Since 1962, when Congress (Kefauver-Harris Amendment) charged the FDA with the responsibility to ensure that each pharmaceutical approved for medical use in the US be shown to be safe and effective, clinical trials have formed the foundation for understanding the balance of benefits and risks associated with the use of medical products. In recent decades, however, clinical trials have become prohibitively expensive, slow to finish, and are often under-enrolled, presenting physicians and patients with major gaps in knowledge about what treatments work for which patients. Addressing these gaps by improving the efficiency and quality of clinical trials is the overarching purpose of the Clinical Trials Transformation Initiative (CTTI). Since its inception in 2007, CTTI?cofounded by Duke University and the U.S. Food and Drug Administration (FDA), and hosted by Duke?has sought to identify and promote practices that will improve the quality and efficiency of clinical trials. CTTI projects address a broad range of trial design and operational issues by focusing on quality, relevance, and efficiency. Examples of these issues include informed consent, subject recruitment, use of central institutional review boards (IRBs), investigational new drug (IND) safety reporting, clinical trial quality, operations and monitoring, and antibacterial drug development, all of which are directly relevant to FDA's mission (Appendix A: CTTI Project Portfolio). Clinical trials comprise a vast number of stakeholders collectively identified by the Institute of Medicine as the Clinical Trials Enterprise (CTE). All CTE stakeholders are represented in CTTI projects, so that recommendations can be implemented and consensus can be reached regarding the potential to encompass improvements in quality and efficiency. CTTI's strategy involves a three-pronged approach: 1) incremental improvement to clinical trial methods and processes; 2) better understanding of the national research portfolio to improve the matching of trials to public health priorities; and 3) a push for transformational change that will provide more than incremental improvements (Appendix B: Strategic Plan). CTTI's work is not limited to recommendations, but also includes the creation of tools and other approaches to facilitate adoption of its recommendations. The overarching goals of this proposal are twofold: 1) To maintain a sustainable administrative and scientific infrastructure that will show the path forward to high-quality, efficient, and influential clinical trials by leveraging a broad and transparent public-private partnership (PPP) to provide best practices and recommendations for reducing research impediments in the conduct of clinical trials; and 2) To subsequently disseminate and facilitate adoption of issued recommendations and findings.

Public Health Relevance

Since 1962, when Congress (Kefauver-Harris Amendment) charged the FDA with the responsibility to ensure that each pharmaceutical approved for medical use in the US be shown to be safe and effective, clinical trials have formed the foundation for understanding the balance of benefits and risks associated with the use of medical products. In recent decades, however, clinical trials have become prohibitively expensive, slow to finish, and are often under-enrolled, presenting physicians and patients with major gaps in knowledge about what treatments work for which patients. Addressing these gaps by improving the efficiency and quality of clinical trials is the overarching purpose of the Clinical Trials Transformation Initiative (CTTI).

Agency
National Institute of Health (NIH)
Institute
Food and Drug Administration (FDA)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
3R18FD005292-03S1
Application #
9352528
Study Section
Special Emphasis Panel (ZFD1-SRC (99))
Project Start
2014-09-01
Project End
2019-08-31
Budget Start
2016-09-01
Budget End
2017-08-31
Support Year
3
Fiscal Year
2016
Total Cost
$764,887
Indirect Cost
Name
Duke University
Department
Pediatrics
Type
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Levitan, Bennett; Getz, Kenneth; Eisenstein, Eric L et al. (2018) Assessing the Financial Value of Patient Engagement: A Quantitative Approach from CTTI's Patient Groups and Clinical Trials Project. Ther Innov Regul Sci 52:220-229
Bloom, Diane; Beetsch, Joel; Harker, Matthew et al. (2018) The Rules of Engagement: CTTI Recommendations for Successful Collaborations Between Sponsors and Patient Groups Around Clinical Trials. Ther Innov Regul Sci 52:206-213
Kumar, Karan R; Clark, David A; Kim, Evan M et al. (2018) Association of Atrial Septal Defects and Bronchopulmonary Dysplasia in Premature Infants. J Pediatr 202:56-62.e2
Hornik, Christoph P; Onufrak, Nikolas J; Smith, P Brian et al. (2018) Association between oral sildenafil dosing, predicted exposure, and systemic hypotension in hospitalised infants. Cardiol Young 28:85-92
Watt, Kevin M; Avant, Debbie; Sherwin, Jennifer et al. (2018) Effect of renal function on antihypertensive drug safety and efficacy in children. Pediatr Nephrol 33:139-146
Herrington, William G; Goldsack, Jennifer C; Landray, Martin J (2018) Increasing the use of mobile technology-derived endpoints in clinical trials. Clin Trials 15:313-315
Corneli, Amy; Wheeler, Chris; Bradley, John et al. (2018) Facilitators and barriers to the successful implementation of pediatric antibacterial drug trials: Findings from CTTI's survey of investigators. Contemp Clin Trials Commun 9:115-120
Salerno, Sara; Hornik, Christoph P; Cohen-Wolkowiez, Michael et al. (2017) Use of Population Pharmacokinetics and Electronic Health Records to Assess Piperacillin-Tazobactam Safety in Infants. Pediatr Infect Dis J 36:855-859
Downey, L C; Cotten, C M; Hornik, C P et al. (2017) Association of in utero magnesium exposure and spontaneous intestinal perforations in extremely low birth weight infants. J Perinatol 37:641-644
Ravisankar, Srikanth; Kuehn, Devon; Clark, Reese H et al. (2017) Antihypertensive drug exposure in premature infants from 1997 to 2013. Cardiol Young 27:905-911

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