The UK is competitive across many areas, including oncology, diseases of the nervous system and diseases of the immune system (Figure 5), illustrating the breadth of its strengths in clinical research. Globally, the UK ranks second in Europe across these disease areas, behind Germany and the USA.
Oncology is the UK’s strongest area for clinical research, with an average of 201 commercial clinical trials started per year since 2012, and 210 in 2017. This is reflective of trends across global comparators (Figure 7), with cancer medicine spending reaching $133 billion, across 700 active organisations and companies, in 2017 globally.
With almost half of the oncology clinical trials started in 2017, trials associated with immune, nervous and cardio-metabolic diseases, have remained constant with between 50-100 trials starting every year since 2012 (Figure 5).
Data shows that the pharmaceutical industry is active in trials for infectious diseases. In 2016 and 2017, 96 clinical trials in infectious diseases started in the UK (Figure 5).
Figure 5. Number of commercial clinical trials started in the UK, by disease area
A gradual rise in oncology commercial clinical trials in the USA has been observed since 2014, reaching a global high of 866 in 2017. This trend is seen across global comparators and likely attributable to the large share of R&D investment cancer receives.
Figure 6. Number of commercial clinical trials started in oncology, by country
Comparatively, the UK ranks 5[th] – jointly with Japan – with 210 oncology commercial clinical trials started in 2017. The NHS Long Term Plan aims to improve genomic services in the UK, supporting a more personalised approach to healthcare delivery.
As genomics is a key tool in stratifying patients, especially in oncology, both routine delivery and clinical research could benefit from such investment. This presents a prime opportunity for the UK to lead in personalised cancer research and care.
Cardio-metabolic diseases include diseases/disorders such as diabetes and coronary heart disease. The number of commercial clinical trials in such areas has been on the decline since 2014.
Across the USA, UK and Germany, there has been an average reduction of 13.1% between 2014 and 2017 (from 466 trials to 405). Japan and China also remain active in cardio-metabolic research, with a collective total of 146 clinical trials started in 2017 (Japan – 103; China – 43).
Figure 7. Number of commercial clinical trials started in cardio-metabolic diseases, by country
As this data combines cardiovascular and metabolic clinical research, under the same parameter, it is important to note that the individual trends for cardiovascular and metabolic research cannot be deduced from this data.
Over 1500 clinical trials are ongoing globally, with metabolic disorders the 2[nd] largest therapeutic area for clinical research, with over 2000 products in the pipeline in 2017.
With such substantial research in these therapeutic areas, the UK should continue to actively contribute to R&D efforts and retain its share of new and ongoing clinical trials in cardio-metabolic diseases.
The third largest area of commercial clinical research in 2017 globally is in nervous system diseases. Excluding a flurry of clinical trials which started in this therapeutic area in 2015, the number of clinical trials started every year since 2012, has been fairly stable.
The UK, alongside Germany, ranks 2[nd] in comparison to the USA, with 61 clinical trials started in 2017. The UK has however seen a decline in activity in this area since 2015 (from 90 trials to 61).
Figure 8. Number of commercial clinical trials started in nervous system diseases, by country
There is a global effort to better understand and treat diseases such as dementia, which currently affects an estimated 850,000 people in the UK. New UK and international initiatives are accelerating research, with charities supporting patient recruitment to an increasing number of clinical trials.
With over 800 commercial clinical trials started in 2017 in immune disorders, this therapeutic area remains a consistent priority for pharmaceutical drug discovery and development.
Nearly 30% of these trials were started in the USA and Canada (242 in 2017), with over 20% started in the UK and Germany (176 in 2017).
Figure 9. Number of commercial clinical trials started in immune disorders, by country
The UK is a world leader in immunology early research, with a strong SME base developing new drugs in this area, and significant advances seen both in our understanding of how the immune system works and how we improve diagnosis and treatment.
The UK must build on this strong foundation, to attract further investment to grow its clinical research base and remain a global competitor in this therapeutic area.
Currently, a critical area for infectious disease research is antimicrobial resistance (AMR) which threatens the effective treatment of a range of infections.
AMR-related infections are estimated to cause 700,000 deaths each year globally, presenting a concerning threat for global public health. Industry play an important role in helping to tackle this global health threat, with companies around the world investing in the research and development of new antibiotics.
In 2016, companies invested $2 billion into AMR research and development, with around 40 new antimicrobials in late-phase clinical development. However, due to the fundamental problem at the heart of antibiotics development – that companies must research new antimicrobials that may never be used – many of these will never reach patients.
In an effort to fix this problem, the UK is pioneering a new initiative to encourage companies sustain investment in R&D into antimicrobials. In 2019, the UK Government announced a pilot of a new economic model to help address this global issue.
Figure 10. Number of commercial clinical trials started in infectious diseases, by country
Reflecting this commitment, the number of infectious disease commercial clinical trials started in 2016 and 2017 remained constant, with the top 5 countries averaging 60 clinical trials between them (USA, China, UK, Spain and Germany. The UK ranks 1st in Europe, with 48 clinical trials started in 2017, demonstrating an attractive environment for infectious disease clinical research.