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Efficiencies and adjacencies: Important considerations for effective clinical CRO partnerships

Engaging a CRO is the start of a long-term relationship, and it is crucial to get off on the right foot.

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1 year ago

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Efficiencies and adjacencies: Important considerations for effective clinical CRO partnerships

By Michael Towse & Frances Murphy

As a pharma or biotech company, few milestones are as exciting as the completion of pre-clinical testing with positive results. With entry to the clinic imminent, this is often the moment you first seek to engage a clinical contract research organization (CRO). Experience suggests that beginning the process sooner is often better, but regardless of the timing, this is the opportunity to ask yourself several important questions, including:

  • What should we think about before approaching a CRO?
  • Which CRO(s) should we approach, and how?
  • How do we evaluate and compare each CRO’s offerings and capabilities?

As with many aspects of clinical research, meticulous preparation can optimize and expedite the CRO selection process. Whereas most CROs offer similar services — ranging from project management and monitoring to biostatistics and data management — each has points of creative differentiation that should inform the selection process. It is also crucial to determine whether all your service needs are to be managed by one CRO or by several, as well as if those services are to include lab support and kitting in addition to clinical tasks. Other important considerations are your planned study size and location, and whether the CRO has the necessary experience in the therapeutic area, mechanism of action, or drug delivery vehicle (see Figure 1).

Figure 1

Answering these questions should generate a preliminary list of potential CROs. However, before initiating contact, it is important to determine the ultimate number of CROs to include in your outreach. In general, it makes sense to solicit proposals from three to five CROs, and to conduct follow-up bid defense meetings (BDMs) with two or three, based on the quality of the responses. Keep in mind that it takes considerable time and manpower for a CRO to produce a custom proposal, which may amount to 30–50 pages. Just as importantly, reviewing and evaluating each proposal can be very time- and resource-intensive for you. Engaging a CRO is the start of a long-term relationship, and it is crucial to get off on the right foot.

Once you’ve built your preliminary list, your professional networks can be a rich source of information on potential candidates, as can your own personal networks. If the study’s lead investigator is already on board, or if you maintain relationships with key opinion leaders, they may have some insights. Whatever your preferred shortlisting method, it is also advisable to reach out to CROs for an initial conversation. These early conversations can also be useful in discerning which CROs themselves are most interested in the study you’ll be conducting.

Submitting the RFP

After some exploratory conversations, and perhaps a capabilities demonstration, it is time to issue a request for proposal (RFP) to your shortlisted CROs. Normally, once received, a multi-disciplinary group of each CRO’s subject matter experts (SMEs) — an example is depicted in Figure 2 — triages the RFP to determine whether the company can fulfill the specified deliverables. The SME team then assembles the proposal, which typically encompasses landscape and feasibility assessments, site outreach, medical insights, strategy, budget, and team profiles. Developing the proposal is a deeply collaborative effort, which is why a 10-working day turnaround time is standard, with perhaps an extension over a particularly busy part of the year.

CRO engagement, Precision for Medicine

Figure 2

The proposal will also include assumptions, particularly if any aspect of the RFP is unclear. Therefore, the more information you share in the RFP, the better the proposal output – and the more worthy of your review time. CROs will often provide an RFP Checklist to help ensure the capture of the right information. Most CROs understand that project funding may depend on attainment of key milestones, such as regulatory submissions and enrollment of the first patient. With information about those targets, the CRO can devise a plan to help achieve them.

Throughout the process you will have an obligation to inform the CRO of any change in project parameters which might necessitate adjustments to the proposal. The RFP process is also a good time to gauge the chemistry between your team and the CRO, as you will plan to be partners for the next few years, through times both rewarding and challenging.

BDM, award and budget

As noted, you should ideally receive several proposals, each informed by the same parameters to enable a like-for-like comparison. However, that may limit CRO creativity. When granted more flexibility, CROs often come back with ideas and opinions on trial design, location, and other factors you may not have yet considered.

After review and evaluation, the top two or three CROs should be invited to present a Bid Defense, and as a key facet of that invitation, your teams should clearly communicate the topics to be addressed during the BDM. Otherwise, the CRO will make assumptions about clinical trial priorities based on experience. The importance of respecting the CRO’s time cannot be overstated, given the Bid Defense team’s extensive preparation and the number of contributors to the proposal. Since the height of the pandemic, BDMs have started to return to an in-person format, although hybrid formats (in-person and virtual) are often the favorite. They typically last about three hours, with much of that time devoted to medical and strategy discussions, and there may not be enough time to cover every topic. That reality underscores the need for pragmatism and realistic expectations. Set these upfront and ensure you are able to discuss the critical aspects leading to study success.

