The shift towards decentralized clinical trials (DCTs) is gaining momentum, with both the U.S. Food and Drug Administration (FDA) and European regulators issuing guidance to encourage their use and ensure patient safety. DCTs leverage digital tools, telemedicine, and local healthcare facilities to make clinical trials more accessible and efficient.
Regulatory Support for Decentralized Trials
In September 2024, the FDA finalized its guidance on "Conducting Clinical Trials With Decentralized Elements," offering recommendations for sponsors, investigators, and other stakeholders involved in drug, biologic, and medical device development. This guidance builds upon earlier recommendations issued during the COVID-19 pandemic, reflecting the lessons learned about remote trials and the potential benefits of DCTs.
Similarly, the EU has published new recommendations aimed at encouraging the adoption of DCTs, with a focus on safeguarding the wellbeing of participating patients. These recommendations are part of the ACT EU initiative, a collaboration between the European Commission, the European Medicines Agency (EMA), and the Heads of Medicines Agencies (HMA) group.
Key Elements of Decentralized Trials
DCTs involve conducting trial-related activities at locations other than traditional clinical trial sites. This can include:
- Telehealth visits
- In-home visits by healthcare professionals
- Remote monitoring and diagnostics
- Direct-to-patient shipment of study drugs
- Electronic informed consent
These elements can significantly reduce the burden on patients, caregivers, and medical providers, while also expanding access to more diverse populations, improving trial efficiencies, and facilitating research on rare diseases and diseases affecting populations with limited mobility.
Addressing Challenges in Decentralized Trials
While DCTs offer numerous advantages, they also present unique challenges that need to be addressed. These include:
- Sponsor/Investigator Responsibility: Clearly defining the roles and responsibilities of sponsors, investigators, and other parties involved in the trial.
- Electronic Informed Consent: Ensuring that patients fully understand the trial protocol and provide informed consent through digital means.
- Data Management: Implementing robust data management systems to collect, monitor, and analyze data from various sources.
- Data Variability: Minimizing data variability by providing detailed instructions, training, and supervision to all personnel involved in data collection.
Ensuring Data Quality and Consistency
To mitigate the risk of data variability, the FDA emphasizes the importance of detailed instructions, education, training, and supervision. For example, training or video supervision could be used to mitigate the risk of data variability compared to self-administered tests. Investigators are responsible for reviewing data from local healthcare professionals and other trial personnel to ensure quality and consistency.
The Future of Clinical Trials
Experts believe that decentralized clinical trials are the "new modus operandi" of clinical research. While not all trials will or should have decentralized elements, Phase 3 trials, in particular, could benefit from their use due to the better-understood safety profiles of the treatments being investigated. As the adoption of DCTs continues to grow, further research into data quality and the impact of decentralized elements on patient access and diversity will be crucial.
