title: Differential Globalization of Industry- and Non-Industry-Sponsored Clinical Trials.
abstract: BACKGROUND
  Mapping the international landscape of clinical trials may inform global health research governance, but no large-scale data are available. Industry or non-industry sponsorship may have a major influence in this mapping. We aimed to map the global landscape of industry- and non-industry-sponsored clinical trials and its evolution over time.
  
  
  METHODS
  We analyzed clinical trials initiated between 2006 and 2013 and registered in the WHO International Clinical Trials Registry Platform (ICTRP). We mapped single-country and international trials by World Bank's income groups and by sponsorship (industry- vs. non- industry), including its evolution over time from 2006 to 2012. We identified clusters of countries that collaborated significantly more than expected in industry- and non-industry-sponsored international trials.
  
  
  RESULTS
  119,679 clinical trials conducted in 177 countries were analysed. The median number of trials per million inhabitants in high-income countries was 100 times that in low-income countries (116.0 vs. 1.1). Industry sponsors were involved in three times more trials per million inhabitants than non-industry sponsors in high-income countries (75.0 vs. 24.5) and in ten times fewer trials in low- income countries (0.08 vs. 1.08). Among industry- and non-industry-sponsored trials, 30.3% and 3.2% were international, respectively. In the industry-sponsored network of collaboration, Eastern European and South American countries collaborated more than expected; in the non-industry-sponsored network, collaboration among Scandinavian countries was overrepresented. Industry-sponsored international trials became more inter-continental with time between 2006 and 2012 (from 54.8% to 67.3%) as compared with non-industry-sponsored trials (from 42.4% to 37.2%).
  
  
  CONCLUSIONS
  Based on trials registered in the WHO ICTRP we documented a substantial gap between the globalization of industry- and non-industry-sponsored clinical research. Only 3% of academic trials but 30% of industry trials are international. The latter appeared to be conducted in preferentially selected countries.
authors.affiliation: Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France.|INSERM U1153, Paris, France.|Université Paris Descartes, Paris, France.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Atal
authors.affiliation: Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France.|INSERM U1153, Paris, France.|Columbia University, Mailman School of Public Health, Epidemiology Department, New York, New York, United States of America.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Trinquart
authors.affiliation: Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France.|INSERM U1153, Paris, France.|Université Paris Descartes, Paris, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.affiliation: Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France.|INSERM U1153, Paris, France.|Columbia University, Mailman School of Public Health, Epidemiology Department, New York, New York, United States of America.|Université Paris Descartes, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
mesh_terms: D002986:Clinical Trials as Topic; D004345:Drug Industry; D038622:Internationality; D012042:Registries; D014944:World Health Organization