CLINICAL TRIALS
- New drugs need to be tested on human volunteers, before they can be approved.
- Clinical trials are carried out on human volunteers to test newly discovered drugs.
- Bio equivalence (BE) studies are conducted on the existing drugs, which are different from clinical trials being conducted on new drugs, which have not entered the market.
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DRUG DEVELOPMENT PROCESS
Currently, a new drug is estimated to cost about $800 million by the time it reaches the market. Clinical trials are the most time consuming and expensive part of the development process.
The clinical trial company bridges science to the market place by performing, assisting and managing pharmaceutical, biotechnology product and medical device development through preclinical and clinical (Phase I to Phase IV) studies.
INDIA'S ADVANTAGES
Overseas drug companies have shown increasing interest in carrying out trials in India because it is cheaper, 50 percent to 75 percent lower than the costs of a similar study in the US.
India's advantage in clinical development are clearly the speed of patient enrollment and shorter time for clinical trials.
The cost of clinical trials in the US and Europe have skyrocketed and recruiting qualified therapy-naive patients, who have not received any prior treatment, can be extremely time consuming and can cause delay in the completion of these trials for months or even years.
Completing clinical drug trials and product development in India could be up to 75% faster.
As per Rabo India Finance, although the average costs of doing Phase I/II/III drug trials in US are $20/50/100 million respectively, in India they are 50% to 60% of the same.
In recent years, India has created a favourable environment for clinical trials.
India signed the WTO agreement (fully effective in 2005) to alleviate issues related to protection of Intellectual Property. Regulatory laws have been updated to conform to the global GCP guidelines. All medical facilities have been mandated to meet the GCP procedures and training support of medical personnel necessary to achieve this goal provided. India has provided exemptions for import duties on clinical trials products and eliminated the procedural hurdles that were prevalent in the past.
India has a very large pool of highly trained physicians, nurses, and technical personnel and numerous world-class medical facilities that meet the global requirements for clinical testing.
Many major pharmaceutical companies have already successfully used clinical trials data from India for US FDA NDA (Federal Drug Authority New Drug Application) submissions.
The broadly developed information technology infrastructure in India provides added advantage to ensure speedy conduct of studies and flow of information data from the sites to the sponsors databases.
As a result, India is seeing a rapid growth of clinical trials. The setting of a large, diverse, and therapy-naive population, low cost for technical services, and use of English as the primary business and medical language is ideal for completing trials rapidly and cost efficiently.
There is need to leverage the India advantage with its value proposition to deliver world-class clinical research services to global pharmaceutical, biotechnology, medical device and nutraceutical organisations.
Clinical Research in India
Cost of research - US vis-C -vis India
Study |
Average US cost
(in millions) |
India Cost |
Phase 1 (normally tests on small groups of healthy humans) |
$20 |
50% less than the average cost in US |
Phase II (tests on individuals afflicted with the condition for which the drug was developed) |
$50 |
60% less than the average cost in US |
Phase III (tests on large groups of afflicted patients) |
$100 |
60% less than the average cost in US |
Source: Rabo India Finance
US FDA submission / registration
Clinical trials performed in India since 1996
Drug Company |
Molecules Researched |
Alcon |
Vegamox |
AstraZeneca |
Merenem |
Cangene |
Hepatitis B Vaccine |
Eli Lilly |
Alimta
Gemcitabine (breast cancer)
Cialis (erectile dysfunction)
Xygris (Septicemia) |
Glaxo |
Lamictal |
Jannsen |
Resperidal |
Novartis |
Tegaserod |
Pfizer |
Voriconazole |
Roche |
Peg-Interferon |
Santen |
Quixin |
Wyeth |
Influenza A Vaccine |
Source: Reliance Research
APOLLO HOSPITALS Apollo Hospitals plans to tie-up with a contract research organisation (CRO) to tap the potential offered by the clinical trials business.
As the sensitive nature of clinical trials make it necessary for procedures to be strictly followed and volunteers to be adequately informed, Apollo uses another agency to keep an eye on the trials.
Spectra, a site management organisation that is largely owned by Apollo, monitors the trials carried out by the hospital. Spectra has an "arm's length" association with Apollo.
Apollo's large volume of patients provide opportunities to recruit volunteers. CRO that carried out the trials would have to pay the hospital a fee.
Apollo had carried out about 65 trials so far and the revenue was about Rs.40 million to Rs.50 million
At the moment, an ethics committee that is made up of members of its medical staff, a lawyer and a representative from the site management organisation supervises Apollo's trials.
RELIANCE CLINICAL RESEARCH SERVICES (RCRS)
RCRS is part of the Reliance Group of Companies and a component of the life science initiative of Reliance.
The company has made a foray into the clinical research services market in USA and Europe.
RCRS is currently conducting several studies for clients based in the US,UK and Middle-East. It is working for indications in oncology, burn wounds, cardiovascular, endocrinology, nephrology, gastroenterology, infectious diseases and vaccines.
Reliance Clinical Research Services (RCRS) is now addressing the clinical research services market in USA and Europe. RCRS is mandated to emerge as an India-based, world-class contract clinical research services organisation.
RCRS provides services in project management, clinical operations, site management, biometrics (data management and biostatistics), medical affairs (pharmacovigilance and medical writing), regulatory affairs, animal studies, quality assurance, molecular diagnostics, ICH-GCP training, archival facility and drug storage and supplies.
The vision of RCRS is to become a world-class full-service contract clinical research service provider, with quality delivery to ICH-GCP (International Conference on Harmonisation. Good Clinical Practice) standards and conduct of speedy clinical trials.
CONTROVERSIES
Indian clinical trials have also stirred controversies in the past primarily because it was found that procedures had not been followed.
A trial's sponsor was the best check for its integrity because a drug company had a lot to lose, if it would be later found that procedures were violated.
GVK Biosciences, a GVK group company, has strongly denied the allegations that it is undertaking illegal clinical trials. The company stated that it is taking up only bio equivalence (BE) studies on generic drugs, which does not require approvals from the Drug Controller General of India (DCGI).
The Hyderabad police had filed a case against the company on May 3rd,2004 based on the complaints received from four unemployed youths who alleged that they were paid just Rs.30 after taking blood samples, as part of the tests, though they were promised employment.
The police also arrested the labour contractors.
Meanwhile, the state government had ordered probe into the entire issue through the state drug controller.
The company claims that it has also formed an ethical committee, chaired by a retired High Court judge, to supervise every BE study before giving the clearance to go ahead with the project.
Meanwhile, the state's Drug Control Administration (DCA) formed a two member special investigation team to probe into the issue. The team has submitted a detailed report to the state government and is in the process of informing the central office.
STRATEGY
The value proposition is built around a strong knowledge base and network in the medical domain, full service project planning, conduct and management of trials throughout India, in-house molecular diagnostic support and in-house Phase I and pre-clinical toxicity ability.
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