Ideally, there will be follow-up and discussion post-BDM. In our experience, it’s important that these interactions are dialogues, not monologues, and that they flow from informed questions asked during the meeting and from constructive feedback in its aftermath. In this way, you will foster an effective process which lays the groundwork for an excellent partnership and a successful clinical trial experience.

The industry norm is for the sponsor to make its selection within three weeks of the BDM. This is especially important if you expect to retain the team that presented at the meeting. The CRO’s teams may be in contention for several clinical trial projects, a reality that highlights the need for speed between BDM and award notification.  

Finally, a word on budget. Notably, the first budget submitted by the CRO will be a draft and should not be the deciding factor in the selection process. If there are strict budgetary constraints, the CRO will likely be prepared to be flexible to work within those parameters, and to adjust the budget where possible. Competing budget quotes should be compared and understood, but the final decision should rest on the overall quality of the proposal. Once that selection is made, the budget negotiations can, and often do, truly begin.

Summary

In short, the selection process is a multifaceted endeavor. At its best, it is the result of considerable time, thought, effort, and resources from both sponsors and the prospective CROs.

As such, the decision of whom to choose should not hinge on a single component of the CRO’s proposal, whether it’s the budget, the site plan, the investigator roster, or the overall project timeline. Rather, your decision should be based on the totality of the proposal, including the CRO’s expertise, flexibility, and creativity. When you consider those factors as key criteria, it can lead not only to a successful study, but to a long-term, value-added partnership that will aid in your quest for therapeutic solutions. With a capable CRO in your corner, you can pursue your mission of addressing unmet patient needs. That makes it especially important to choose your CRO partner wisely.

Michael Towse, Precision for Medicine

Michael Towse, vice president, business communications, Precision For Medicine

Michael Towse is a dedicated communication specialist with a 20 year background spanning development across a diverse range of CRO environments; from business development to training. His diverse career includes working through the development of communication material, the delivery of communication and initiatives and time spent on the strategic alignment of sales and marketing strategies to corporate objectives and those objectives central to motivating staff, building teams, and driving business forward.
Frances Murphy, Precision for Medicine

Frances Murphy, regional vice president clinical business solutions EU & APAC, Precision For Medicine

Frances Murphy is a leading authority in clinical CROs, focused on client services and regional growth implementation. Murphy is a dedicated proponent of harnessing truly personalized medicine to develop more effective treatments for patients and brings a high ethical standard to discussions and values transparency and collaboration.

 

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Health Officials: Man Dies From Bubonic Plague In New Mexico

Health Officials: Man Dies From Bubonic Plague In New Mexico

Authored by Jack Phillips via The Epoch Times (emphasis ours),

Officials in…

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3 hours ago

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March 13, 2024

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Health Officials: Man Dies From Bubonic Plague In New Mexico

Authored by Jack Phillips via The Epoch Times (emphasis ours),

Officials in New Mexico confirmed that a resident died from the plague in the United States’ first fatal case in several years.

A bubonic plague smear, prepared from a lymph removed from an adenopathic lymph node, or bubo, of a plague patient, demonstrates the presence of the Yersinia pestis bacteria that causes the plague in this undated photo. (Centers for Disease Control and Prevention/Getty Images)

The New Mexico Department of Health, in a statement, said that a man in Lincoln County “succumbed to the plague.” The man, who was not identified, was hospitalized before his death, officials said.

They further noted that it is the first human case of plague in New Mexico since 2021 and also the first death since 2020, according to the statement. No other details were provided, including how the disease spread to the man.

The agency is now doing outreach in Lincoln County, while “an environmental assessment will also be conducted in the community to look for ongoing risk,” the statement continued.

“This tragic incident serves as a clear reminder of the threat posed by this ancient disease and emphasizes the need for heightened community awareness and proactive measures to prevent its spread,” the agency said.

A bacterial disease that spreads via rodents, it is generally spread to people through the bites of infected fleas. The plague, known as the black death or the bubonic plague, can spread by contact with infected animals such as rodents, pets, or wildlife.

The New Mexico Health Department statement said that pets such as dogs and cats that roam and hunt can bring infected fleas back into homes and put residents at risk.

