WHAT IS A CLINICAL TRIAL?

A clinical trial is a carefully designed research study that tests how well a medical intervention—such as a new drug, vaccine, medical device, treatment strategy, or behavioral intervention—works in people.

 

Clinical research is medical research involving people. In summary, clinical research is carried out in order to provide scientific evidence for the safety, and efficacy of a drug or an intervention (for instance medicine, dietary supplements or other non-drug therapies). There are two different types of clinical research:

Interventional Trials

A clinical interventional trial tests either a new drug or a non-drug therapy (exercise or diet) to see if it can improve symptoms or stop the disease. It is set so some volunteers get the drug, others get an inactive pill (placebo). Both groups are monitored to see who does better.

Observational Trials

A clinical observational trial, like Enroll-HD, usually just takes measurements to explore how a disease changes over time and what affects the health of people with a particular disease. There is no drug being tested.

How are the trials and studies done?

Everyone who wants to conduct a trial or study needs approval from the authoroties and ethic committees.  Drug trials performed in Europe needs approval both from the European Medicines Agency and from the ethic committees in each country where there are participants.  These authorities are responsible for vetting the risk/benefit ratio of the trial – their approval does not mean that the therapy is ‘safe’ or effective, only that the trial may be conducted.

Depending on product type and development stage, investigators initially enroll volunteers or patients into small pilot studies and subsequently conduct progressively larger scale comparative studies. Clinical trials can vary in size and cost, and they can involve a single research center or multiple centers, in one country or in multiple countries. Clinical study design aims to ensure the data collected in the study holds high standards and measure the potential effect – positive, negative or no effect – in a scientifically sound way.  The procedures has to be publicly available to allow independent evaluation of the reported results.

FROM LABORATORY TO APPROVED TREATMENT

Click below to learn more about how medicines are approved by the European Medicine Agency (EMA)

CLINICAL TRIALS EXPLAINED BY Hoffmann-La Roche

Learn about the stages and types of clinical trials. Find also the frequently asked questions (FAQ) about Huntington’s studies.

WHY SHOULD I GET INVOLVED?

Scientists work constantly to find enhanced ways to treat diseases, but improved treatments can never become a reality without testing in clinical trials with human volunteers. Individuals with HD are urgently needed to participate in the ongoing enrolling clinical trials focused on HD. In some studies, those who are at risk, caregivers and healthy volunteers are also needed. Recruiting and retaining trial participants is now the greatest obstacle, other than funding, to developing the next generation of HD’s treatments.

By participating in clinical research, you can help to accelerate progress and provide valuable insight into potential treatments and methods of prevention.

Benefits of clinical trials
Participating in clinical trials has the potential to help both the individual participant and other individuals who have HD or are at risk of developing it:

  • You can play a more active role in your own health care.
  • You can gain access to potential treatments before they are widely available.
  • You can receive expert medical care at leading healthcare facilities — often free of cost — while participating in important medical research.
  • You can help future generations by contributing to HD research.

Risks of participation
Patient safety is the most important aspect of every HD clinical trial. The procedures for each study are reviewed by an expert committee not directly involved in the trial, helping ensure that patient safety is protected.

There are risks, however, when participating in clinical trials:

  • There may be unpleasant or even serious side effects related to the potential treatment(s) being studied.
  • The experimental treatment may not be effective.

Details of risks related to participation in the clinical study are spelled out in the consent form participants (or their proxies) sign when they agree to participate.

Reasons for optimism
No new treatment advances to the clinical testing phase unless there is strong evidence indicating it will be as effective as, or more effective than, currently available therapies. Every clinical trial contributes valuable knowledge, whether or not the treatment works as hoped.

Participating in clinical studies gives us optimism for today and promise for the future. They provide many participants with access to cutting-edge treatments and expert medical care. And some day they will lead us to the end of HD.

Participants receive a high standard of care
All participants receive regular care related to the trial and opportunities to talk to clinical trial staff. Research shows that people living with the disease who are involved in clinical trials tend to do somewhat better than people in a similar stage of their disease who are not enrolled in clinical trials, regardless of whether the experimental treatment works. Scientists believe this advantage may be due to the general high quality of care provided during clinical trials.

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SNP-single nucleotide polymorphisms

a single-letter spelling difference in a gene. SNPs, pronounced ‘snips’, are common and most don’t change the function of the gene.

