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Busner J, Pandina G, Domingo S, Berger AK, Acosta MT, Fisseha N, Horrigan J, Ivkovic J, Jacobson W, Revicki D, Villalta-Gil V. Clinician- and Patient-reported Endpoints in CNS Orphan Drug Clinical Trials: ISCTM Position Paper on Best Practices for Endpoint Selection, Validation, Training, and Standardization. Innov Clin Neurosci 2021; 18:15-22. [PMID: 35096477 PMCID: PMC8794479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The International Society of CNS Clinical Trials Methodology (ISCTM) Working Group on Rare Disease/Orphan Drug Development is dedicated to improving and streamlining trials to best develop new treatments for rare diseases. The rarity of these disorders requires a drug development strategy that differs from those of nonrare conditions. Rare disease drug development programs are challenged with small sample sizes, heterogeneous clinical presentations, and few, if any, off-the-shelf endpoints. When disease-specific clinical endpoints exist, they might not be validated and are typically not well known or broadly used in clinical practice. This paper aims to provide an overview of the special issues surrounding endpoints in rare disease drug development, with guidance, practical applications, and discussion. DISCUSSION The paper covers regulatory considerations in endpoint selection; identification of relevant measurement domains; methods of quantifying clinical meaningfulness; incorporation of patient- and clinician-reported outcomes; considerations for global clinician- and patient-rated clinical assessments; cognition assessment challenges in rare diseases; translation considerations; training, standardization, and calibration of assessors; and endpoint quality assurance. Additionally, it provides guidance and resources for those involved in drug development for rare diseases. CONCLUSION In keeping with the mission of ISCTM and the rare disease/orphan drug development working group, this article is designed to encourage thoughtful consideration and provide insight and guidance to promote and further efforts in in central nervous system (CNS) rare disease drug development efforts.
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Affiliation(s)
- Joan Busner
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Gahan Pandina
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - SilviaZaragoza Domingo
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Anna-Karin Berger
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Maria T Acosta
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Nahome Fisseha
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Joseph Horrigan
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Jelena Ivkovic
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - William Jacobson
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Dennis Revicki
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
| | - Victoria Villalta-Gil
- All authors are members of the ISCTM Working Group for Rare Disease/Orphan Drug Development; Drs. Busner and Pandina are Co-Chairs
- Dr. Busner is with Signant Health in Blue Bell, Pennsylvania, and the Department of Psychiatry, Virginia Commonwealth University School of Medicine in Richmond, Virginia
- Dr. Pandina is with Janssen Pharmaceuticals in Titusville, New Jersey
- Dr. Domingo is with Neuorpsyncro in Barcelona, Spain. Dr. Berger is with Lundbeck in Copenhagen, Denmark
- Dr. Acosta is with National Human Genome Research Institute, National Institutes of Health, in Bethesda, Maryland
- Dr. Fisseha is with AbbVie Pharmaceuticals in North Chicago, Illinois
- Dr. Horrigan is with AMO Pharma Limited and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, in Durham, North Carolina
- Dr. Ivkovic was with Lundbeck in Copenhagen, Denmark at the time this was written, but she is now with Zealand Pharma in Soborg, Denmark
- Dr. Jacobson is with Harmony Biosciences in Plymouth Meeting, Pennsylvania
- Dr. Revicki was with Evidera in Bethesda, Maryland
- Dr. Villalta-Gil is with VeraSci in Durham, North Carolina
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