Koneksa Health, New York, New York, USA.
Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA.
Clin Transl Sci. 2023 Aug;16(8):1323-1330. doi: 10.1111/cts.13533. Epub 2023 May 8.
Recently, digital health technologies (DHTs) and digital biomarkers have gained a lot of traction in clinical investigations, motivating sponsors, investigators, and regulators to discuss and implement integrated approaches for deploying DHTs. These new tools present new and unique challenges for optimal technology integration in clinical trial processes, including operational, ethical, and regulatory issues. In this paper, we gathered different perspectives to discuss challenges and perspectives from three different stakeholders: industry, US regulators, and a public-private partnership consortium. The complexities of DHT implementation, which include regulatory definitions, defining the scope of validation experiments, and the need for partnerships between BioPharma and the technology sectors, are highlighted. Most of these challenges are related to translation of DHT-derived measures into endpoints that are meaningful to clinicians and patients, participant safety, training, and retention and privacy of data. The example of the Wearable Assessments in the Clinic and Home in PD (WATCH-PD) study is discussed as an example that demonstrated the advantages of pre-competitive collaborations, which include early regulatory feedback, data sharing, and multistakeholder alignment. Future advances in DHTs are expected to spur device-agnostic measured development and incorporate patient reported outcomes in drug development. More efforts are needed to define validation experiments for a defined context of use, incentivize data sharing and development of data standards. Multistakeholder collaborations via precompetitive consortia will help facilitate broad acceptance of DHT-enabled measures in drug development.
最近,数字健康技术(DHT)和数字生物标志物在临床研究中得到了广泛关注,这促使赞助商、研究者和监管机构讨论并实施集成方法来部署 DHT。这些新工具为临床试验过程中最佳技术集成带来了新的和独特的挑战,包括操作、伦理和监管问题。在本文中,我们汇集了不同的观点,从三个不同的利益相关者:行业、美国监管机构和公私合作伙伴关系联盟,讨论了挑战和观点。DHT 实施的复杂性包括监管定义、定义验证实验的范围以及生物制药和技术部门之间合作的必要性,这些都突显了出来。这些挑战大多与将 DHT 衍生的测量值转化为对临床医生和患者有意义的终点、参与者安全、培训以及数据的保留和隐私有关。Wearable Assessments in the Clinic and Home in PD(WATCH-PD)研究的例子被讨论为一个展示了预先竞争合作优势的例子,包括早期的监管反馈、数据共享以及多方利益相关者的一致性。预计 DHT 的未来进展将刺激设备无关的测量开发,并将患者报告的结果纳入药物开发中。需要更多的努力来为定义的使用场景定义验证实验,激励数据共享和开发数据标准。通过预先竞争的联盟进行多方利益相关者合作将有助于促进 DHT 支持的措施在药物开发中的广泛接受。