Guest Blog: Ken Getz Calls for Commitment and Consistency to Realize Full Potential of Patient Engagement

Ken Getz, director of sponsored research programs and research associate professor, Tufts Center for the Study of Drug Development, Tufts University, offered his insights on patient engagement at CTTI’s 10-year Anniversary Symposium on Tues., Feb. 6. He shares those thoughts here in a special guest blog.

As a veteran observer and analyst of the clinical research enterprise, I am very proud of and amazed by the extent to which the patient engagement movement has touched the entire continuum of new medical interventions development.

New services have been created to improve the participant experience, including electronic informed consent forms and direct-to-patient clinical trials. Regulatory agencies have established mechanisms to gather input into clinical outcomes most relevant to patient communities. Sponsors are supporting more meaningful end-of-trial experiences, such as the return of plain language trial results summaries and e-clinical data to study volunteers. The movement has mobilized stakeholders and stimulated more collaboration than we have ever seen before.

However, while we see a proliferation of patient engagement initiatives and guidelines, there are few signs of standard and consistent commitment and practice. Almost daily, new entrants offer technology solutions that can create more fragmentation and market confusion. We also see wide variability in receptivity to, and implementation of, patient engagement initiatives. Nearly all organizations have vocalized concerns about the financial return, long-term value, and perceived risks of patient engagement.

CTTI is committed to helping organizations work through these barriers and obstacles. I have had the privilege of participating in several CTTI projects, including a recent study that quantified the high expected net present value of patient engagement practices for a typical oncology drug development program.

We must do everything we can to give the patient engagement movement the opportunity to take hold and realize its compelling promise. Only then will clinical research and clinical care best serve the needs of public and patient health.

Now Available: CTTI Symposium Presentations

For those unable to attend the CTTI 10-year Symposium on Feb. 6, we are pleased to share slides from each of the exciting, informative sessions:

Meeting Presentations

  1. Welcome and Introduction to CTTI by Pamela Tenaerts, CTTI
  2. Welcome from the Executive Committee by Jacqueline Corrigan-Curay, FDA, CDER
  3. Keynote Address by Robert Califf, Duke University / Verily
  4. Reflection on Quality by Design by Robert Temple, FDA, CDER
  5. Quality by Design Project Overview and Recommendations by Ann Meeker-O’Connell, Johnson & Johnson
  6. Quality by Design Case Study by Julie Dietrich, Amgen, Inc
  7. PGCT Project Overview and Recommendations by Bray Patrick-Lake, Duke Clinical Research Institute
  8. PGCT Case Study by Ron Bartek, Friedreich’s Ataxia Research Alliance
  9. PGCT Case Study by Jeff Sherman, Horizon Pharma
  10. Single IRB of Record Project Overview and Recommendations by Soo Bang, Celegene
  11. Single IRB of Record Case Study by Hallie Kassan, Feinstein Institute for Medical Research, Northwell Health

Thank you again to all of our esteemed presenters who made the CTTI Symposium a great success! Keep an eye on this blog for a complete recap of the event later this week.

Four Key Areas Where CTTI Has Transformed Clinical Trials

This year, CTTI marks its 10th year of working with a variety of stakeholders to positively change clinical trials, making them more streamlined, efficient, and patient-focused. To commemorate this milestone, we will #CelebrateCTTI throughout the month of January. Join us for the celebration—visit this blog, follow us on Twitter, and register to attend our 10 Year Anniversary Symposium on Tues., Feb. 6.

Since its inception in 2007, CTTI has made transformational shifts in the design and conduct of clinical research. Let’s take a look at the evolution of clinical trials in four key areas, among many, in which CTTI has played a critical role in moving the industry toward more efficient, high-quality, and patient-centric trials:

Trial Quality

Regulators have long acknowledged a need to change how the industry approaches clinical trial quality in order to focus on reducing errors that undermine data integrity and patient safety. Drawing on the expertise of key stakeholders, CTTI issued recommendations on effective and efficient trial monitoring in 2012. The following year, FDA issued final guidance on a risk-based approach to monitoring, reflecting principles from CTTI’s work. CTTI also developed the concept of Quality by Design, taking the focus from a reactive approach using audits to a proactive approach that builds quality into clinical trials at the outset. CTTI released its Quality by Design recommendations and toolkit in 2015, and its work in this area has been cited in FDA guidance and incorporated into GCP guidelines.

Patient Engagement

CTTI has been a pioneer in patient engagement, involving patient representatives in its organizational leadership and throughout its project teams. Spurred by the FDA’s Safety and Innovation Act of 2012, CTTI initiated the Patient Groups & Clinical Trials Project to establish best practices for engaging patients in clinical research. In 2014, CTTI released landmark recommendations that are currently used by multiple stakeholders to facilitate productive relationships with patient groups around clinical trials. In 2017, CTTI and FDA announced a partnership on a new initiative, the Patient Engagement Collaborative, to improve patient engagement across the FDA.

