High quality protocols facilitate proper conduct, reporting, and external review
 of clinical trials. However, the completeness of trial protocols is often
 inadequate. To help improve the content and quality of protocols, an
 international group of stakeholders developed the SPIRIT 2013 Statement
 (Standard Protocol Items: Recommendations for Interventional Trials). The SPIRIT
 Statement provides guidance in the form of a checklist of recommended items to
 include in a clinical trial protocol. This SPIRIT 2013 Explanation and Elaboration paper provides important
 information to promote full understanding of the checklist recommendations. For
 each checklist item, we provide a rationale and detailed description; a model
 example from an actual protocol; and relevant references supporting its
 importance. We strongly recommend that this explanatory paper be used in
 conjunction with the SPIRIT Statement. A website of resources is also available
 (www.spirit-statement.org). The SPIRIT 2013 Explanation and Elaboration paper, together with the Statement,
 should help with the drafting of trial protocols. Complete documentation of key
 trial elements can facilitate transparency and protocol review for the benefit
 of all stakeholders.

https://www.bmj.com/content/bmj/346/bmj.e7586.full.pdf

SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials

The pharmaceutical industry is under growing pressure from a range of environmental issues, including major losses of revenue owing to patent expirations, increasingly cost-constrained healthcare systems and more demanding regulatory requirements. In our view, the key to tackling the challenges such issues pose to both the future viability of the pharmaceutical industry and advances in healthcare is to substantially increase the number and quality of innovative, cost-effective new medicines, without incurring unsustainable R&D costs. However, it is widely acknowledged that trends in industry R&D productivity have been moving in the opposite direction for a number of years. Here, we present a detailed analysis based on comprehensive, recent, industry-wide data to identify the relative contributions of each of the steps in the drug discovery and development process to overall R&D productivity. We then propose specific strategies that could have the most substantial impact in improving R&D productivity.

/pdf/how-to-improve-r-d-productivity-the-pharmaceutical-industry-40dxa89ine.pdf

How to improve R&D productivity: the pharmaceutical industry's grand challenge

Background The Ad26.COV2.S vaccine is a recombinant, replication-incompetent human adenovirus type 26 vector encoding full-length severe acute respiratory syndrome coronavirus 2 (SARS-CoV-...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa2101544

Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)60946-5.pdf

Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial

https://www.gastrojournal.org/article/S0016-5085(13)00846-9/pdf

Subcutaneous golimumab induces clinical response and remission in patients with moderate-to-severe ulcerative colitis.

A PhRMA Working Group on adaptive clinical trial designs has been formed to investigate and facilitate opportunities for wider acceptance and usage of adaptive designs and related methodologies. A White Paper summarizing the findings of the group is in preparation; this article is an Executive Summary for that full White Paper, and summarizes the findings and recommendations of the group. Logistic, operational, procedural, and statistical challenges associated with adaptive designs are addressed. Three particular areas where it is felt that adaptive designs can be utilized beneficially are discussed: dose finding, seamless Phase II/III trials designs, and sample size reestimation.

http://www.gemini-grp.com/Bayes/PhRMA.pdf

Adaptive Designs in Clinical Drug Development—An Executive Summary of the PhRMA Working Group

‘Multistage testing with adaptive designs’ was the title of an article by Peter Bauer that appeared 1989 in the German journal Biometrie und Informatik in Medizin und Biologie. The journal does not exist anymore but the methodology found widespread interest in the scientific community over the past 25 years. The use of such multistage adaptive designs raised many controversial discussions from the beginning on, especially after the publication by Bauer and Kohne 1994 in Biometrics: Broad enthusiasm about potential applications of such designs faced critical positions regarding their statistical efficiency. Despite, or possibly because of, this controversy, the methodology and its areas of applications grew steadily over the years, with significant contributions from statisticians working in academia, industry and agencies around the world. In the meantime, such type of adaptive designs have become the subject of two major regulatory guidance documents in the US and Europe and the field is still evolving. Developments are particularly noteworthy in the most important applications of adaptive designs, including sample size reassessment, treatment selection procedures, and population enrichment designs. In this article, we summarize the developments over the past 25 years from different perspectives. We provide a historical overview of the early days, review the key methodological concepts and summarize regulatory and industry perspectives on such designs. Then, we illustrate the application of adaptive designs with three case studies, including unblinded sample size reassessment, adaptive treatment selection, and adaptive endpoint selection. We also discuss the availability of software for evaluating and performing such designs. We conclude with a critical review of how expectations from the beginning were fulfilled, and – if not – discuss potential reasons why this did not happen. © 2015 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

/pdf/twenty-five-years-of-confirmatory-adaptive-designs-3255o18f2p.pdf

Twenty-five years of confirmatory adaptive designs: opportunities and pitfalls

Adaptive designs for dose-finding based on efficacy–toxicity response

In this article, we give a general definition of adaptive designs, describe their structure, and provide a classification of adaptive designs, mapping them against the drug development process.

Adaptive Designs: Terminology and Classification:

Adaptive seamless designs have been considered as one possible way to shorten the time and patient exposure necessary to discover, develop, and demonstrate the benefits of a new drug. We introduce the concept of adaptive designs and describe the current statistical methodologies that relate to adaptive seamless designs. We also describe the decision process involved with seamless designs and present some illustrative examples.

Vladimir Dragalin

Papers

Adaptive Designs in Clinical Drug Development—An Executive Summary of the PhRMA Working Group

Twenty-five years of confirmatory adaptive designs: opportunities and pitfalls

Adaptive designs for dose-finding based on efficacy–toxicity response

Adaptive Designs: Terminology and Classification:

Adaptive seamless Phase II/III designs : Background, operational aspects, and examples