|No stones, please.|
Yesterday, Alec Gaffney was kind enough to ask my opinion on GSK's signing on to the AllTrials initiative to bring full publication of clinical trial data. Some of my comments made it into his thorough and excellent article on the topic. Today, it seems worthwhile to expand on those comments.
1. It was going to happen: if not now, then soon
As mentioned in the article, I – and I suspect a fair number of other people in the industry -- already thought that full CSR publication was inevitable. In the last half of 2012, the EMA began moving very decisively in the direction of clinical trial results publication, but that's just the culmination of a long series of steps towards greater transparency in the drug development process. Starting with the establishment of the ClinicalTrials.gov registry in 1997, we have witnessed a near-continuous increase in requirements for public registration and reporting around clinical trials.
It's important to see the AllTrials campaign in this context. If AllTrials didn't exist, something very much like it would have come along. We had been moving in this direction already (the Declaration of Helsinki called for full publication 4 years before AllTrials even existed), and the time was ripe. In fact, the only thing that I personally found surprising about AllTrials is that it started in the UK, since over the past 15 years most of the advances in trial transparency had come from the US.
2. It's a good thing, but it's not earth-shattering
Practically speaking, releasing the full CSR probably won't have a substantial impact on everyday clinical practice by doctors. The real meat of the CSR that doctors care about has already been mandated on ClinicalTrials.gov – full results posting was required by FDAAA in 2008.
There seems to be pretty clear evidence that many (perhaps most) practicing physicians do not read the complete articles on clinical trials already, but rather gravitate to abstracts and summary tables. It is highly doubtful, therefore, that a high percentage of physicians will actually read through a series of multi-hundred-page documents to try to glean fresh nuances about the drugs they prescribe.
Presumably, we'll see synopsizing services arise to provide executive summaries of the CSR data, and these may turn out to be popular and well-used. However, again, most of the really important and interesting bits are going to be on ClinicalTrial.gov in convenient table form (well, sort-of convenient – I admit I sometimes have a fair bit of difficulty sifting through the data that’s already posted there).
3. The real question: Where will we go with patient-level data?
In terms of actual positive impact on clinical research, GSK's prior announcement last October – making full patient-level data available to researchers – was a much bigger deal. That opens up the data to all sorts of potential re-analyses, including more thorough looks at patient subpopulations.
Tellingly, no one else in pharma has followed suit yet. I expect we’ll see a few more major AllTrials signatories in fairly short order (and I certainly intend to vigorously encourage all of my clients to be among the first wave of signatories!), but I don’t know that we’ll see anyone offer up the complete data sets. To me, that will be the trend to watch over the next 2-3 years.
[Image: Transparent abode courtesy of flikr user seier+seier.]