Developing Novel Endpoints Generated by Mobile Technology for Use in Clinical Trials
Mobile technology can be used in clinical trials to generate novel endpoints that provide new kinds of information that were previously difficult or impossible to access. Novel endpoints derived from mobile technologies can make clinical trials more efficient and less burdensome to trial participants while contributing to meaningful, real-world understanding about patient experiences and outcomes that goes beyond the brief data “snapshots” typically gathered in clinical care or research settings.
But despite these potential benefits, novel endpoints are at present only rarely used in clinical trials. This is due to barriers arising from widespread uncertainty about how to identify and choose novel endpoints that would be useful in trials designed to support regulatory approval for new therapies, or a new indication for an existing therapy.
CTTI’s Novel Endpoints Project, a part of CTTI’s larger Mobile Clinical Trials (MCT) Program, has developed recommendations and tools to address these barriers and clarify the best pathways for identifying, selecting, and developing novel endpoints derived from mobile technologies. Along with these actionable recommendations, CTTI created four detailed use cases that show how mobile technologies can be used to collect novel endpoints in regulatory clinical trials.
 Definition of a novel endpoint: new endpoints that are 1) not currently used, or 2) existing endpoints that can now be measured in new ways, using mobile technology.
Craig Lipset Pfizer’s head of clinical innovation
“By engaging with experts who have been early champions of mobile technology in trials and combining that with patient insights, CTTI has created practical recommendations and action-oriented tools that have the potential to really accelerate the use of mobile technology in clinical trials. In particular, the use cases provide a realistic pathway for incorporating novel endpoints through technology into clinical development programs. CTTI’s recommendations show we may be closer than previously believed to realizing the benefits of these novel endpoints, creating a sense of urgency to act.”
Valentina Dilda, PhD Director, Experimental Medicine, CHDI Foundation
“As we embark on a two-phase effort to develop a digital battery for use in Huntington Disease trials, we plan to use CTTI’s MCT Novel Endpoints recommendations to guide our work. In doing so, we feel strongly that we can reach our goal more quickly and more efficiently—ultimately, and most importantly, benefiting patients.”
Despite the evolution of mobile technology capable of monitoring and measuring data, it remains uncommon for such novel clinical endpoints to be used in clinical trials, especially those trials that are performed to support regulatory approval for a new therapy or indication. All stakeholders—patients and patient groups, investigators, research sponsors, regulators, and technology developers—would benefit from clarification regarding the processes for developing these novel endpoints in order to realize the benefits of incorporating mobile technology into clinical trials.
Developing Novel Endpoints Generated by Mobile Technology for Use in Clinical Trials (2015–2017), one of four projects within CTTI’s MCT Program.
Describe best practices for identifying, selecting, and developing novel endpoints, generated using mobile technology, for use in regulatory clinical trials.
The results from the MCT Novel Endpoints Project will inform the development of novel endpoints generated from mobile technologies for use in FDA-regulated clinical trials.
CTTI hosted a multi-stakeholder expert meeting to develop four use cases describing the steps involved in developing a novel endpoint from data generated by a mobile device. This process helped CTTI to outline requirements at each step in the process, identify challenges that may occur, and propose solutions to those challenges. The use cases informed the development of more general recommendations and tools that clarify the pathway for developing technology-derived novel endpoints. The MCT Novel Endpoints Project Team has also conducted a systematic review of published clinical studies using novel endpoints in order to learn from existing approaches. This article will be posted here following publication.
CTTI convened a multi-stakeholder expert meeting to draft use cases, each developing a particular novel endpoint. Meeting attendees explored the use of accelerometers to measure treatment benefit in clinical trials of heart failure, Parkinson’s disease, and Duchenne muscular dystrophy, and the use of continuous glucose monitors to measure treatment benefit in clinical trials of diabetes. In addition to the four use cases, a meeting summary is available that highlights themes from these discussions.
A set of recommendations were distilled from the meeting findings and related discussions. The recommendations, which are expected to have short-, medium-, and long-term benefits when applied in clinical trials, are grouped into two main sections. The first, which focuses on optimizing the selection of novel endpoints, identifies the following key recommendations:
The second section provides recommendations on practical approaches to developing novel endpoints, including:
These major recommendations are presented in detail, along with complementary materials that include an interactive tool for choosing among possible novel endpoints for development, a quick reference for interacting with regulatory authorities during the process of novel endpoint development, a summary of required steps in novel endpoint development, a plain-language process summary, and detailed, disease area-specific use cases.
The team has also conducted a systematic review of published clinical studies that have employed novel endpoints. The resulting paper will be posted here following publication.
|Team Member||Ashish Narayan||Feinstein Institute for Medical Research|
|Social Science Lead||Brian Perry||Clinical Trials Transformation Initiative|
|Team Leader||Cheryl Grandinetti||Food and Drug Administration|
|Team Member||Elektra Papodopoulos||Food and Drug Administration|
|Project Manager||Jen Goldsack||Clinical Trials Transformation Initiative|
|Executive Committee Champion||John Alexander||Duke University|
|Team Leader||Kaveeta Vasisht||Food and Drug Administration|
|Team Member||Ken Skodacek||Food and Drug Administration|
|Team Member||Komathi Stem||monARC Bionetworks|
|Team Leader||Lauren Bataille||The Michael J Fox Foundation for Parkinson's Research|
|Team Member||Marc Walton||Johnson & Johnson Pharmaceutical Research and Development|
|Team Leader||Martin Landray||University of Oxford, CTSU|
|Team Member||Nirav Sheth||MC10|
|Team Leader||Rob DiCicco||GlaxoSmithKline|
|Team Member||Theresa Strong||Foundation for Prader-Willi Research|
|Team Leader||Will Herrington||University of Oxford, CTSU|