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Answers for all your clinical trial related questions
What is a clinical trial?
Clinical trials are medical research studies that involve the participation of volunteers to help scientists understand and develop new ways to prevent, detect, or treat diseases and their symptoms.
These investigational treatments may be new drugs, a combination of drugs, new ways to deliver an already marketed drug or a medical device.
Before a new medication is approved, it must undergo a series of lengthy and rigorous tests, first in the laboratory, then in animals, and ultimately in humans.
A new medication or medical device must not only be safe and effective, but in many cases it must also demonstrate a superior benefit when compared to similarly approved products.
A clinical study is conducted according to a research plan, known as a protocol, that has been developed by the pharmaceutical company and reviewed by the FDA along with an Institutional Review Board (IRB) representing the public interest. These agencies monitor the progress of these studies.
The protocol determines:
- The reason for the study
- The number of participants
- The criteria used to determine who is eligible for the study
- A schedule for procedures, tests, drugs, and dosages
- The length of the study
- What information will be gathered about the participants
Clinical trials are led by a principal investigator, who is often a medical doctor, along with a research team made up of doctors, nurses, and other healthcare professionals. All of the participants are volunteers. It is important to research a variety of people to detect different responses to a single investigational product.
What do the different phases of a clinical trial mean?
Investigational products such as medications, devices, or procedures are tested in various clinical trial phases to find different kinds of information.
Phase 1 Studies
Phase 1 studies include a small number (20-80) of participants. They are usually healthy volunteers, but in some cases are patients with advanced disease (e.g., cancer, mental health disorders), and are often the first time tested in humans.
The purpose of Phase 1 studies is to:
- evaluate safety
- identify side effects
- determine a safe dose range
- learn how the investigational product is absorbed and handled by the body (pharmacokinetics/dynamics)
Phase 1 studies generally take several months to complete. Approximately 70% of Phase 1 studies continue to Phase 2.
Phase 2 Studies
Phase 2 studies enroll more people with the condition under study than Phase 1 studies (100-300 participants). In Phase 2 studies, researchers further evaluate safety and determine if the investigational product has the intended effect in humans. These studies are sometimes randomized controlled trials where one group of patients receives the investigational product while another group (the “control group”) receives a standard treatment or placebo. In order to provide unbiased comparative information, these studies are often “blinded,” which means neither the patients nor the researchers know who is receiving the investigational product.
Phase 2 studies usually take up to two (2) years to complete. About 33% of Phase 2 conducted successfully move on to Phase 3.
Phase 3 Studies
In Phase 3, larger numbers (thousands) of patients with the disease are included:
- confirm or further evaluate an investigational product’s effectiveness
- monitor side effects
- compare it to commonly used treatments
- collect other information that will be used to determine whether the investigational product should be approved and marketed
These trials are usually randomized and masked trials that generally take up to several years (1-4 years) to complete. 25 to 30% of Phase 3 studies are completed and are submitted to the FDA by the pharmaceutical company for approval to market the investigational product in the United States.
Phase 4 Studies
Phase 4 studies, often called Post-Marketing Surveillance Trials, are conducted after the investigational product has been granted approval from the FDA for consumer sale. These studies involve people in various populations and are generally intended to collect additional information after the investigational product is approved and marketed regarding its risks, benefits and use in various populations over a longer period. Results from Phase 4 studies can influence whether an investigational product should be taken off the market or if restrictions should be applied to the use of the investigational product.
Why should I participate in a clinical trial?
By taking part in a clinical trial, you have an opportunity to try a new treatment that may or may not be better than those that already exist.
As a study participant, you can also help others better understand how the treatment works in people of different races and genders because different people may respond differently to the investigational product. Regulatory agencies such as the FDA seek to ensure that people of different ages, races, ethnicities, and genders are included in clinical trials.
Some reasons to participate in a clinical trial:
- Access to new treatments not available on the market
- Access to free medication
- Compensation for participating (in some trials)
- Satisfaction in helping advance medical research
Your participation is voluntary, which means you can leave the study at any time.
Each clinical research study has specific eligibility criteria that a participant must meet in order to be enrolled in the study. Therefore, not everyone who applies for a clinical research study will be accepted.
What types of clinical research studies are available?
There are many different types of clinical research studies, including:
- Prevention studies, which look for better ways to prevent disease in people who have never had the disease or to prevent a disease from returning. These approaches may include medicines, vitamins, vaccines, minerals, or lifestyle changes.
- Interventional studies, which test new treatments, new combinations of drugs, or new approaches for therapy.
- Diagnostic studies, which are conducted to find better tests or procedures for diagnosing a particular disease or condition. Screening studies test the best way to detect certain diseases or health conditions.
