Clinical Trials

The clinical trial process typically follows four specific steps, or phases, which help researchers collect different types of information about the drug being studied.

As you review potential trials, you'll see them designated by their phase number. You can enroll in any phase of a trial, with no requirement to participate in previous or subsequent phases. Trial phases are sometimes combined into a single study, so you may see some trials designated by more than one number, such as phase I/II or II/III.

• Phase I – Testing with a small group (generally 20-80 people), often healthy volunteers (i.e., people who do not have the disease), to better understand the treatment's safety profile, including side effects
• Phase II – Testing with a larger group (generally several hundred people) of patients with the disease, to find out if the drug is providing the desired effect, how effective it is, and what dose works best; more safety information is also collected
• Phase III – Testing with an even larger group (generally 300-3,000 people) of patients with the disease to confirm that the drug is effective, to better understand the safety profile (including side effects), and sometimes to compare it with current or similar treatments
• Phase IV –Testing carried out after a treatment has been approved, usually with large groups of several thousand people with the disease, to provide ongoing data about safety and efficacy over the long-term

Note that the number of participants is often smaller in clinical trials for drugs that treat rare diseases.

Once you and your doctor have identified an appropriate clinical trial, you may contact the study organizers; contact information will be included with each trial's details. The organizers will set up an appointment to determine whether you or your child meets the eligibility criteria.

Once eligibility is confirmed, you will be provided with an informed consent document, which provides specific information about the trial, including:

• How the study will be conducted
• Specific participant requirements
• Risks and potential benefits of participation
• Study duration
• Cost to you, if any
• Payment to you, if any
• Names and phone numbers of key contacts

The informed consent process exists to help ensure that trial participants can make an educated decision about participation. Before you sign the informed consent document, be sure to discuss anything that's unclear to you with the study organizers and/or your doctor. Remember that the document is not binding, and participants may leave a trial at any time.

Timeframes vary based on the trial. Some are very short, while others continue for years to ensure long-term follow-up. This information is included in the informed consent document provided to prospective participants prior to enrolling in a trial.

Not all studies compensate participants for their time, nor do they reimburse all costs a patient or family may incur as a result of participating in a trial. For information on a specific trial, you should review the informed consent document created for that particular trial, as well as other information provided to you by the clinical trial site or investigator, which will outline the costs, reimbursement, and compensation available for a study.

Each trial is different, and the specific eligibility requirements will dictate whether geography is a factor. As you review potential trials, you'll find information about location. Many trials have study sites across multiple locations and countries.

Most trials require regular medical procedures, medical tests, and sometimes hospitalizations. It may be possible to travel to a non-local study site, but keeping up with trial requirements can be difficult if participants live far away. Your doctor and the study organizers can help determine if a trial's locations and travel requirements are suitable for you or your loved one.

No. Clinical trials provide the basis for the development and approval of new treatments. The safety and/or the effectiveness of the drug is not always fully known at the time of the trial, which is why it's important to study these drugs in specific groups of volunteers. Not all medications are found to be effective and/or safe, and the decision to participate in a clinical trial is a personal one that should be made in partnership with the patient's doctor.

In addition, in some trials some of the participants may get a placebo (a substance that has no active ingredient, such as a sugar pill), which gives researchers something to compare with the study drug. Usually, participants are assigned randomly to the drug or placebo groups, and both before and during the trial neither participants nor researchers know who is getting the drug and who is getting the placebo. This approach is called a "randomized, double-blind study" and is intended to reduce bias and promote objectivity in study results.

Yes. While clinical trials may offer the chance to try an investigational treatment, there are also risks to consider:

• The investigational treatment may have side effects—including potentially very serious ones.
• The investigational treatment may not work for everyone in the trial.
• In some trials, some participants may get a placebo (a substance that has no active ingredients, such as a sugar pill), to allow for objective comparison with the drug being studied. Usually, participants are randomly assigned, and both before and during the trial neither participants nor researchers know what each participant is getting.
• The routine for the investigational treatment may take more time or be more complicated than what the participant is used to. For example, participants may need to get regular tests, have frequent check-ins with the study site, stay in a hospital, or follow a plan for taking the medicine.

During the planning stages of a clinical trial, regulatory authorities work to ensure that proposed trials do not place participants at extreme risk or harm. Nevertheless, anyone considering participating in a trial should carefully discuss potential risks and benefits with their doctor.

Regulatory agencies in different countries—such as the FDA (Food and Drug Administration) in the U.S.—are responsible for safeguarding public health by ensuring that current and new medical products are safe and effective. They review data from clinical trials to help make decisions about new drug approvals.

Regulatory authorities also set some standards and structures for the clinical trial process, especially around informing and protecting participants. Study organizers are responsible for designing clinical trials that are thoughtful and ethical, and may seek additional guidance from regulators throughout the trial process.

Before a clinical trial is initiated, its protocol must be reviewed and approved by a group of experts called an Institutional Review Board (IRB), made up of doctors, researchers, and members of the community. At the start and all through the research, the IRB helps ensure that the study is ethical and the rights and welfare of participants are protected.

During a trial, results may be reviewed by an independent team of experts called a Data Monitoring Committee (DMC) or Data Safety and Monitoring Board (DSMB), who check for any concerns related to drug safety. The DMC or DSMB can recommend to regulatory authorities or the researchers that the trial be stopped at any time if the study is not effective, is harming participants, or is unlikely to serve its scientific purpose.

All clinical trials have defined "endpoints"—specific criteria for measuring the benefit of a medicine and evaluating the trial’s results. Typically, researchers use one of two types of endpoints:

• Clinical endpoints are generally the most reliable way to measure response in clinical trials. They directly measure the ability to feel better, function better, or live longer.
• Surrogate endpoints use biomarkers to indirectly measure a drug’s effect. A biomarker is a physical, biochemical, or genetic characteristic that can be objectively measured. Surrogate endpoints use biomarkers that are believed to be closely related to clinical benefit.

When a trial ends, the data collected during the study is analyzed to assess how participants responded to the investigational treatment. Reports are then sent to regulatory authorities to determine appropriate next steps

Access to study treatment after completion of a clinical trial varies. In some cases, trial participants can continue to receive the investigational therapy in an extension of the original trial, or in a separate, long-term trial. However, this is not always the case. Ask about this when considering whether or not to take part in a trial.