Clinical Research During COVID: How Were Therapeutic Areas Affected?

In the past few months, we’ve talked a lot about decentralized clinical trials and the adaptation the clinical research industry needed to (and still does) go through. The is that Covid-19 put a lot of clinical trials on pause in 2020 and it became apparent that for research to go on in difficult times, the industry needs to become good at what was recently only a mitigation strategy – virtual clinical trials. 

However, any adaptation needs to rely on solid data as you cannot mitigate risks unless you know where they are. 

How many trials were put on pause?

Which therapeutic areas (TAs) were the most affected?

How did Covid impact TAs growing in previous years?

And what is happening to TAs in Q1 of 2021? 

These are the questions we had in mind at the beginning of this year. So, we did what we always do – we trusted data. Out of this data, we highlighted interesting trends and shared them with you in our whitepaper Recovering from Covid: The 2021 Clinical Research Market

Today I’d like to take a look at what happened to TAs in particular. If you’d like to know more about geographical regions and their unique challenges, I urge you to get the whitepaper – there are some very interesting things going on in Q1 of 2021

Therapeutic areas growing pre-Covid

2019 marked an increase in the sheer number of started clinical trials compared to 2018. Before Covid-19 changed trajectories in 2020, there were 5 TAs that marked the biggest growth in 2019 compared to the previous year.

NB! We’re using the MeSH system of categorizing conditions into TAs. Where applicable we have renamed some (Cardiovascular diseases = Cardiology but Autoimmune diseases doesn’t always = Immunology). Under MeSH, one and the same condition can fall under 2 or more TAs, so keep this in mind when reading the data. 

Therapeutic areas during Covid-19 (2020)

To see how Covid-19 affected TAs in 2020, let’s first take a look at the impact it had on the top 5 TAs growing in the previous year. 

As you can see above, only Oncology managed to mark a positive growth, while Rare diseases was the least negatively impacted, marking the smallest decrease in research. 

Despite slowing down research in previously thriving therapeutic areas, Covid-19 also created new opportunities in others. For example, when we include Covid-19 clinical trials in our calculations for 2020, there are 2 TAs that saw an impressive growth – Infectious diseases (+167.96%) and Respiratory diseases (+163.75%)

Covid-19 research, indeed, kept the industry busy while other trials were postponed. But how did these 2 TAs actually do in 2020 if we take Covid-19 out of the equation? Research in Infectious diseases went down -15.63%; Respiratory diseases marked a decline of -6.84%. 

There were, however, 2 TAs that were growing in 2020 despite the crisis Covid brought. They are Ophthalmology with +11.21% and Oncology with +0.17%. This seems like a very small increase in comparison with the percentages we saw in 2019 but other TAs suffered even bigger losses.

Let’s take a look at the top 5 TAs that were negatively impacted in 2020

As you can see, when we exclude Covid-19 research, Infectious diseases is actually the second most impacted TA. Autoimmune diseases suffered the biggest loss, despite its impressive growth in 2019. Cardiology, on the other hand, wasn’t growing in 2019 but it’s in the top 5 TAs that marked a drop in research once Covid hit. 

Therapeutic areas in Q1 of 2021

In Q1 of 2021, though the pandemic was far from over, we had answers to a lot of questions and with the hope of vaccination on the horizon, the climate seemed more stabilized. Covid-19 cases were going down in certain regions and this affected research as well. 

To see which TAs were beginning to recover in Q1 of 2021, we compared the number of trials to their pre-Covid values – Q1 of 2020. This way we could observe whether research was going back to normal or even growing. Here are the top 5 TAs that were recovering in Q1 of 2021

Though Cardiology is still in the negative, it is recovering relative to its 2020 decline. Oncology and Rare diseases are slowly growing as well but the biggest ‘winner’ is Ophthalmology, which marked a growth even during 2020. Gastroenterology, on the other hand, was not growing in 2019 or 2020 but is now among the TAs that are on a track to recovery. 

What does the future hold?

This is probably the question that I’m the most curious about. As you’ll see in our Overview of the market trends, geographical regions that were growing in terms of research in 2019 and then growing even more in 2020 took a big and unexpected hit in Q1 of this year. Could the same thing happen to TAs that are growing now? 

If I had to make predictions, I’d say that Oncology and Rare diseases are going to recover even better in the months to come. They’re very ‘trendy’ TAs but more importantly, there are many innovations in those areas that need to be put to the test. 

Dermatology is an interesting one as it’s one of the easiest to conduct virtual trials in, yet it was among the top 5 negatively affected in 2020. My feeling is that apart from skin cancer (which under MeSH could fall under both Oncology and Dermatology), skin diseases are likely to be underestimated during a pandemic. Patients are less likely to seek trials for their skin condition during a lockdown than they are for a disease that feels more urgent.

In either case, we’ll have to see the numbers for this quarter to be able to speak of a trend. Stay tuned for our updates.

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