Legal, Regulatory, and Practical Issues to Consider When Adopting Decentralized Clinical Trials: Recommendations From the Clinical Trials Transformation Initiative

TLDR

Traditional clinical trials are costly, inefficient, and burdensome, prompting interest in decentralized approaches that could enhance trial efficiency. The Clinical Trials Transformation Initiative launched a Decentralized Clinical Trials project to generate recommendations addressing legal, regulatory, and practical challenges in U.S. DCT design and conduct. Through qualitative group interviews, an expert meeting, and stakeholder engagement, CTTI identified key DCT challenges and formulated recommendations covering protocol design, telemedicine, supply chain, investigator oversight, and safety monitoring.

Abstract

Traditional clinical trials are often expensive, inefficient, include selected populations, and can create significant participant burden via travel and other logistical demands. Using new technologies and methodologies to promote a decentralized approach has the potential to improve the efficiency of clinical trials. The Clinical Trials Transformation Initiative (CTTI)—a public–private partnership to improve clinical trials—launched a multi-stakeholder Decentralized Clinical Trials (DCTs) Project to provide recommendations on addressing the actual and perceived legal, regulatory, and practical challenges with DCT design and conduct in the United States. Informed by qualitative group interviews and an expert meeting, CTTI engaged stakeholders to identify key challenges to implementing DCTs and possible solutions. The CTTI DCT project team used the interview findings and expert feedback to develop recommendations that will drive broader use of DCTs. CTTI's recommendations cover protocol design, use of telemedicine and mobile healthcare providers, medical product supply chain, investigator delegation and oversight, and safety monitoring considerations. By implementing these recommendations, sponsors, contract research organizations, and others can help advance successful medical product development using mobile technologies and methodologies in DCTs.