Presented by Sue Robinson, Premier Research at the ICR Symposium - Finders Keepers: Novel Patient Recruitment & Retention Strategies, November 2011

1. Feasibility Solutions to
Clinical Trial Nightmares
Sue Robinson
Director, Patient Recruitment
1: 28/11/2011

2. What do our Project Managers dream about?
Low investigator
Protocol rejection
acceptance
Slow start up Poor recruitment
2: 28/11/2011

3. How can feasibility help?
 Early, detailed feasibility can provide solutions to all
these nightmares!
 BUT…..
 More commonly in our industry we rely on feasibility
conducted during the 10 day proposal process to provide
the strategy and planning for multi million dollar studies
and programs!
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4. It’s never too soon for feasibility for…..
Protocol Development
Country & site strategy
Recruitment planning
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5. Protocol development
 Placebo control
 Washout periods
 Patient assessments tools
 Specialist equipment
 Invasive procedures
 Too many visits
 Complex diary data
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6. Avoid protocol rejection / amendments
 Justify study design
 Explain rescue medication and patient evaluation in
detail
 Match protocol with standard of care
o Assess investigator common practice for diagnosis, treatment
and long term evaluation
 Take care when including labs for paediatrics
 Consider that patients have a life outside of the study
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7. Successful strategy development includes
Investigator & Patient Sponsor Protocol
Motivation Requirements Design
Competing Trial Country & site Patient
Environment distribution Population
Regulatory
Previous study Disease Environment
Data Prevalence and Timelines
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8. Investigator and patient motivation
What motivates.....
Investigators Patients
...to join a study
1. Access to relief of symptoms
1. Scientific
2. Long term treatment of illness
interest/recognition/publication etc.
3. Regular check ups and contact with
2. Benefit of better treatment options
medical staff (TLC)
for patients
4. Reduced treatment or clinic
3. Lower costs of treatment for site
attendance costs
and/or patients
5. Education and information about
4. Appropriate fee
their condition/study/treatment
5. Funds for improved equipment/ options
facilities
6. Meeting others with same
illness
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9. Recruitment planning
Identify the ideal site
profile
Balance recruitment
time with site numbers
and distribution
Know your target
patient population
Data collection is key
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10. Questionnaire lottery
Feasibility data isn’t
just about estimated
recruitment rates from
investigators
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11. RA patients who haven’t had
The patient funnel biological therapy in last 3 months
Do you have a database of RA patients?
If yes, how many on your database?
# of RA patients seen per month
% treated with biological therapy
# biological therapy
failures per month
# newly
diagnosed RA
pts seen per
month
Target pt
pool
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12. The patient funnel isn’t the complete story…
Patient
Phase and
recruitment
study design
approaches
Complexity of Investigator
study protocol Other grant
influences
include:
Access to Competing
assessments studies
Reimbursement for
Investigator/ site staff
equivalent treatment
motivation
and assessment
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13. Feasibility in practice – A case study
Phase 2, placebo controlled study requiring ~800
FI patients with minimal scar tissue with
moderate to severe FI symptoms
Feasibility: Protocol Site
6 weeks update: identification:
(+2 weeks KOLs) 4 weeks 4 weeks
Case Study: FI 13: 28/11/2011

14. Feasibility summary Interested sites
7
 Data from 104 sites in 21 countries 6
globally 5
 Highest level of interest found in 4
Europe 3
 Diverse range of physicians and 2
healthcare professionals see these 1
patients 0
Finland
Belgium
Australia
Bulgaria
Hungary
Mexico
France
Poland
Czech Repubilc
Russia
Austria
Norway
Italy
Spain
Netherlands
New Zealand
Germany
Argentina
USA
Sweden
UK
 Limited previous study activity
mainly in devices, injectables and
nerve stimulation
 Many patients are not actively treated in the sites, many are in
other institutions, healthcare facilities or in many cases not
seeking medical advice but self medicating
Case Study: FI 14: 28/11/2011

15. Protocol updates following feasibility
Change of FI assessment Reduced patient
score numbers
Reduced post screening Patient evaluation
run in period procedure modified
Modification to extended Refined diary data to be
first visit collected
Case Study: FI 15: 28/11/2011

16. Country selection
▪ Five regions assessed but low
Regional % split of patients
interest from AP & LA
▪ Countries selected based on level of
interest and recruitment potential
19% 29%
▪ Main response from WE & CEE
▪ US included for marketing purposes
52% ▪ Recruitment expected to be higher
in CEE based on feasibility results
▪ Majority of sites confirm they would
WE CEE NA need outreach/advertising to
support recruitment
Case Study: FI 16: 28/11/2011

17. Build patient recruitment strategy on feasibility
data and local knowledge
Gastroenterologists are the ideal site
but many others see these patients
Main reason for declining = lack of
patients...
...but could sites be interested
with supported outreach and referral
Case Study: FI 17: 28/11/2011

18. Understand the FI patient flow
Case Study: FI 18: 28/11/2011

19. Patient recruitment challenges identified
 A topic not openly discussed – quite frankly it’s embarrassing
 Our patient population is hidden – only 1 in 8 present
 Practicalities of travelling to sites for visits – limited reach of patient
catchment area
 Overcoming specific hurdles of protocol at the crucial consent stage
 Intrusive exams
 Treatment free run-in period
 Long first treatment visit in clinic
 Placebo controlled study
 Significant portion of population potentially excluded due to presence
of cardiovascular conditions
Case Study: FI 19: 28/11/2011

20. Proposed 3 tiered approach to material development
Identity, tools for site, direct to patient outreach
Essential items & referral
Press/radio advertising in selected countries,
Targeted Media
washroom advertising, website and targeted
campaign mailing kit
Mini protocol, pre screen checklist, visual
informed consent guide, patient brochure,
Nice to have conversation guide, print advertorial, banner
advertisement referral fact card & loyalty and
retention items
Case Study: FI 20: 28/11/2011

21. No more nightmares…feasibility can lead to
much sweeter dreams…
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