Stopping a Phase 3 trial for 'Benefit'19 Oct 2020 22:46
From Placing and Open Offer RNS 14.10.2020 -
"Following a positive pre-Investigational New Drug (IND) Application meeting with the U.S. Food and Drug Administration (FDA) regarding the design of a Phase III randomised placebo-controlled trial of SNG001 in hospitalised COVID-19 patients, and with manufacturing scale-up activity underway, the Company is pleased to announce the proposed Fundraising of up to £87.0 million to support the Phase III clinical development of SNG001 for COVID-19 patients."
Note the use of Placebo.
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source:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024796/#:~:text=Ethically%2C%20clinical%20trials%20must%20sometimes,%2C%20benefit%2C%20and%20futility%20concerns.
Ethically, clinical trials must sometimes be stopped early when the results show no justification for exposing human subjects to additional potential risk by continuing the trial. The 3 ethics scenarios are based on safety, benefit, and futility concerns.
1.
Safety: The risks to human subjects unexpectedly outweigh the benefits because of unexpected severe adverse events. When the institutional review board (IRB) approves a trial, it has determined that it meets US Food and Drug Administration (FDA) criteria for IRB approval at 21 CFR 56.111. Section (a)(2) states: “Risks to subjects are reasonable in relation to anticipated benefits, if any, to subjects, and the importance of the knowledge that may reasonably be expected to result.”11 This determination changes when a study unexpectedly causes serious illness or death in human subjects. The study may then be suspended by the FDA, the sponsor, and/or the IRB until the risk-benefit ratio is reevaluated. An example is drug manufacturer Bial's phase 1 clinical trial in healthy volunteers.12
2.
Benefit: The study hypothesis is unexpectedly proven early within predesignated criteria. Continuing to expose subjects in the inferior arm to additional potential risks or keeping them from benefitting from the therapies in the superior arm is hard to justify ethically. An example is the SPRINT study discussed above.
3.
Futility: The study hypothesis is unexpectedly shown to be unprovable within the constraints of the trial based on a statistical analysis of early study data, usually done at a planned interim analysis. In such cases, there is no benefit to balance against subjecting subjects to potential risks. An example is the cessation of the Verastem VX-6063 phase 2 clinical trial.
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Might the SNG001 phase 3 trial be stopped for Benefit reasons? - Recall that 3 patients died recently taking placebo in ph2 trials.
RM would have to be careful developing the predefined stopping rules criteria.
He has spoken to the FDA, and this might have been a discussed. We already know SNG001 is safe.
The results of the 'At Home' study are imminent.
With the COPD / Hospital Covid trial / @ home study results available, will a positive peer review, and phase 3 trial proceeding successfully, stop the t