 
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at risk

You do not know if you carry the genetic mutation for HD gene 

 
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TFC-total functional capacity

A standardized rating scale for function in HD, used to assess capacity to work, handle finances, perform domestic chores and self-care tasks.
Scores range from 0 to 13, with higher scores indicating better functional capacity. 

 
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Double-blinded

 means that neither the participant nor the clinical trial doctor can choose or know the group the participant is in until the trial is over. This approach helps to prevent bias.

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Open label

A trial in which the patient and doctor know what drug is being used. Open label trials are susceptible to bias through placebo effects.

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Gene therapy

a technique that aims to treat or prevent diseases by modifying a person’s genes. It involves introducing, removing, or changing genetic material (DNA or RNA) within a patient’s cells.

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UHDRS- Unified Huntington Disease Rating Scale

A standardized neurological examination that aims to provide a uniform assessment of the clinical features of HD

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CAG repeat

The stretch of DNA at the beginning of the HD gene, which contains the sequence CAG repeated many times, and is abnormally long in people who will develop HD

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Wild-type

the opposite of ‘mutant’. Wild-type huntingtin, for example, is the ‘normal’, ‘healthy’ protein

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Tolerabilty

How well a person can handle a treatment without having serious or uncomfortable side effects.

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Striatum

Part of the brain that  coordinates multiple aspects of cognition, including both motor and action planning, decision-making, motivation, reinforcement, and reward system.

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Randomized allocation

A type of allocation strategy in which participants are assigned to the arms of a clinical trial by chance.

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Radioligand

a radioactive substance that binds to a specific target in the body, allowing visualization of that target’s distribution and activity

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Protein

Protein builds, maintains, and replaces the tissues in your body. The building blocks of life.

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Premanifest / Prodromal

Prior to onset or diagnosis of movement symptoms.

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Placebo

A placebo is a dummy medicine containing no active ingredients. The placebo effect is a psychological effect that causes people to feel better even if they’re taking a pill that doesn’t work.

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PK - Pharmacokinetics

The movement of drugs through the body

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PD - Pharmacodynamics

The body’s biological response to drugs

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PET scan

Positron emission tomography which produces detailed 3-dimensional images of the inside of the body.

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Neuron

Brain cells that store and transmit information

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MRI

Magentic resonance imaging: A technique using powerful magnetic fields to produce detailed images and visualizes the structure of organs, tissues, and bones 

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mHTT

Mutant huntingtin protein. The protein produced by the faulty HD gene.

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Manifest

after HD diagnosis, or when symptoms are already showing

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Longitudinal study

A study where each participant is looked at several times over a time period – unlike a cross-sectional study, where each participant is looked at only once

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HTT

one abbreviation for the gene that causes Huntington’s disease. The same gene is also called HD and IT-15

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fMRI

functional MRI:As with MRI, a technique using powerful magnetic fields  but focusing on brain function by measuring and mapping changes in blood flow, revealing which areas of the brain are active during specific tasks or cognitive processes

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CSF - cerebrospinal fluid

A clear fluid produced by the brain, which surrounds and supports the brain and spinal cord.

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Efficacy

A measure of whether a treatment works or not

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ASO(Antisense oligonucleotides)

A type of gene silencing treatment in which specially designed DNA molecules are used to switch off a gene

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Biomarker

a test of any kind – including blood tests, thinking tests and brain scans – that can measure or predict the progression of a disease like HD. Biomarkers may make clinical trials of new drugs quicker and more reliable

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BDNF

Brain-derived neurotrophic factor: a growth factor that may be able to protect neurons in HD.

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Allele

one of the two copies of a gene

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Plasma

Liquid component of the blood.

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Gene

The basic unit of heredity passed from parent to child. Genes are made up of sequences of DNA and are arranged, one after another, at specific locations on chromosomes in the nucleus of cells.

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Phase

Clinical trial phases are different stages of research that assess the safety and effectiveness of a new medical treatment or intervention in humans.

Each phase has a specific goal and involves a different number of participants. Generally, there are 4 phases (I-IV), with Phase I focusing on safety and dosage, Phase II on efficacy and side effects, Phase III on comparing the new treatment with standard treatments, and Phase IV on long-term safety monitoring.