAL TRIALS NATURAL HISTORY • how does a disease change, progress, or develop over time? PREVENTION • how to prevent a disease from developing or recurring? SCREENING OR DIAGNOSTIC • how to detect a medical condition or diagnose a particular disease QUALITY OF LIFE • measure ways to improve comfort and quality of life with a chronic illness TREATMENT • testing a new medication, procedure, or device http://www.nih.gov/health/clinicaltrials/basics.htm
  5. 5. CLINICAL TRIAL “PHASES” PHASE I • healthy human volunteers (20-80) • establish safety and side effects • evaluate drug absorption, metabolism, clearance PHASE II • first use in patients with disease/medical condition (100-300) • limited duration, narrow patient criteria • establish efficacy, short-term safety http://www.nih.gov/health/clinicaltrials/basics.htm
  6. 6. CLINICAL TRIAL “PHASES” PHASE III • confirmation of therapeutic benefit under “real-life” conditions • 1000-3000 patients • wider patient criteria • often multi-center, multi-national, comparative • longer-term safety, drug interactions, contraindications PHASE IV • after-market trials • long-term safety data • identify rare side effects http://www.nih.gov/health/clinicaltrials/basics.htm
  7. 7. HOW A DRUG COMES TO BE DiMasi et al, 2003, Journal of Health Economics 22: 151–185. Preclinical 1 - 6 yrs 1 in 8 move on Drug discovery and development
  8. 8. HOW A DRUG COMES TO BE DiMasi et al, 2003, Journal of Health Economics 22: 151–185. Preclinical 1 - 6 yrs 1 in 8 move on Drug discovery and development http://sydney.edu.au/bmri/research/brain-drug-discovery/index.php
  9. 9. HOW A DRUG COMES TO BE DiMasi et al, 2003, Journal of Health Economics 22: 151–185. Clinical Phase I • safety • $15 million • 22 months Phase II • safety, dosing, efficacy • $23 million • 26 months Phase III • safety, efficacy, side effects • $87 million • 31 months Investigational new drug application 6 - 11 yrs 30% 14% 9%40% Preclinical 1 - 6 yrs 1 in 8 move on Drug discovery and development
  10. 10. HOW A DRUG COMES TO BE DiMasi et al, 2003, Journal of Health Economics 22: 151–185. Clinical Phase I • safety • $15 million • 22 months Phase II • safety, dosing, efficacy • $23 million • 26 months Phase III • safety, efficacy, side effects • $87 million • 31 months Investigational new drug application 6 - 11 yrs 30% 14% 9%40% Approval 1-2 yrs 8% New drug application Market 11-14 yrs Phase IV also post- market surveillance Preclinical 1 - 6 yrs 1 in 8 move on Drug discovery and development
  11. 11. PROTECTION OF RESEARCH PATIENTS http://www.mastercontrol.com/newsletter/good-clinical-practices-review-application.html
  12. 12. PROTECTION OF RESEARCH PATIENTS DECLARATION OF HELSINKI - 1975 • protect health, dignity, integrity, privacy of volunteers • study must conform to accepted scientific principles • research protocol must be established and followed • protocol must be approved by independent ethics committee • benefits must outweigh risks • participation must be voluntary, without duress • informed consent must be obtained • privacy and confidentiality must be protected http://www.wma.net/en/30publications/10policies/b3/
  13. 13. PROTECTION OF RESEARCH PATIENTS BELMONT REPORT - 1979 • Smithsonian Institute • respect for persons – autonomy of patients • beneficence – protection from harm, ensure well-being of patients • justice – results should benefit all (not just those who can afford it, etc) COMMON RULE - 1981 • US federal policy derived from Declaration of Helsinki • enforces compliance by research bodies • safeguards informed consent • provides for IRB regulations • establishes protections for vulnerable populations (prisoners, children, pregnant women) http://www.mastercontrol.com/newsletter/good-clinical-practices-review-application.html
  14. 14. PROTECTION OF RESEARCH PATIENTS ICH • International Conference on Harmonisation • brings together regulatory bodies of Japan, Europe and US • develop standards for ethical and scientific research • quality, safety, efficacy, regulatory issues • reduce duplicate testing GCP • Good Clinical Practices • human subject protection – patient rights, integrity, confidentiality • standards for design, conduct, performing, monitoring, recording data http://ichgcp.net/2-the-principles-of-ich-gcp-2 http://www.wma.net/en/30publications/10policies/b3/