Central IRB

Although U.S. regulators are enthusiastic about the use of a central IRB to promote more efficient multi-site clinical trials, enterprise-wide implementation has lagged. CTTI initiated the Central IRB Project in 2010, creating recommendations and resources to help organizations identify and address barriers to the adoption of a central IRB. The NIH issued a draft policy in 2014 referencing CTTI’s recommendations and a final policy in 2016 requiring all NIH-funded multi-site clinical trials to use a central IRB effective in 2018.

Real-World Evidence

Since its inception, CTTI has recognized that “real-world evidence” from electronic health records, mobile devices, and other sources can provide unique insights into important clinical questions and could improve the efficiency of clinical trials. The FDA Amendments Act of 2007, which mandated FDA to develop a system to link safety data from multiple sources, paved the way for the use of connected datasets in clinical trials. After partnering with the FDA and Harvard Pilgrim Health Care Institute to assess the feasibility of using the Sentinel database for clinical research, CTTI supported the first trial using Sentinel. CTTI also launched a program in 2016 to support the use of mobile technology in clinical trials, issued recommendations in 2017 on how to use registries as reusable platforms for trials, and announced a Real-World Evidence Project in 2017.

CTTI Selected to Support FDA Efforts to Increase Patient Engagement Through New Collaborative

CTTI has been engaged by the U.S. Food and Drug Administration (FDA) to support its Patient Engagement Collaborative (PEC), an effort created in partnership with CTTI to bring together members of the patient community to discuss the best ways for patients to participate in the FDA’s regulatory discussions about medical products.

“Engaging patients as partners in the development of medical products is critical to the success of the clinical research enterprise, and CTTI is pleased to be hosting this new forum for patients and regulators to discuss and exchange ideas,” said Pamela Tenaerts, MD, MBA, CTTI Executive Director. “This is an important initiative that will benefit not only patients and regulators, but all stakeholders in the research enterprise.”

The Patient Engagement Collaborative is being created because of public feedback the FDA requested on Section 1137, Patient Participation in Medical Product Discussions, of the Food and Drug Administration Safety and Innovation Act (FDASIA). One suggestion was to create an outside group to give input on patient engagement across the FDA.

“The FDA is committed to expanding its efforts to engage patients in its regulatory decision-making processes and the new PEC will include a diverse group of representatives from outside the FDA who will help enhance the agency’s understanding of how to best engage across patient communities,” said Rachel E. Sherman, MD, MPH, FDA Principal Deputy Commissioner. “CTTI has a well-established network of patients and patient advocates, and we look forward to working with them in this important effort.”

The Patient Engagement Collaborative will bring 16 patients, caregivers, and patient group representatives together with the FDA several times a year to discuss topics such as communication, transparency, and new ways for patients and the FDA to work together. The new group will be hosted by CTTI, which has strong ties to the patient community.

Nominations to join the Patient Engagement Collaborative will be accepted until Jan. 29. Learn more about what is expected of members and how to apply in the Federal Register Notice. You are also welcome to join a call hosted by CTTI and the FDA on Fri., Jan. 12, at 2pm ET if you have questions about applying. Join by calling 800-988-9752 and use participant code 4753141.

CTTI Cited during the FDA’s Patient Engagement Advisory Committee Inaugural Meeting

Findings and recommendations from CTTI’s Patient Groups & Clinical Trials work were presented during the inaugural meeting of the FDA’s Patient Engagement Advisory Committee (PEAC) on Oct. 11-12, 2017.

At the meeting, Bray Patrick-Lake, director of stakeholder engagement, Duke Clinical Research Institute, discussed patient engagement efforts in the clinical trial enterprise and presented work conducted by CTTI to establish best practices for effective engagement with patient groups around clinical trials, which include:

  • Engage the “patient voice” by establishing partnerships from the beginning of the research and development program to improve trial design and execution
  • Clearly define the expectations, roles, and responsibilities of all partners, including the resources being committed, data being shared, and objectives of the program
  • Manage real or perceived conflicts of interest by establishing policies that require full disclosure, transparency, and accountability

The PEAC is composed of patients and caregivers who provide perspective to the FDA on complex issues relating to medical devices, the regulation of devices, and their use by patients. This first meeting brought together patients, patient organizations, FDA, industry, and other medical and scientific experts for discussion on incorporating patient perspectives in the design, conduct, and reporting of medical device clinical trials.

Meeting materials, including slide presentations, are available on the FDA website.

