Research & Clinical Trials

Clinical trials are the most important step needed to bring new medicines to pharmacy shelves. All medicines that you’ve purchased – from chemotherapy to penicillin– have gone through the clinical trial process, which demonstrates safety and effectiveness. Therefore, clinical trials are necessary to bring new and innovative medicines, devices, and treatment options to the market so that your doctor can prescribe, and insurance can cover, these innovative therapies. For rare diseases with no or very few effective treatments, it is even more important for there to be trials for new, potential treatment options. Generally, clinical trials are done in phases. Consider each phase a “checkpoint” in which researchers and regulators check in with the safety and effectiveness data of the potential new drug Phase 1 includes (healthy) people without any medical conditions and focuses on determining the safety of the potential new drug. Phase 2 includes people living with the disease or condition that will hopefully be treated by the new drug and measures safety (again) and looks for biologic, hopefully beneficial, effects in patients living with the disease under consideration Phase 3 continues to measure those things in more people living with the disease or condition.  In this phase, the investigator must show, statistically, that the product is safe and can improve one or more aspect of the disease.

Participating in a clinical trial is an important decision that should always be discussed with a healthcare provider. Potential benefits include access to potential new treatments and helping to bring new medicines to market.  During the time you are in the trial, you are guaranteed to have expert care and constant monitoring of your health from the clinical trial team. During a clinical trial, you are guaranteed to be given medical care and monitoring of your condition. Most of the time, the study sponsor covers most (if not all) of the costs associated with your participation in the study, which might include travel. Be sure to talk to your doctor and the clinical trial team about costs and reimbursement rules.

Clinical trials follow a protocol that is carefully reviewed by the investigator’s institution (medical center) or by a third party committee, to assure that the research fulfills all the current ethical and legal requirements of studies involving humans.   Because the product under study will NOT YET have been shown to be safe and effective, all possible side effects may not be known at this point in the process.  Only by studying the product in patients with the disease or condition can we learn about the new potential treatment’s benefits and adverse effects. The FDA will also review the “Informed Consent Form” to be sure it spells out everything that is known and not yet known about the product, so the potential trial participant (patient with the disease) can make a “fully-informed decision” to participate or not to participate. Additionally, because patients who are participating in a clinical trial are monitored closely, the clinical trial team will know immediately if a patient’s condition is worsening. If symptoms get worse, the clinical trial team will ensure that the clinical trial participant gets the medication needed to help a patient improve. This could mean using the typical standard of care or ensuring that patient has access to the potential new treatment being studied in the trial.

If you are interested in a clinical trial, you should always first discuss this decision with your doctor; there is a chance your current doctor is part of the clinical trial team. If they are not, they will still be your doctor and will be in charge of overseeing your care. However, you will likely have to visit a doctor who is part of the clinical trial team in addition to your regular doctor.

One of the most important things that happens when a clinical trial is completed is that researchers analyze the data. This often takes months. Then, analyzed data is presented to regulators and expert scientists within agencies such as the FDA in the US or the EMA in Europe, who evaluate the data for safety and efficacy. If the data shows the drug that was studied is safe and more effective than placebos or other treatments at treating a certain disease, the regulators formally approve the product, with or without requiring further studies to be conducted, and clear the way for the drug-maker to market the drug that was tested. While data is being evaluated, many clinical trial teams offer “extension periods” for patients that participated in the trial. The extension periods may allow people to continue accessing the potential new treatment until regulators make the final decision. These are usually voluntary.

Every clinical trial will have different requirements, but most clinical trials include a schedule of regular visits with doctors and nurses on the study team within a relatively short time-frame.

Site: The hospital or medical center where a clinical trial is taking place. Clinical trials often have many sites across a country or many countries.

Investigator: The doctor leading the clinical trial team at a particular site.

Sponsor: The entity – possibly a drug-maker or government agency – that is responsible for creating and overseeing the clinical trial.

Investigational drug / experimental drug / investigational product: The potential product, not yet approved for marketing for a specific disease, that is being tested in a clinical trial. It can be a drug, a blood or plasma product, a medical device, or a medical procedure/technique.