  15. 15. PROTECTION OF RESEARCH PATIENTS IRB • institutional review board • doctors, scientists, lay people • scientific, ethical, and regulatory oversight • ensure that rights and welfare of participants are protected • appropriate recruitment population? • how are patients recruited? • adequate disclosure and informed consent? • are risks too great? http://www.fda.gov/forconsumers/consumerupdates/ucm134723.htm
  16. 16. PROTECTION OF RESEARCH PATIENTS FDA • Food and Drug Administration • has authority over clinical trials • inspects and audit research sites • ensures rights and welfare of participants • reviews data quality and integrity http://www.fda.gov/forconsumers/consumerupdates/ucm134723.htm
  17. 17. PROTECTION OF RESEARCH PATIENTS INFORMED CONSENT • disclose purpose and protocol for study • adequate information for potential volunteers to decide whether to enroll • Q&A opportunity for investigator and patient • no obligation to join a study • consent must be written • consent may be withdrawn at any time http://www.fda.gov/forconsumers/consumerupdates/ucm134723.htm http://ori.dhhs.gov/education/products/RCRintro/c03/0%20c3.html
  18. 18. MEMBERS OF THE RESEARCH TEAM PATIENT Clinical Research Coordinator Principal Investigator Sub-investigator Private physician Clinical research associate Study monitor Contract research organization Study sponsorIRB FDA
  19. 19. CONSIDERATIONS BEFORE ENROLLING RISKS • potential side effects from treatment (may be minor to life-threatening) • may be assigned to a placebo control group • impact on daily activities (time commitment, etc) BENEFITS • access to new treatments before they are widely available • regular and careful medical follow-up with research team during trial • help contribute to medical science • play more active role in one’s medical care • results of the study may benefit other people and future generations http://www.nih.gov/health/clinicaltrials/basics.htm
  20. 20. QUESTIONS TO ASK THE STUDY • what is the purpose of the trial? • why do we think this new treatment will work or help? PARTICIPATION • what tests or procedures are required during the study? • how do these tests/procedures differ from standard treatment? • who will be in charge of my care? RISKS AND BENEFITS • benefits to me? • what are the chances of side effects? • how serious are those potential side effects? • are there other options to treat my condition? http://www.nih.gov/health/clinicaltrials/basics.htm
  21. 21. QUESTIONS TO ASK QUALITY OF LIFE • how will this trial impact my daily living? • how long will the study last? • what are my responsibilities? • can I take other medications during the trial? COST • will I have to pay for any part of the trial? • will my health insurance cover any part of the costs? • are there any travel expenses? • is there compensation for my participation? http://www.nih.gov/health/clinicaltrials/basics.htm
  22. 22. REASONS FOR ENROLLING (OR NOT) ENROLL • a trusted physician recommended study • additional attention and care through trial participation • encouraged by friends/family • altruism • (desire to live) DECLINE • anxiety about randomization • worry not best treatment • logistical difficulties • concerned about side effects • friends/family against study Albrecht et al, 2003, Journal of Cancer Educ 18: 210–214.
  23. 23. ADDITIONAL RESOURCES http://clinicalresearchtrials.nih.gov http://www.researchmatch.org http://www.clinicaltrials.gov
  24. 24. RESEARCH AT SMG CURRENT • Breast cancer • Breast implants • Colorectal cancer • Dust mite allergies • Osteoporosis • Overactive bladder PAST • Diabetes • Prostate cancer • Rheumatoid arthritis • Tinnitus
  25. 25. THANK YOU!
  26. 26. ETHICAL ATROCITIES WORLD WAR II • Nazi experimentation on human prisoners  freezing, poison, chemical warfare, etc  tried at Nuremberg • Imperial Japanese Army experimented on coerced humans  biological warfare agents  offered immunity by General MacArthur for exclusive access to data TUSKEGEE SYPHILIS • compared effects of treating vs no treatment for syphilis • involved impoverished African-American men • not given informed consent • not informed of diagnosis, placebo treatment, or risks