Trends of Phase I Clinical Trials of New Drugs in Mainland China Over the Past 10 Years (2011-2020)

Abstract

Background: In recent years, the number of clinical trials initiated in China has increased rapidly. The aim of this study was to overview the changing landscape of phase I clinical trials in mainland China from 2011 to 2020. Methods: We analyzed phase I clinical trials registered on 3 websites including the Chinese Clinical Trial Registry, ClinicalTrials.gov, and the China National Medical Products Administration Center for Drug Evaluation platform. Findings: A total of 2,842 phase I clinical trials were posted from January 1, 2011, to December 31, 2020. The overall number of clinical trials for innovative drugs was 1,497, accounting for half of all the phase I clinical trials (53%). Among these 1,486 innovative drug clinical trials, 924 were newly tested drugs with an average annual growth rate of 59%. Biological drug research increased significantly from 22.6% during 2011-2015 to 33.3% during 2016-2020. These principal investigators (PIs) of these clinical trials were mainly from Beijing (n = 871), followed by Shanghai (n = 496) and Jiangsu (n = 281). As for the therapeutic area of phase I clinical trials, cancer took up the most percentage of all the clinical trials (35%), followed by infectious disease (9%), nervous system disease (9%), etc. Most phase I clinical trials are conducted on healthy volunteers (n = 1,642, 57.8%), some cancer drugs are conducted in patients with cancer (n = 846, 29.8%), and only a few clinical trials were conducted in the elderly (n = 7). Among these clinical trials of the newly tested innovative drugs, the first in human (FIH) clinical trials accounted for 82% (744), and the First in Chinese (FIC) clinical trials only took up 18% (167). Only a small number of drugs could be made the transition to phase II (n = 207, 22%). In addition, despite the number of newly tested drugs during 2011-2015 (n = 163) was much less than that in 2016-2020 (n = 761), the percentage of drugs that could enter into phase II clinical trials in 2011-2015 (34%) was higher than that in 2016-2020 (20%). Conclusion: In the past 10 years, the development of phase I clinical trials has achieved great progress in mainland China due to the novel design and drug innovation policy. Nevertheless, future efforts are needed to make for improving the phase transition success rate of innovative drugs.

Keywords: geographical distribution; innovative drugs; phase I clinical trial; phase transition; therapeutic area.

Figure 1

Flow diagram of the phase I clinical trial selection process.

Figure 2

Change of phase I clinical trials in mainland China during 2011–2020. (A) Annual change of phase I clinical trials in mainland China during 2011–2020. The data cutoff date was December 30, 2020; (B) The changes of the chemical drug, biological drug, and traditional Chinese medicine every 5 years; (C) The changes of a single center and multicenter design every 5 years.

Figure 3

Geographical distribution of phase I clinical trials during 2011–2020.

Figure 4

Therapeutic areas of phase I clinical trials during 2011–2020. (A) Therapeutic areas in phase I clinical trials during 2011–2020. The darkest of one color represented phase 1 clinical trials of both innovative and noninnovative drugs; The slighter color shows the phase 1 clinical trials of innovative drugs; The lightest color represented the clinical trials conducted on the noninnovative drug. (B) Annual change of phase I clinical trials about oncology during 2011–2020.

Figure 5

Changes of newly tested innovative drugs. (A) Percentage of FIH or FIC clinical trials of newly tested innovative drugs conducted in mainland China during 2011–2020. (B) Successful rate of phase transition of a newly tested innovative drug. FIH, first in human; FIC, first in China.