Officials warned people in the area to “avoid sick or dead rodents and rabbits, and their nests and burrows” and to “prevent pets from roaming and hunting.”

“Talk to your veterinarian about using an appropriate flea control product on your pets as not all products are safe for cats, dogs or your children” and “have sick pets examined promptly by a veterinarian,” it added.

“See your doctor about any unexplained illness involving a sudden and severe fever, the statement continued, adding that locals should clean areas around their home that could house rodents like wood piles, junk piles, old vehicles, and brush piles.

The plague, which is spread by the bacteria Yersinia pestis, famously caused the deaths of an estimated hundreds of millions of Europeans in the 14th and 15th centuries following the Mongol invasions. In that pandemic, the bacteria spread via fleas on black rats, which historians say was not known by the people at the time.

Other outbreaks of the plague, such as the Plague of Justinian in the 6th century, are also believed to have killed about one-fifth of the population of the Byzantine Empire, according to historical records and accounts. In 2013, researchers said the Justinian plague was also caused by the Yersinia pestis bacteria.

But in the United States, it is considered a rare disease and usually occurs only in several countries worldwide. Generally, according to the Mayo Clinic, the bacteria affects only a few people in U.S. rural areas in Western states.

Recent cases have occurred mainly in Africa, Asia, and Latin America. Countries with frequent plague cases include Madagascar, the Democratic Republic of Congo, and Peru, the clinic says. There were multiple cases of plague reported in Inner Mongolia, China, in recent years, too.

Symptoms

Symptoms of a bubonic plague infection include headache, chills, fever, and weakness. Health officials say it can usually cause a painful swelling of lymph nodes in the groin, armpit, or neck areas. The swelling usually occurs within about two to eight days.

The disease can generally be treated with antibiotics, but it is usually deadly when not treated, the Mayo Clinic website says.

“Plague is considered a potential bioweapon. The U.S. government has plans and treatments in place if the disease is used as a weapon,” the website also says.

According to data from the U.S. Centers for Disease Control and Prevention, the last time that plague deaths were reported in the United States was in 2020 when two people died.

Tyler Durden Wed, 03/13/2024 - 21:40

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I created a ‘cosy game’ – and learned how they can change players’ lives

Cosy, personal games, as I discovered, can change the lives of the people who make them and those who play them.

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12 hours ago

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March 13, 2024

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Cosy games exploded in popularity during the pandemic. Takoyaki Tech/Shutterstock

The COVID pandemic transformed our lives in ways many of us are still experiencing, four years later. One of these changes was the significant uptake in gaming as a hobby, chief among them being “cosy games” like Animal Crossing: New Horizons (2020).

Players sought comfort in these wholesome virtual worlds, many of which allowed them to socialise from the safety of their homes. Cosy games, with their comforting atmospheres, absence of winning or losing, simple gameplay, and often heartwarming storylines provided a perfect entry point for a new hobby. They also offered predictability and certainty at a time when there wasn’t much to go around.

Cosy games are often made by small, independent developers. “Indie games” have long been evangelised as the purest form of game development – something anyone can do, given enough perseverance. This means they can provide an entry point for creators who hadn’t made games before, but were nevertheless interested in it, enabling a new array of diverse voices and stories to be heard.

In May 2020, near the start of the pandemic, the small poetry game A Solitary Spacecraft, which was about its developer’s experience of their first few months in lockdown, was lauded as particularly poignant. Such games showcase a potential angle for effective cosy game development: a personal one.

Personal themes are often explored through cosy games. For instance, Chicory and Venba (both released in 2023) tackle difficult topics like depression and immigration, despite their gorgeous aesthetics. This showcases the diversity of experiences on display within the medium.

However, as the world emerges from the pandemic’s shadow, the games industry is facing significant challenges. Economic downturns and acquisitions have caused large layoffs across the sector.

Historically, restructurings like these, or discontent with working conditions, have led talented laid-off developers to create their own companies and explore indie development. In the wake of the pandemic and the cosy game boom, these developers may have more personal stories to tell.

Making my own cosy game

I developed my own cosy and personal game during the pandemic and quickly discovered that creating these games in a post-lockdown landscape is no mean feat.

What We Take With Us (2023) merges reality and gameplay across various digital formats: a website, a Discord server that housed an online alternate reality game and a physical escape room. I created the game during the pandemic as a way to reflect on my journey through it, told through the videos of game character Ana Kirlitz.

The trailer for my game, What We Take With Us.

