Updated on 12 October 2015
Dr Teoh Yee Leong, chief executive officer, Singapore Clinical Research Institute
Singapore: We are generally more familiar with the pharmaceutical led trials, where the pharmaceutical companies develop new drugs or medical devices in their laboratory and seek partnership with the hospitals, where their Investigators help recruit patients for the clinical trials. The protocols for these trials are developed by the pharmaceutical companies, with the aim of collecting the relevant scientific data for licensure of their drugs or medical devices for eventual commercialisation.
In Singapore, there has been an increased level of interest in Investigator-Initiated Trials (IITs). Unlike pharmaceutical led trials, the IITs are led by physicians who wish to design trials to answer some of their clinical questions. Some of these investigator led trials use a licensed drug for different therapeutic indications, while others may focus on comparing different treatment options of a disease and evaluate which treatment option is better or more cost-effective.
One of the prominent IITs in Singapore includes the study of low dose topical Atropine eye drops to reduce the progression of childhood myopia. Atropine itself is an old drug, commonly used in the field of ophthalmology to dilate the pupils prior to an eye examination. A few years ago, a landmark investigator led study showed that a diluted and low dose of Atropine eye drops could slow down the progression of childhood myopia in Singapore. This ground-breaking result has a significant impact on Singapore's population and benefitted many children with childhood myopia.
Some other interesting local IITs include the study of using Aspirin, which is a common and affordable drug for fever and pain relief, to treat colon cancer and the study of platelet transfusion in severe dengue patients.
While these examples of IITs focus on the use of currently available licensed drugs or treatment options, there are also other IITs which use new drugs or therapeutic options, similar to the pharmaceutical led trials. Smaller pharmaceutical or biotech companies may not have sufficient financial resources to run sponsored trials. Therefore, they rely on partnerships with the academic medical centres to lead these types of IITs. A recent example is the MUC-1 therapeutic cancer vaccine Phase 1 trial, which is sponsored by Singapore Clinical Research Institute (SCRI) and partnering with National Cancer Centre Singapore and Mircovax LLC, an US-based biotech company.