title: Risk of discontinuation of Advanced Therapy Medicinal Products clinical trials.
abstract: OBJECTIVE
  Advanced therapy medicinal products (ATMPs) constitute a class of innovative products that encompasses gene therapy, somatic cell therapy, and tissue-engineered products (TEP). There is an increased investment of commercial and non-commercial sponsors in this field and a growing number of ATMPs randomized clinical trials (RCT) and patients enrolled in such trials. RCT generate data to prove the efficacy of a new therapy, but the discontinuation of RCTs wastes scarce resources. Our objective is to identify the number and characteristics of discontinued ATMPs trials in order to evaluate the rate of discontinuation.
  
  
  METHODS
  We searched for ATMPs trials conducted between 1999 to June 2015 using three databases, which are Clinicaltrials.gov, the International Clinical Trials Registry Platform (ICTRP), and the EU Drug Regulating Authorities Clinical Trials (EudraCT). We selected the ATMPs trials after elimination of the duplicates. We identified the disease areas and the sponsors as commercial or non-commercial organizations. We classified ATMPs by type and trial status, that is, ongoing, completed, terminated, discontinued, and prematurely ended. Then, we calculated the rate of discontinuation.
  
  
  RESULTS
  Between 1999 and June 2015, 143 withdrawn, terminated, or prematurely ended ATMPs clinical trials were identified. Between 1999 and June 2013, 474 ongoing and completed clinical trials were identified. Therefore, the rate of discontinuation of ATMPs trials is 23.18%, similar to that for non-ATMPs drugs in development. The probability of discontinuation is, respectively, 27.35, 16.28, and 16.34% for cell therapies, gene therapies, and TEP. The highest discontinuation rate is for oncology (43%), followed by cardiology (19.2%). It is almost the same for commercial and non-commercial sponsors; therefore, the discontinuation reason may not be financially driven.
  
  
  CONCLUSIONS
  No failure risk rate per development phase is available for ATMPs. The discontinuation rate may prove helpful when assessing the expected net present value to support portfolio arbitration and may be considered by patients and potential investigators in their decisions to participate in ATMP trials. These results carry limitation because the rationale for discontinuation is unknown. Further research about the reasons of discontinuation and the risk of negative results is needed to inform stakeholders.
authors: Faculty of Medicine - Public Health department, University Aix-Marseille, Marseille, France.
authors: Eve
authors: E
authors: Hanna
authors: Creativ-Ceutical, Paris, France.
authors: Cecile
authors: C
authors: Rémuzat
authors: Faculty of Medicine - Public Health department, University Aix-Marseille, Marseille, France.
authors: Pascal
authors: P
authors: Auquier
authors: Faculty of Medicine - Public Health department, University Aix-Marseille, Marseille, France.
authors: Mondher
authors: M
authors: Toumi
keywords: ATMP; RCT; advanced therapy medicinal products; clinical trials; risk of discontinuation