Players would follow in Ana’s footsteps by completing a series of ten tasks in their real-world space, all centred on improving wellbeing – something I and many others desperately needed during the pandemic.

But creating What We Take With Us was far from straightforward. There were pandemic hurdles like creating a physical space for an escape room amid social distancing guidelines. And, of course, the emotional difficulties of wrestling with my pandemic journey through the game’s narrative.

The release fared poorly, and the game only garnered a small player base – a problem emblematic of the modern games industry.

These struggles were starkly contrasted by the feedback I received from players who played the game, however.

This is a crucial lesson for indie developers: the creator’s journey and the player’s experience are often worlds apart. Cosy, personal games, as I discovered, can change the lives of those who play them, no matter how few they reach. They can fundamentally change the way we think about games, allow us to reconnect with old friends, or even inspire us to change careers – all real player stories.

Lessons in cosy game development

I learned so much about how cosy game development can be made more sustainable for creators navigating the precarious post-lockdown landscape. This is my advice for other creators.

First, collaboration is key. Even though many cosy or personal games (like Stardew Valley) are made by solo creators, having a team can help share the often emotional load. Making games can be taxing, so practising self-care and establishing team-wide support protocols is crucial. Share your successes and failures with other developers and players. Fostering a supportive community is key to success in the indie game landscape.

Second, remember that your game, however personal, is a product – not a reflection of you or your team. Making this distinction will help you manage expectations and cope with feedback.

Third, while deeply considering your audience may seem antithetical to personal projects, your game will ultimately be played by others. Understanding them will help you make better games.

The pandemic reignited the interest in cosy games, but subsequent industry-wide troubles may change games, and the way we make them, forever. Understanding how we make game creation more sustainable in a post-lockdown, post-layoff world is critical for developers and players alike.

For developers, it’s a reminder that their stories, no matter how harrowing, can still meaningfully connect with people. For players, it’s an invitation to embrace the potential for games to tell such stories, fostering empathy and understanding in a world that greatly needs it.

Looking for something good? Cut through the noise with a carefully curated selection of the latest releases, live events and exhibitions, straight to your inbox every fortnight, on Fridays. Sign up here.

Adam Jerrett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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KIMM finds solution to medical waste problem, which has become a major national issue

A medical waste treatment system, which is capable of 99.9999 percent sterilization by using high-temperature and high-pressure steam, has been developed…

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15 hours ago

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March 13, 2024

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A medical waste treatment system, which is capable of 99.9999 percent sterilization by using high-temperature and high-pressure steam, has been developed for the first time in the country.

Credit: Korea Institute of Machinery and Materials (KIMM)

A medical waste treatment system, which is capable of 99.9999 percent sterilization by using high-temperature and high-pressure steam, has been developed for the first time in the country.

The Korea Institute of Machinery and Materials (President Seog-Hyeon Ryu, hereinafter referred to as KIMM), an institute under the jurisdiction of the Ministry of Science and ICT, has succeeded in developing an on-site-disposal type medical waste sterilization system that can help to resolve the problem caused by medical waste, which has become a national and social issue as the volume of medical waste continues to increase every year. This project was launched as a basic business support program of the KIMM and was expanded into a demonstration project of Daejeon Metropolitan City. Then, in collaboration with VITALS Co., Ltd., a technology transfer corporation, the medical waste treatment system was developed as a finished product capable of processing more than 100 kilograms of medical waste per hour, and was demonstrated at the Chungnam National University Hospital.

Moreover, the installation and use of this product have been approved by the Geumgang Basin Environmental Office of the Ministry of Environment. All certification-related work for the installation and operation of this product at the Chungnam National University Hospital has been completed, including the passage of an installation test for efficiency and stability conducted by the Korea Testing Laboratory.

Through collaboration with VITALS Co., Ltd., a corporation specializing in inhalation toxicity systems, the research team led by Principal Researcher Bangwoo Han of the Department of Urban Environment Research of the KIMM’s Eco-Friendly Energy Research Division developed a high-temperature, high-pressure steam sterilization-type medical waste treatment system by using a high-temperature antimicrobial technology capable of processing biologically hazardous substances such as virus and bacteria with high efficiency. After pulverizing medical waste into small pieces so that high-temperature steam can penetrate deep into the interior of the medical waste, steam was then compressed in order to raise the boiling point of the saturated steam to over 100 degrees Celsius, thereby further improving the sterilization effect of the steam.