- Quality of Life studies (or Supportive Care studies), which explore and measure ways to improve comfort and the quality of life for individuals with a chronic illness.
Usually, clinical trials compare a new product or therapy to something else to see if it works as well or better to treat or prevent a disease or condition. In a masked study, a participant may be randomly assigned to receive the test product or an existing, approved therapy.
In some studies, participants may be assigned to receive a placebo (a product with no therapeutic action that looks or acts like the test product). Comparison with a placebo can be the fastest and surest way to demonstrate the therapeutic effectiveness of new products.
Potential participants are told before they enter a trial whether placebos are going to be used in the study and the risks and benefits of the study medication(s).
What happens during a clinical research study?
The following process generally occurs during the conduct of a clinical research study:
Pre-Screening
The clinical research group will review their existing patient databases or medical charts to identify potential patients who may be eligible to participate in the clinical research study. They may also place advertisements on the internet, in newspapers, radio, or television to recruit interested participants. They may also conduct seminars, free health screenings, or forums.
Potential participants from these pre-screening efforts are contacted and briefly interviewed to confirm if they are eligible to participate in the clinical research study.
Informed Consent
If you are potentially eligible to participate in a clinical research study, an appointment will be scheduled for you to come to the clinical research site and meet with one of the research staff members. Before any study-related procedures are performed, you will be required to sign an informed consent form which details the study design, risks and benefits, your rights as a study participant, and whom to contact in case of an emergency. During the informed consent process, you will have an opportunity to ask questions you may have regarding the study and your participation. You should receive a copy of the signed informed consent form for your records and future reference.
Screening Visit
Once you agree to participate in the clinical research study and have signed the informed consent form, the study screening procedures will be administered. The purpose of the screening visit is to determine if you meet the specific inclusion and exclusion criteria for the specific clinical research study you agreed to participate in. Generally, during the screening visit, you may be asked to answer questions regarding your medical history, medications, and other treatments you are taking, and complete questionnaires. A member of the research team may also assess your general health by performing a physical examination, EKG, and collecting blood/urine samples.
Generally, the investigational product is not dispensed during the screening visit.
Study Visits (Treatment Visits)
If you meet the specific inclusion and exclusion criteria for the study, you will be asked to return to the clinic for a series of study visits, sometimes referred to as Treatment Visits. It is generally during these study visits that a study participant will receive the investigational product or the comparator product (which sometimes can be a placebo). The number of study visits and the interval in which the visits occur varies from study to study.
End of Study Visit
Once you have reached the end of the treatment visit, an End of Study Visit is conducted. Generally, the same or similar assessments conducted prior to you receiving the investigational product are repeated.
The research team will also discuss your follow-up treatment options (which may include receiving standard-of-care treatments for your illness).
If required by the study, you may be asked to return to the research site for a follow-up safety visit.
Follow-up Safety Visit
The number of follow-up safety visits and the interval in which the visits occur, varies from study to study. The purpose of this visit is to ensure you are not experiencing any lingering side effects from the investigational product or the overall participation in the study.
What are the risks?
Risks are involved in clinical research, as in routine medical care and activities of daily living. Most clinical research studies pose side effects that are temporary and go away when the treatment is stopped. However, some research subjects experience side effects that can be permanent or require medical attention.
Some side effects appear during treatment, while others may not show up until after the treatment is over.
Some investigational products that are being tested have side effects that can be unpleasant, serious, or even life-threatening. Because the investigational products being studied are new, researchers don’t always know what the side effects will be in humans.
The specific risks associated with any research protocol are described in detail in the informed consent document, which you are asked to sign before taking part in research. In addition, the major risks of participating in a study will be explained to you by a member of the research team, who will answer your questions about the study.
Before deciding to participate, you should carefully weigh these risks. Although you may not receive any direct benefit as a result of participating in a clinical research study, the information collected by your participation may help others.
What is informed consent?
To help you decide if you want to be in a study, the FDA requires that study participants are given complete information about the study before they agree to take part.
Informed consent forms should be written so the participant can easily understand them and should include the following:
- Purpose of the research
- How long the study will take
- What will happen in the study, and which parts of the study are experimental
- Possible risks or discomforts
- Possible benefits
- Other procedures or treatments that the participant might want to consider instead of the treatment being studied
- The FDA may look at study records, but the records will be kept secret
- Whether any medical treatments are available if the participant is hurt, what those treatments are, where they can be found, and who will pay for the treatment
- The person to contact with questions about the study, participant rights, or if the participant can get hurt
- The participant can quit at any time
If you don’t understand the information included in the informed consent form, be sure to ask the doctor or other research staff member to explain it. This discussion should take place in private, and you must be given enough time to make an informed decision. In most studies, you should be allowed to take the consent form home for further discussion with others, such as family, caregivers, and primary care physicians. Make sure you understand all of it before you agree to be in the study.