Placebo – A placebo is sometimes referred to as a “sugar pill”, but can be any number of treatments that are not the potential new treatment being studied. In order to test the effectiveness of a drug, researchers need to determine the effectiveness of a potential new treatment, researchers compare the disease course and symptoms when the potential new treatment is taken vs. when it is not. When someone is not taking the potential new treatment during the clinical trial, they are taking the placebo.

Placebo vs. control: Placebo does not always mean “sugar pill” or “no treatment given”. Sometimes, clinical trials test new potential treatments against what is the current standard of care. If someone is not getting the potential new treatment, they are acting as the “Control” in the clinical trial. In some innovative trials, people act as their own control, meaning they go through a period in the trial where they take the potential new treatment and compare their symptoms to a period when the person did not take the potential new treatment.

REMEMBER- the clinical trial team will monitor each clinical trial participant’s symptoms carefully. If someone who is participating in a trial starts to “worsen”, the clinical trial team will be sure to treat the symptoms with either standard of care (whatever therapy previously helped the participant) or the potential new treatment being tested in the trial. This helps to ensure that placebos do not harm clinical trial participants in the long term.

Blinded: During a clinical trial, results are more valid if researchers are able to compare how symptoms change in patients taking the potential new treatment against those who do not when the researchers do not know who is receiving which treatment. This helps to eliminate bias (everybody wants new treatments to work!). People that might be blinded in a clinical trial include the 

When thinking about clinical trials, there are many things to consider. Remembering that safety is always a top priority in clinical trials, it is still important to have conversations with your doctor, your family, and your insurance provider about this decision. Here is a list of questions to get answered:

When will I know whether I received the potential new treatment being studied in the trial?

How will the study team communicate with my regular doctor?

Will the study sponsor cover any expenses not covered by insurance? Is there an opportunity to be reimbursed for traveling to participate in the trial?

What is the plan for care or receiving the drug when the trial is over?

[Answer given by Dr. Sami Khella, Professor and Chair of Neurology, Penn Presbyterian] When a new medicine is tested in a clinical trial, frequently, a patient participating in the trial will be asked to stop her or his current medicine usually for a short period of time. This is called “a wash out period” or “a run-in period.”  As the name wash out implies,  it is done for 2 reasons:

1. To clear the medicine itself from your body, and to clear its most recent effects on your body. This gives the new medicine a chance to work without confusion from the effects of the old medicine.
2. To avoid a drug-drug interaction between the old and new medicines.

Remember that participants in clinical trials are monitored very closely and the health and safety of all participants is the top priority of any clinical trial.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare disease where the
body’s natural defenses, like antibodies, attack the covering of the nerves, called myelin,
and damage nerve function. While symptoms aren’t the same for everyone, CIDP can
make your arms and legs feel weak and slow your movements. The purpose of the ARISE
Study is to evaluate the safety and efficacy of an investigational medication in adults with
active CIDP.

Eligible patients will be:

• Adults aged 18 years or older
• Diagnosed with active CIDP
• Either:
  • Willing to discontinue current treatment of intravenous immunoglobulin (IVIg) or subcutaneous immunoglobulin (SCIg) and/or corticosteroids prior to study entry OR
  • Newly diagnosed with CIDP and have never been treated, or you have not taken medication for CIDP for at least 3 months prior to study entry

What can I expect if I join the study?

• You will receive a thorough medical exam and your CIDP diagnosis will be confirmed.
• If you qualify and are currently receiving treatment for CIDP, you will be asked to discontinue or taper off this treatment.
• You will receive study-required medical care throughout the study by a neuromuscular neurologist.
• All who qualify will receive the investigational medication for a portion of the study. The investigational medication will be an IV infusion.
• If you qualify for another portion of the study, you will be randomly assigned to receive either the investigational medication or a placebo that has no active drug. You will not know which treatment you will receive.
• If you qualify for all portions of the study and wish to continue, you can expect to spend up to 2–5 years in the study.

Participants will receive study-required medical care at no cost. Participants who qualify to receive the investigational medication will receive it at no cost. The study will not pay for other medical care or current medication(s) needed to support your daily health care routine.

Visit https://globaltrialfinder.janssen.com/trial/CR109195 and https://clinicaltrials.gov/ct2/show/NCT05327114 to learn more about this clinical study.