THE BASICS OF CLINICAL RESEARCH: WHAT IT IS AND WHY IS IT IMPORTANT

INTRODUCTION

Clinical research is the study of health and illness in people.it looks at new ways to prevent, detect, treat, or understand disease. It may test new drugs or combination of drugs; new surgical procedures or devices; or new ways to use existing treatments. Clinical research involves people and it is generally carried out to evaluate the efficacy of therapeutic drug, a medical/surgical procedure, or a device as a part of treatment and patient management. Any research that evaluates the aspects of a disease like symptoms, risks factors, and pathophysiology, among others termed as clinical research. to assess the potential of a therapeutic drug/device in the management, control, and prevention of disease.

HISTORY OF CLINICAL RESEARCH

1. Public health service Syphilis study (1932)

2. US Food, Drug and Safety act (1938)

3. Nuremberg Code (1947)

4. Declaration of Helsinki (1964)

5. The National Research Act (1974)

6. The Belmont Report (1979)

7.International conference on Harmonisation -ICH (1990)

WHAT IT IS?

Clinical research is a component of medical and health research intended to produce knowledge valuable for understanding human disease, preventing, and treating illness, and promoting health. Clinical research is a process of planning, implementing and analysis of clinical study involving interactions with patients, diagnostic clinical materials or data, or populations in any of the following categories: 

(1) disease mechanisms (etiopathogenesis)

(2) bi-directional integrative (translational) research 

(3) clinical knowledge, detection, diagnosis, and natural history of disease

(4) therapeutic interventions including development and clinical trials of drugs, biologics, devices, and instruments

(5) prevention (primary and secondary) and health promotion

(6) behavioural research

(7) health services research, including outcomes, and cost-effectiveness

(8) epidemiology; and 

(9) community-based and managed care-based trials.

WHY ITS IMPORTANT?

New techniques for screening and diagnosis of a disease

New drugs to market 

New method for surgery

New approach for standard therapy

New combination of standard treatment

New techniques such as gene therapy

MAJOR COMPONENTS THE CLINICAL RESEARCH

Sponsors: Include private and public sector funding organizations such as the National Institutes of Health, pharmaceutical companies, medical device manufacturers, biotechnology firms, universities, private foundations, and national societies.

Research organization: Include academic health center, private research institutes, survey research organizations, federal government intramural research programs, and contracts.

Investigators: Investigators are the scientists performing clinical research with a qualification (e.g., MD, Ph.D., RN, DDS, PharmD).

Participants: Human volunteers, medical information and biological materials of human origin, or data derived from volunteers. may be healthy volunteers or populations at large.

Oversight Entities: Include Institutional Review Boards, Food and Drug Administration, Department of Health and Human Services, Veterans Affairs, National Committee for Quality Assurance, and other national regulatory agencies.

Stakeholders/Consumers: Include health insurers, managed care organizations, health care systems, organized medicine, voluntary health agencies, patient advocacy groups, purchasers of health care, and providers of health care, public health systems, and individual consumers

TYPES OF CLINICAL RESEARCH TRIALS

BASED ON RESEARCHER BEHAVE           BASED ON THE PURPOSE                     

observational study                                               Prevention trails

Interventional study                                              Screening trials 

                                                                              Diagnostic trials 

                                                                              Treatment trials 

                                                                              Quality trials 

                                                                              Compassionate use trials                                


PHASES OF CLINICAL TRIAL 

Phase 0

Phase 1

PHASE 2

PHASE 3

PHASE 4

-Phase 0 also called as human micro-dosing studies 

-Gathers preliminary and pharmacokinetics 

-Gives no data on safety or efficacy

-small number of subjects (10-15)

-First stage of testing in human subjects (20-100)

-Designed to assess the safety, tolerability, pk, and pd of drug.

Phase I:

  • SAD

  • MAD


-Therapeutic exploratory trials (20-300)

-Efficacy in patients (primary objective)

-safety issues (secondary objective)

Phase 2:

-Phase 2a: (Designed to asses dosing) requirements)

-Phase 2b :(Designed to study efficacy)

-Therapeutic confirmatory trials (300-3000).

-To establish in large number of patients, methods of usage etc....

Phase 3:

Phase 3a: To get sufficient and significant data 

Phase 3b: Allows patients to the treatment, label expansion, additional safety data.


-Post marketing studies (PMS)

-involves safety surveillance 

-Determine behavior of drug in real life situations 

-Evaluate action of drug in situation of missed dosage or over dosage

CLINICAL RESEARCH PROCESS INVOLVES:

PLANNING

IMPLEMENTATION

ANALYSIS

- Protocol 

- Informed consent form 

- Case report form 

- DatabaseDatabase design and finalization 

- Site selection process 

- IRB/IEC approval 

- Study design supply finalization  




-Site activation 

-Initial patient screening 

- Baseline exam and enrollment 

-Data acquisition and data entry

-Data validation 

-Data cleaning and quality control 

- Data base lock 

- Statistical analysis and regulatory submission 

- SAP 

- Outcome measures 

- Report


CONCLUSION

Clinical research strengthens its position as important component of the pathway from discovery to improved treatment outcomes for patients. All participants and stakeholders, including physician, patients, and health care providers, agencies, foundations, industry, must reevaluate their current roles and responsibilities in clinical trails and work together to develop a more effective health benefits to all involved in research. All the trials must be planned in such a way that prerequisites are ready in time after planning the study data must be maintained with accuracy for analysis and good practices. one must always strive for the ideal, but in most cases must settle for the best comprise.

REFERENCES

Institute of Medicine (US) Clinical Research Roundtable; Tunis S, Korn A, Ommaya A, editors.Washington (DC): National Academies Press (US); 2002 https://www.ncbi.nlm.nih.gov/books/NBK220715/

https://www.hopkinsmedicine.org/research/understanding-clinical-trials/clinical-research-what-is-it.html

https://clinicaltrials.gov/ct2/about-studies/learn

https://s4be.cochrane.org/blog/2021/04/06/an-introduction-to-different-types-of-study-design/


Student name: Sanobar Shifali

Student Id: 081/052023

Qualification: Pharm-D

E-Mail ID: sanobarpharmd@gmail.com









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