Medical Research BADRAG meeting Jan 2013 Dr H Sari-Kouzel
Dec 25, 2015
Overview
Why do we need research How it it done Different types of research New drug development Taking part in research Questions
Why do Research?
Understand disease process Develop medicines Prevent disease development – vaccines Reduce burden of disease
Planning Research
Develop protocol
consultation patient / participation groups
Risk management
Consent / confidentiality
Seeking Ethical Approval
Research Ethics committees– Group of members of public and experts.– Review research proposals– Independent– Ethical standards; respects the dignity, rights,
safety, and well being of the people who take part
Types of Research
Clinical trials – medicines – devices
Non clinical trials– Lab based; animal models, human tissue, genetic
studies, etc– Epidemiology; smoking tobacco is cause of lung
cancer. – Clinical research; quality of life,
Lab based research
Animal models of disease similar to human. Human tissue; surgery, post mortem, live
samples, synovial fluid (joint aspiration) Genetic research; blood or saliva samples
Human Tissue Act 2004
An Act to make provision with respect to activities involving human tissue; to make provision about transfer of human remains from certain museum collections; and for connected purposes.
[15th November 2004]
Human Tissue Act 2004
illegal Removing, storing or using human tissue
with out consent. DNA “theft”- taking and testing DNA without
consent. Storing tissue or organ for a purpose not
stated. Organ trafficking
New Drug Development
Pre clinical ; Lab, animal, toxicity
Phase I Healthy Volunteers
Phase II first patients, dose ranging
Phase III more patients marketing application
Phase IV post marketing studies
Phase III clinical trials
Involves patients Randomised controlled clinical trial; Gold
standard – blind, double blind. Proposal with full details of the trial protocol. Ethical approval
Results
Results published in a peer-reviewed journal. Standard for reporting results. Analysis is scrutinised by other researchers. License to market the medicine MHRA (UK) ,
in other countries FDA, European.
Dissemination of Results
Presentations at conferences - abstract Publication in Medical journals Newspapers Headlines
National institute of clinical excellence NICE
Independent organisation Provides national guidance and standards Appraisals for new drugs/ devices Cost effectiveness new drugs Makes recommendations TAG ensure equal
access for patients across England Input from experts as well as public
Phase IV Post Marketing
MRHA reporting system for new drugs, black triangle▼
Any side effects should be reported. professionals and public are encouraged to
report Yellow card system
Post Marketing
Databases set up to monitor the drug in the real world.
2000 first biologics - anti TNF were licensed for use
Concerns about the long term effect
Biologics register – BSRBR
BSRBR
Based in Manchester University
Funded by a number of pharmaceutical companies
Independent
NICE approval recommended entry to register
Patient consent was required
Baseline questionnaire, 6 monthly
BSRBR
Support from patients and rheumatologist phenomenal
Important information UK wide collected and reports published regularly.
Similar registries in other countries has provided real experience of biologics
Non Clinical trials
Ethical approval required Patient consent Researcher
– theory – Design’s a study to answer a question – Pilot study – test the water– Expand
Research is fundamental to the NHS
“Research is vital in providing the new knowledge needed to improve health outcomes”
the White Paper 2010
National Institute for Health Research
National body Established April 2006 Framework National Research Facility Improving the health and wealth of the nation
through research.
Role of NHS
Every Trust has a dedicated Research and Development R&D team
Most trusts have a clinical trial unit/ research facility to run clinical trials
Dedicated research nurses and admin team Run commercial and non commercial studies
Taking Part in Research
Doctors and allied health professionals in training learn about research
Do projects Learn to appraise published papers Good clinical practice- training updates for
doctors
Patients taking Part in Research
Patients invited Patients provided information about the
project Opportunity to discuss Patient consent Enrolment
Standards in Research
Ethical standards to protect people 1947Nuremburg Code 1964 Declaration of Helsinki 1996 international conference of
harmonisation GCP 1996 Medical Research Council GCP 2004 European Directives update 2013 2005 Research Governance Framework
Patients taking part in Research
www.NHS choice.co.uk/clinical trials www.healthtalkonline.org/medical research/
From Serendipity to Science
Gold injections – 1928 injecting Gold salts– 1961first controlled trial
Methotrexate – 1951use described– 1978 formal clinical trial
Biologics– 1995 Clinical trials – 2000 Licenced used clinical practice