loading page

The impacts of undetected noncompliance in phase II, III, and IV clinical trials: An overview
  • Elise Le Flohic,
  • Bernard Vrijens,
  • Mickael Hiligsmann
Elise Le Flohic
Maastricht University

Corresponding Author:[email protected]

Author Profile
Bernard Vrijens
AARDEX Group
Author Profile
Mickael Hiligsmann
Maastricht University
Author Profile

Abstract

Aim: This research aims to provide an overview of the consequences of undiagnosed non-adherence in clinical trials. Methods: This research was conducted with a mixed-methods approach. It combines a literature review and qualitative semi-structured interviews with key opinion leaders. Based on this groundwork, the consequences of undiagnosed non-adherence in clinical trials were summarized and reported in a figure. This study focused on phases II, III, and IV in ambulatory settings across a variety of therapeutic areas and indications. Results: Various consequences of non-adherence in trials were investigated. In phase II, drug efficacy may be underestimated, variability in the outcomes may be high, and a distorted picture of side effects could be reported, resulting in an uncertain impression of the investigational product’s profile, and complicating decision-making. The sponsor may need to increase the sample size of the upcoming phase III study to improve its power, representing additional costs, or even terminate the study. In phase III, similar phenomena may be observed, making demonstration of efficacy to the regulatory bodies more difficult. Lastly, in phase IV, a distortion in pharmacometrics may occur; the drug may underperform, prescriptions may be refilled less often than expected, or extra expenses may be incurred by the payers. This can result in post-marketing dose reduction, new competitors coming into the market, and eventually, product withdrawal. Conclusion: This research highlighted the many potential adverse consequences of undiagnosed non-adherence in clinical trials, including additional costs. Collecting accurate data appeared to be crucial for decision-making throughout the drug development process.
23 Jan 2023Submitted to British Journal of Clinical Pharmacology
07 Mar 2023Submission Checks Completed
07 Mar 2023Assigned to Editor
07 Mar 2023Review(s) Completed, Editorial Evaluation Pending
26 Mar 2023Reviewer(s) Assigned
16 May 2023Editorial Decision: Revise Major
28 Jul 20231st Revision Received
28 Jul 2023Submission Checks Completed
28 Jul 2023Assigned to Editor
28 Jul 2023Review(s) Completed, Editorial Evaluation Pending
29 Jul 2023Reviewer(s) Assigned
16 Oct 2023Editorial Decision: Revise Major
28 Jan 2024Review(s) Completed, Editorial Evaluation Pending
26 Feb 2024Editorial Decision: Revise Minor
06 Mar 20243rd Revision Received
11 Mar 2024Submission Checks Completed
11 Mar 2024Assigned to Editor
11 Mar 2024Review(s) Completed, Editorial Evaluation Pending