Low-risk trials for children and pregnant women threatened by unnecessary strict regulations. Does the coming EU Clinical Trial Regulation offer a solution?

• Published in: European journal of pediatrics Vol. 179; no. 8; pp. 1205 - 1211
• Main Authors: Knaapen, Max, Ploem, Martine Corrette, Kruijt, Maya, Oudijk, Martijn A., van der Graaf, Rieke, Bet, Pierre M., Bakx, Roel, van Heurn, L. W. Ernst, Gorter, Ramon R., van der Lee, Johanna H.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2020; Springer Nature B.V
• Subjects: Child; Children; Clinical trials; Clinical Trials as Topic - ethics; Clinical Trials as Topic - legislation & jurisprudence; Clinical Trials as Topic - standards; Compliance; European Union; Female; Government Regulation; Humans; Medical research; Medicine; Medicine & Public Health; Pediatrics; Practice Guidelines as Topic; Pregnancy; Regulation; Research Design - legislation & jurisprudence; Research Design - standards; Research Personnel - ethics; Research Personnel - legislation & jurisprudence; Research Personnel - standards; Review; Risk; Therapeutic Human Experimentation - ethics; Therapeutic Human Experimentation - legislation & jurisprudence; Pragmatic clinical trials; Clinical trial regulation; Investigator initiated research; ICH-GCP guideline; Risk-based trial regulation
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-020-03715-3

Investigator-initiated clinical trials are crucial for improving quality of care for children and pregnant women as they are often excluded from industry-initiated trials. However, trials have become increasingly time-consuming and costly since the EU Clinical Trial Directive entered into force in 2001. This directive made compliance with ICH-Good Clinical Practice Guidelines (ethical and quality standard for conducting human subject research) mandatory for all clinical trials, regardless of its risk-classification. By discussing two investigator-initiated, ‘low-risk’ drug trials, we aim to illustrate that compliance with all GCP requirements makes trials very laborious and expensive, while a clear rationale is missing. This discourages clinical researchers to start and carry out investigator-initiated research. However, the forthcoming EU Clinical Trial Regulation (No 536/2014) seems to provide a solution as it allows for less stringent rules for low-risk trials. We want to raise awareness for these developments in both the clinical research community and the European and national regulatory authorities. Implementation of this forthcoming Regulation regulatory policies should be done in such a way that investigator-initiated trials evaluating standard care interventions will become more feasible. This will allow us to obtain evidence on optimal and safe treatments, especially for groups that are underrepresented in medical research. What is Known • Investigator-initiated trials are indispensable for improving care for children and pregnant women as they are often excluded from industry-initiated trials • Trials have become increasingly time-consuming and costly because of mandatory compliance with ICH-GCP guidelines What is New • The forthcoming EU Clinical Trial Regulation allows less stringent rules for low-risk trials • The national legislator and regulatory authorities should recognize the importance of this opportunity and implement the Regulation in such a way that investigator-initiated trials will become more feasible