title: Clinical trials in the Middle East and North Africa (MENA) Region: grandstanding or grandeur?
abstract: BACKGROUND
  Nearly 31% of the world's clinical trials are conducted outside the US and 25% of the new drug applications include data from international sites. The high population growth, demand for medication, increased prevalence of life-style related and rare genetic diseases in the MENA countries should be associated with a consequent scale-up of clinical trials in these countries. However, the region sponsors under 1% of global clinical trials.
  
  
  METHODS
  Determinants including the regulatory environment, patient protection, physician-preparedness, types of diseases, costs of trials and pace of subject recruitment, were analyzed to identify critical factors that influence barriers to the conduct clinical trials in MENA.
  
  
  RESULTS
  Strategic planning by the CRO can help overcome challenges related to regulatory and oversight requirements. Barriers related to trial quality and subject protection can be mitigated by risk-based monitoring. Growing healthcare infrastructure and communication technologies provide clear advantages for subject recruitment. Low operating costs combined with the increase in pharmaceutical sales provide incentives for the future conduct of clinical trials.
  
  
  CONCLUSIONS
  Although the opportunities and challenges cited are common to the MENA region, further studies are needed to assess other potential contributing variables for the conduct of clinical trials specific to each MENA country.
  
  
  CONCLUSIONS
  Challenges in drug importation and site oversight can be overcome with systematic interventions. Social media network and community awareness programs can assist reductions in barriers in obtaining effective informed consents. Increasing pharmaceutical sales, population growth, high prevalence of genetic and life-style related diseases and reduced clinical trial development costs offer expanding opportunities for future clinical trials in MENA.
authors.affiliation: Department of Academic Affairs, Medical Affairs, Tawam Hospital, Post Box 15258, Al Ain United Arab Emirates. Electronic address: schandra@tawamhospital.ae.
authors.forename: Satish Chandrasekhar
authors.initials: SC
authors.lastname: Nair
authors.forename: Halah
authors.initials: H
authors.lastname: Ibrahim
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
mesh_terms: D000293:Adolescent; D000328:Adult; D000352:Africa, Northern; D000368:Aged; D002986:Clinical Trials as Topic / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards*; D017046:Cost Savings; D003906:Developing Countries; D017277:Drug Approval / Q000379:methods / Q000458:organization & administration; D004345:Drug Industry / Q000191:economics / Q000379:methods / Q000458:organization & administration; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D008877:Middle East; D018579:Patient Selection; D012577:Schools, Medical; D055815:Young Adult
keywords: Clinical trials; Disease pool; Gas price index; Middle East North Africa; Recruitment; Regulatory