Meanwhile, in the case of the high-pressure steam sterilization method, it is vitally important to allow the airtight, high-temperature and high-pressure steam to penetrate deep into the medical waste. Therefore, the research team aimed to improve the sterilization effect of medical waste by increasing the contact efficiency between the pulverized medical waste and the aerosolized steam.

By using this technology, the research team succeeded in processing medical waste at a temperature of 138 degrees Celsius for 10 minutes or at 145 degrees Celsius for more than five (5) minutes, which is the world’s highest level. By doing so, the research team achieved a sterilization performance of 99.9999 percent targeting biological indicator bacteria at five (5) different locations within the sterilization chamber. This technology received certification as an NET (New Excellent Technology) in 2023.

Until now, medical waste has been sterilized by heating the exposed moisture using microwaves. However, this method requires caution because workers are likely to be exposed to electromagnetic waves and the entrance of foreign substances such as metals may lead to accidents.

In Korea, medical waste is mostly processed at exclusive medical waste incinerators and must be discharged in strict isolation from general waste. Hence, professional efforts are required to prevent the risk of infection during the transportation and incineration of medical waste, which requires a loss of cost and manpower.

If medical waste is processed directly at hospitals and converted into general waste by applying the newly developed technology, this can help to eliminate the risk of infection during the loading and transportation processes and significantly reduce waste disposal costs. By processing 30 percent of medical waste generated annually, hospitals can save costs worth KRW 71.8 billion. Moreover, it can significantly contribute to the ESG (environmental, social, and governance) management of hospitals by reducing the amount of incinerated waste and shortening the transportation distance of medical waste.

[*Allbaro System (statistical data from 2021): Unit cost of treatment for each type of waste for the calculation of performance guarantee insurance money for abandoned wastes (Ministry of Environment Public Notification No. 2021-259, amended on December 3, 2021). Amount of medical waste generated on an annual basis: 217,915 tons; Medical waste: KRW 1,397 per ton; General waste from business sites subject to incineration: KRW 299 per ton]

As the size and structure of the installation space varies for each hospital, installing a standardized commercial equipment can be a challenge. However, during the demonstration process at the Chungnam National University Hospital, the new system was developed in a way that allows the size and arrangement thereof to be easily adjusted depending on the installation site. Therefore, it can be highly advantageous in terms of on-site applicability.

Principal Researcher Bangwoo Han of the KIMM was quoted as saying, “The high-temperature, high-pressure steam sterilization technology for medical waste involves the eradication of almost all infectious bacteria in a completely sealed environment. Therefore, close cooperation with participating companies that have the capacity to develop airtight chamber technology is very important in materializing this technology.” He added, “We will make all-out efforts to expand this technology to the sterilization treatment of infected animal carcasses in the future.”

 

President Seog-Hyeon Ryu of the KIMM was quoted as saying, “The latest research outcome is significantly meaningful in that it shows the important role played by government-contributed research institutes in resolving national challenges. The latest technology, which has been developed through the KIMM’s business support program, has been expanded to a demonstration project through cooperation among the industry, academia, research institutes, and the government of Daejeon Metropolitan City.” President Ryu added, “We will continue to proactively support these regional projects and strive to develop technologies that contribute to the health and safety of the public.”

 

Meanwhile, this research was conducted with the support of the project for the “development of ultra-high performance infectious waste treatment system capable of eliminating 99.9999 percent of viruses in response to the post-coronavirus era,” one of the basic business support programs of the KIMM, as well as the project for the “demonstration and development of a safety design convergence-type high-pressure steam sterilization system for on-site treatment of medical waste,” part of Daejeon Metropolitan City’s “Daejeon-type New Convergence Industry Creation Special Zone Technology Demonstration Project.”

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The Korea Institute of Machinery and Materials (KIMM) is a non-profit government-funded research institute under the Ministry of Science and ICT. Since its foundation in 1976, KIMM is contributing to economic growth of the nation by performing R&D on key technologies in machinery and materials, conducting reliability test evaluation, and commercializing the developed products and technologies.

 

This research was conducted with the support of the project for the “development of ultra-high performance infectious waste treatment system capable of eliminating 99.9999 percent of viruses in response to the post-coronavirus era,” one of the basic business support programs of the KIMM, as well as the project for the “demonstration and development of a safety design convergence-type high-pressure steam sterilization system for on-site treatment of medical waste,” part of Daejeon Metropolitan City’s “Daejeon-type New Convergence Industry Creation Special Zone Technology Demonstration Project.”

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