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In Kürze

Klinische Studien – eine Frage der Perspektive

Berlin (pag) – Die Perspektive von Patienten mit Multipler Sklerose (MS) sollte in klinischen Studien stärker berücksichtigt werden. Empfehlungen dafür hat eine Arbeitsgruppe veröffentlicht, der Mitarbeiter der Charité, des Instituts für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) sowie Vertreter der Arzneimittelkommission der deutschen Ärzteschaft angehören.

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„Wenn wir die Studien in Zukunft so konzipieren, dass sie sich stärker an den Bedürfnissen der Betroffenen orientieren, erhalten wir Studienergebnisse, die uns eher in die Lage versetzen, die Patientinnen und Patienten zielgerichteter und individualisiert medizinisch zu versorgen“, sagt Friedemann Paul vom Experimental and Clinical Research Center, einer gemeinsamen Einrichtung von Charité und Max-Delbrück-Centrum für molekulare Medizin.
Eine Auswertung 29 zulassungsrelevanter Phase-III-Studien zu Arzneimitteln zur MS-Behandlung zeigt laut Arbeitsgruppe, dass die Patientenperspektive und damit Symptome wie Fatigue oder die gesundheitsbezogene Lebensqualität in der Regel nicht berücksichtigt wurden. Untersucht wurden dagegen biologische Indikatoren und Endpunkte zu bildgebenden Verfahren „mit unklarer Bedeutung für die Krankheitsschwere der Betroffenen“, heißt es.
Die Arbeitsgruppe empfiehlt, Patient-Reported Outcomes stärker in den Fokus zu rücken. Die individualisierte Ausrichtung der medi-zinischen Behandlung erfordert es, dass Studien nicht nur für die Zulassung relevante klinische und radiologische Befunde berücksichtigen, sondern auch die Patientenperspektive. Dies gelte insbesondere für sehr belastende Symptome wie Fatigue, Schmerzen, Depressionen und kognitive Einschränkungen. Ebenso sollten Studienteilnehmer länger beobachtet werden, um mehr Erkenntnisse über wesentliche Folgekomplikationen und Nebenwirkungen zu erhalten.

Lücken der Transparenz

Die Charité hat 2016 eine Initiative für Patienten mit MS gestartet. Ihr Ziel ist, die Qualität klinischer MS-Studien zu verbessern. Sie vernetzt Betroffene, Experten, Behörden, Institutionen sowie Unternehmen. Unterdessen werden Vorwürfe an deutsche Unikliniken laut, dass sie die Veröffentlichung klinischer Studien vernachlässigen. Gemeinsam mit TranspariMED hat die BUKO Pharma-Kampagne untersucht, ob deutsche Universitäten die Resultate von Medikamentenstudien veröffentlichen. Laut EU-Gesetzgebung müssen die Ergebnisse zwölf Monate nach Abschluss im europäischen Register EudraCT hinterlegt werden. Der Untersuchung zufolge sind im Schnitt nur 6,7 Prozent aller Studien zeitgerecht veröffentlicht worden. Die Ergebnisse von 445 klinischen Studien fehlten. „Die Berliner Charité trägt zur Lücke mit allein 68 fehlenden Berichten bei“, kritisiert die BUKO Pharma-Kampagne. Das Universitätsklinikum habe damit nur drei Prozent der fälligen Studienergebnisse veröffentlicht. Positiv falle dagegen die Uni Münster auf, die immerhin 61 Prozent der Ergebnisse in EudraCT publiziert hat.

Weiterführende Links

Clinical Trial Transparency at German Universities:
https://bukopharma.de/images/aktuelles/CT_Transparency_German_Uni_2019.pdf

Suggestions for improving the design of clinical trials in multiple sclerosis:
https://link.springer.com/article/ 10.1007%2Fs13167-019-00192-z