Doctor: Atal Ignacio
Title: World mapping of clinical trials
Supervisors: Raphaël Porcher, Ludovic Trinquart
Doctoral school: ED 393 Epidemiology and Biomedical Information Sciences, Université Paris Cité
Date of thesis defense: 23/11/2017
Jury: Jacques Demotes, Bruno Falissard, Marie-Christine Jaulent, Aurélie Névéol, Philippe Ravaud, Raphaël Porcher
By knowing what clinical research is undertaken worldwide, where it is conducted, which diseases are studied, and who is supporting it, we could have a better understanding on how is created the knowledge concerning health interventions. A global landscape of health research may inform policy makers on knowledge gaps and on how to reallocate resources to address health needs, in particular in low-resource settings. In this thesis we mapped clinical research, i.e. we analyzed at a macro-level the complex system of health research to bring information on the global landscape of health research effort. We based our analyses on clinical trial registries included in the International Clinical Trials Registry Platform from the World Health Organization.
In a first project, we evaluated within 7 regions the local alignment between the effort of research and the burden for 27 groups of diseases. This work needed the development of a knowledge-based classifier of clinical trial registries according to diseases studied based on natural language processing methods. We mapped 117,180 randomized controlled trials. For high-income countries, the research effort was well aligned with the needs. In all other regions we identified reseach gaps. In particular, for Sub-Saharan Africa, where major causes of burden such as HIV and malaria received a high research attention, research was lacking for major causes of burden, especially for common infectious diseases and neonatal disorders.
In a second project, we compared the mappings of multi-country trials for industry- and non-industry–sponsored clinical trials, and analyzed the networks of collaboration of countries participating together to the same multi-country trials. We showed that among industry- and non-industry–sponsored trials, 30% and 3% were multi-country, respectively. The collaboration within Eastern European coun- tries was particularly over-represented for industry-sponsored research. Industry sponsors may thus have a greater capacity to conduct globalized research, using well-defined networks of countries.
Our large-scale mappings of all registered clinical trials shed light on major gaps in the effort of health research as compared to health needs. In addition, we showed the influence of different sponsors in the globalization of clinical research. These projects are in-line with the development of a global observatory for health research.