Before you can be in the study, you must sign the informed consent form, showing that you have been given this information and understand it. The informed consent form is not a contract, and you can leave the study at any time and for any reason. You may ask questions at any time throughout the study.
In addition, you must also be informed of any new information learned during the study that may affect your willingness to continue to participate in the study.
What questions should I ask the research staff?
Here are some questions to ask your doctor to help you decide if you want to take part in a clinical trial:
- What is the study trying to find out?
- What kinds of tests and exams will I have to take while I’m in the study? How much time do these take? What is involved in each test?
- How often does the study require me to go to the doctor or clinic?
- Will I be hospitalized? If so, how often and for how long?
- What are the costs to me? Will my health insurance pay for it?
- What follow-up will there be?
- What will happen at the end of the study?
- What are my other treatment choices? How do they compare with the treatment being studied?
- What side effects can I expect from the treatment being tested? How do they compare with the side effects of standard treatment?
- How long will the study last?
Who can participate in a clinical research study? What is a research subject?
A research subject is a person who meets the inclusion/exclusion criteria and agrees to take part in a clinical research study. A research subject may be either a healthy individual or an individual with a specific disease or condition.
The study protocol outlines who can participate in a clinical research study.
The criteria that allow a person to participate in a clinical research study are called inclusion criteria, and the criteria that disqualify a potential research subject are called exclusion criteria.
These criteria are based on factors such as age, gender, the type and stage of a disease, previous/current treatment history, and other medical conditions.
Who conducts clinical studies?
Every clinical research study is led by a Principal Investigator, who is often a licensed medical doctor, and a clinical research team that may include doctors, nurses, social workers, and other healthcare professionals. In general, the clinical research team roles and responsibilities will include:
- Principal Investigator (PI): A person responsible for the ethical conduct of the research study. This includes protecting human subjects’ rights, safety, and welfare, protocol (study) compliance, and adherence to institutional, state, and federal regulations and guidance. The PI is responsible for ensuring informed consent is appropriately obtained from each participant and for appropriately maintaining study records. The PI is also responsible for complying with the financial and administrative policies and regulations associated with the award, overall fiscal management of the project, and conflict of interest disclosure. The PI oversees all aspects of a clinical trial, from protocol design, recruitment, data collection, analysis, and interpretation of results, but some tasks can be delegated to other research team members (Co-Investigators and Key Personnel). The PI is responsible for ensuring that all research team members have appropriate education, training, and qualifications to assume delegated study tests. All study team members are responsible for ensuring that the conduct of the study is compliant with institutional, state, federal and industry guidance and regulations.
- Sub-Investigator: The Sub-Investigator may perform all or some of the PI functions, but they do not accept primary responsibility for the research study. The sub-investigator is under the supervision of the PI and is responsible for performing study–related procedures and making important study-related decisions in compliance with the ethical conduct of the study.
- Research Coordinator: The Research Coordinator oversees and coordinates the daily activities of clinical research studies. They work closely with the clinical teams and investigators to ensure that all protocol-required procedures and visits occur according to protocol-specified guidelines. Research Coordinators generally manage participant enrollment and ensure compliance with the protocol and other applicable regulations. This includes but is not limited to participant recruitment, obtaining informed consent, educating participants on the details of the research study, assessing participant eligibility, facilitating participant care and follow-up per protocol, creating source documentation, assisting in the assessment of toxicities/adverse events and reporting serious adverse events per IRB and sponsor requirements. They are generally the primary contact person for the research subject.
Is my information kept confidential?
The clinical research team will make every effort to ensure that your Personal Health Information (PHI) is kept confidential. Your information will not be shared without your permission, except as required by law.
Suppose you choose to submit your information to us through this website with your permission.
In that case, this information will be entered into our clinical research database for both current and future study opportunities. You can ask to have your information removed at any time.
If you choose to call in and speak to one of our research specialists over the phone, your information will be captured in the same electronic database. Again, this is voluntary and can be removed at any time.
Will it cost me anything to participate?
In most clinical research studies, all visits, tests, and procedures related to the study are free of charge. If you qualify for one of our research studies, you may be compensated for your time and travel. The amount of compensation (as well as any expenses not covered by the study) will be reviewed during the informed consent process.
How long do the appointments/visits last?
The number of study visits, duration, and frequency will vary depending on the study design. Typically, the study visits are at least 30 minutes. However, some may be a few hours. The initial visit (screening visit) will generally be longer as it will include an informed consent process, an assessment of your medical history, a collection of laboratory samples, and various study-related questionnaires. During the informed consent process, participants will be provided detailed information regarding the study visits and the overall duration of the study.