Getting Down to the Bottom Line: The Financial Impact of Patient Engagement in Clinical Trials

CTTI publishes framework for estimating the impact of patient engagement on key business drivers

To fully realize the impact of patient engagement in clinical trials, there is a need for robust and rigorous study of its quantitative effects on research and development. To begin to address this gap, CTTI recently published an approach for assessing the financial value of patient engagement that accounts for the business drivers of cost, risk, revenue, and time.

In a set of recommendations published along with the financial model, CTTI’s Patient Groups & Clinical Trials Project team outlines “rules of engagement” for successful collaborations between research sponsors and patient groups around clinical research. Together, the articles in Therapeutic Innovation & Regulatory Science (TIRS) provide a blueprint for establishing effective patient group engagement in research programs.

While research sponsors are increasingly partnering with patients in the design and conduct of clinical development programs, sponsors may be reluctant to go beyond pilot initiatives because of uncertainty in the return on investment. The new CTTI article describes a novel approach to quantifying the financial impact of patient-centric initiatives using risk-adjusted financial modeling techniques that integrate key business drivers into a summary metric (expected net present value). Expected net present value (ENPV) is a widely used metric by industry for project strategy and portfolio decisions.

Drawing on published data to develop a case study for a typical oncology development program, the authors also show how patient engagement activities that avoid a protocol amendment or improve the patient experience can contribute considerable financial value.

Ongoing work by CTTI’s Patient Groups & Clinical Trials Project is examining how sponsors and patient groups characterize the benefits of patient engagement and investments required for engagement. Along with the ENPV model, the project aims to provide resources to assist in determining which of the many engagement opportunities provide the greatest value.

CTTI Shares Tools for Improving Trials in 2 Presentations at SCOPE Summit

This year’s SCOPE Summit, taking place January 24-26, 2017, in Miami, FL, will feature three presentations on CTTI recommendations for adopting quality by design, patient engagement, and recruitment in clinical trials. SCOPE, the Summit for Clinical Ops Executives, is focused on issues around clinical trial best practices, and attendees include industry leaders from over 500 organizations. CTTI looks forward to the opportunity to engage with decision-makers across the clinical trial enterprise to improve clinical trial planning and management.

Don’t miss our informative sessions with actionable takeaways:

Presentation: Moving Recruitment Planning Upstream to Reduce Barriers to Participation: Recommendations from the CTTI Recruitment Planning Project

Presenter: Beth Mahon, Janssen Research and Development

Date & Time: Tuesday, January 24 from 11:15 – 11:40 AM ET

Description: Learn the importance of proactivity in clinical trials planning in order to reduce participation barriers. This session will describe recommendations from CTTI’s Recruitment Project, which provide a framework for strategic recruitment planning that begins during the trial design and development process.

Presentation: Patient Group Engagement in Clinical Trials: Best Practices for Best Value

Presenter: David Leventhal, Pfizer, Inc. and Ken Getz, Tufts Center for the Study of Drug Development

Date & Time: Wednesday, January 25 from 5:20 – 5:45 PM ET

Description: Learn to apply actionable recommendations for establishing strong, active patient group engagement during all phases of the research and development life cycle. We’ll also share our net present value model that helps to quantify the value, including financial return on investment, of patient engagement. These tools and best practices resulted from CTTI’s Patient Groups & Clinical Trials Project.

Happy Holidays from CTTI – Gifts you can use

Happy Holidays

If quality, efficient trials are on your wish list, we’ve got you covered.

CTTI’s latest recommendations and tools:

In 2016, there were over 30,000 downloads from the CTTI website. Popular favorites include our evidence-based recommendations on trial qualityinformed consent, and patient group engagement.

By engaging all stakeholders to develop actionable solutions, we are creating a better system for clinical trials. Thank you to all of our members and contributors for their efforts this past year, and best wishes for a successful 2017!

FDA and CTTI to Collaborate on New Patient Engagement Initiative

The FDA and the Clinical Trials Transformation Initiative (CTTI) will be collaborating to establish a new external work group related to patient engagement at the FDA. The FDA has long involved patients and considered patient perspectives in its work. This new initiative is part of the FDA’s continued commitment to fostering greater patient participation and input in regulatory medical product matters. Stakeholders suggested an external work group as a way for FDA to enhance patient engagement (View Report).

The FDA will leverage CTTI’s strengths in multi-stakeholder engagement to coordinate the new work group. CTTI, a public-private partnership, has a strong community of patient advocates and caregivers within its membership. The new work group will create a forum to exchange information, ideas, and experiences on matters of interest to patients and patient advocates related to patient engagement at the FDA. The work group will be similar to the European Medicines Agency’s Patients’ and Consumers’ Working Party, which marks its 10th anniversary in June 2016.

Additional details will be released as the work group develops.