The ambition of EMA’s new centralized clinical trials information system (CTIS) is to make Europe a more attractive and cohesive market in which to conduct trials. A survey to capture the early feedback and experiences with CTIS of pharma, biotech and CRO leaders across the UK, Germany, Switzerland, and the US, is reporting overwhelmingly positive experience with the platform, Arriello’s Kieran O’Donnell and Nicola Kidman outline the survey findings.

In the late summer, Arriello commissioned a comprehensive survey of European and US pharma companies’ initial experiences of the EMA’s new centralized clinical trials information system (CTIS). The new platform and portal are designed to streamline the submission, assessment and approval of trials across EU markets, under the new Clinical Trials Regulation (CTR)¹, applicable since the end of January 2022 and mandatory for all new trials from January 31, 2023.

Expectations for the new system have been high — if tentative. Under previous attempts to streamline clinical trial requirements and approval processes under a European Clinical Trials Directive, too much was left to interpretation, meaning that each member state transposed the legislation slightly differently.

The August 2022 survey, conducted by Censuswide, took place at roughly the halfway point between the CTR go-live and the mandatory date for compliance with CTIS for new studies. The intention was to capture the early feedback and experiences of 400 relevant Director+/relevant Functional Heads in Pharma, Biotech and CRO companies (100 each across the UK, Germany, Switzerland, and the US).

High level of CTIS activity already

While mixed early experiences of the new platform might have been expected, the survey findings have proved remarkably upbeat. 

The first surprise was the level of activity already taking place through CTIS by August, given that CTIS use isn’t mandatory until after the end of January 2023. Over 90 per cent of respondents claimed to be already registered in the new centralized system; 40 per cent had used it to submit a clinical trial application (CTA), and just over 17 per cent had applications pending. 

With the deadline for conformance with CTR and CTIS use looming, it is to be expected that teams will increasingly default to the new platform and process, to remove the risk of having to transition to it part way through a trials program, so it could be that as the year has ticked on companies have opted to make the switch sooner rather than later.

Overall, 92 per cent of survey participants said their organization was planning a clinical trial through the centralized EMA system over the coming six months, with Switzerland then Germany recording the highest responses (98 and 96 per cent respectively). Nine in 10 US respondents reported that this was the case. In the UK, 85 per cent had plans to plan a clinical trial through the CTIS over the remainder of the year.

Of those that had already registered a trial through the CTIS, more than a third (37 per cent) had found the experience faster/shorter than expected, and 31 per cent said the process had been easier than expected. Biotechs were most likely to be impressed with the speed of using the new system. Just over three-quarters of respondents whose companies had registered a trial through the CTIS said assessment deadlines had been achieved, rising to 99 per cent of US organizations. 

Not entirely pain free

Although experiences of the new portal haven’t been pain free, there was no obvious single point of concern. Issues spanned:

• Organizational structure: cited by 38 per cent of all respondents, rising to 43 per cent of US respondents
• Training/information overload: cited by 36 per cent overall, with a contrast between German and Swiss respondents (50 per cent of Germans found this to be a barrier, compared with just 25 per cent of Swiss respondents). CROs were the most likely to have an issue with this.
• Transition point identification: an issue for 35 per cent of all respondents, with Germany, the US and UK more concerned about this than Swiss survey participants (only a quarter of which felt this to be a barrier). 
• Fear of the unknown: cited by 33 per cent of all respondents, rising to 38 per cent of German respondents
• A lack of clearly defined process steps: for 33 per cent overall, rising to 39 per cent of German participants, yet accounting for just a quarter of Swiss respondents.

Traditional pharma organizations were most likely to have encountered issues with organizational structure and transition point identification. And, while two-thirds of all respondents claim to have already performed appropriate adaptation to their Quality systems for CTR/CTIS, there is work still to be done.

Multiple benefits 

All respondents appeared to have a good grasp of the intended benefits of the CTIS, confirmed to include:

• Faster approvals: expected by 35 per cent of all respondents (rising to 40 per cent of US respondents);
• A wider group experience: cited by 33 per cent of all respondents (rising to 50 per cent of consultancies);
• Efficiency of scale: cited by 30 per cent;
• Harmonized processes: 28 per cent;
• Greater transparency: 28 per cent (rising to 40 per cent of US respondents while by contrast falling to 16 per cent of Swiss respondents);
• Fostering of innovation & research: 26 per cent (falling to 16 per cent of Swiss respondents); and
• More uniform decisions: 25 per cent.

Biotechs were most switched on by the potential for accelerated trial approvals. For traditional pharma, harmonized processes, increased transparency, and efficiency of scale were the top three expected benefits.

Increasing sponsor interest in Europe for clinical trials

The vast majority (81 per cent) of all respondents said they expected a net increase in the volume of sponsored trial activity in Europe, rising to 94 per cent of US respondents  — a third of which said they expected a lot more of this. 

While this is encouraging, there is still a way to go in achieving total harmonization of clinical trial vetting across Europe’s diverse markets. Acceptance of the new centralized model appears strong, as well as the belief that harmonization will reduce barriers to performing clinical studies in Europe and make the region a more attractive market overall for new innovation in life sciences.

As the risk of having to transition between systems mid study grows, the number of companies registering clinical trials via the new CTIS is likely to have increased sharply since the survey was carried out in August. The submission, assessment and approval of trials across EU markets through the platform, under the new Clinical Trials Regulation, is soon to become mandatory. The survey appears to show that most pharma and biotech companies are working hard to be ready to reap the benefits.

Reference

1. Clinical Trials Regulation, EMA: https://www.ema.europa.eu/en/human-regulatory/research-development/clinical-trials/clinical-trials-regulation