Abstract
Clinical research has become increasingly globalized, but the extent of globalization has not been assessed. To describe the globalization of clinical research, we used all (n = 13,208) multinational trials registered at ClinicalTrials.gov to analyzed geographic connections among individual countries. Our findings indicate that 95% (n = 185) of all countries worldwide have participated in multinational clinical research. Growth in the globalization of clinical research peaked in 2009, suggesting that the global infrastructure that supports clinical research might have reached its maximum capacity. Growth in the globalization of clinical research is attributable to increased involvement of non-traditional markets, particularly in South America and Asia. Nevertheless, Europe is the most highly interconnected geographic region (60.64% of global connections), and collectively, Europe, North America, and Asia comprise more than 85% of all global connections. Therefore, while the expansion of clinical trials into non-traditional markets has increased over the last 20 years and connects countries across the globe, traditional markets still dominate multinational clinical research, which appears to have reached a maximum global capacity.
Highlights
Clinical trials have become increasingly globalized [1] due to the inclusion of more non-traditional locations, especially those in central and eastern Europe, Latin America, and Asia [2,3,4]
The availability of software developed to analyze vast social networks, together with the large repository of data at ClinicalTrials.gov, has made it possible to analyze global connectivity among all those countries that have participated in multinational clinical research
It would appear that since 2009, there has been a plateau in multinational clinical research
Summary
Clinical trials have become increasingly globalized [1] due to the inclusion of more non-traditional locations, especially those in central and eastern Europe, Latin America, and Asia [2,3,4]. The increased globalization of clinical research has arisen for several reasons, but primarily due to the need for faster and more economically efficient studies [3, 5]. Moves towards standardizing and harmonizing clinical research practices have facilitated the rise of globalized clinical research [6], and there has been increasing pressure from the research community for commercial companies to make all clinical trial data available through publicly accessible registries [7]. The availability of software developed to analyze vast social networks, together with the large repository of data at ClinicalTrials.gov, has made it possible to analyze global connectivity among all those countries that have participated in multinational clinical research. We describe a network analysis of connectivity among all multinational studies registered at ClinicalTrials.gov to provide the first comprehensive quantitative description of the globalization of clinical research
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