Accelerating excellence in clinical trials: In conversation with Dr Andrew Pink
As Director of the Adult Clinical Trials Unit at St John’s Institute of Dermatology and Deputy Director of the NIHR South London Commercial Research Delivery Centre (CRDC), Dr Andrew Pink has spent more than a decade leading Phase II–IV studies that bring emerging treatments for conditions such as eczema, and psoriasis and prurigo nodularis directly into NHS care.
A senior clinical academic and Chief Investigator within King’s Health Partners (KHP), he has worked closely with the KHP Clinical Trials Office (KHP-CTO) to deliver innovative ,novel, relevant and high quality clinical research.
With extensive experience across both non commercial and industry funded studies, he has played a key role in advancing adaptive and platform trial designs that improve efficiency, accelerate delivery and generate commercially meaningful evidence.
Through his collaboration with the KHP-CTO, Dr Pink has helped expand commercial research capacity, support new principal investigators and improve patient access to novel therapies across one of the UK’s most diverse populations.
Here he shares how trial innovation and integrated support across KHP is shaping a leading environment for commercial clinical research.
Talking Trials with Dr Pink
You’ve worked on both platform and traditional studies. Can you explain how they differ, and what the benefits are?
AP: “One of my big interests is innovation in trials methodologies. Traditional trials have often utilised standard parallel arm designs where you have a control and a comparator arm/arms and run them next to one another for a certain amount of time up until the primary endpoint. It is a very robust trial method, but one challenge is that every time you want a new comparison, you have to set up an entirely new trial.
“A multi‑arm, multi‑stage platform trials is a form of adaptive trial. As the trial is running, you can make predefined changes to it and continue on the same platform. So instead of going right back to square one and writing a new protocol each time you want to add a new trial arm (or treatment), you can amend the master protocol and then efficiently introduce it.”
What are the main advantages of running a platform trial?
AP: “It’s really all about efficiency; it’s time efficient work efficient and cost efficient. You get your answers faster. You can change the standard of care faster and you can get many more direct comparisons more quickly.
“One of the biggest reasons we wanted to run BEACON [trial] in eczema is that we’ve been almost completely dependent on network meta-analyses. We’ve relied on indirect comparisons from different trials. Eczema reached a point where there were lots of new therapies coming through and, if we set this up in time, we had the opportunity to integrate as many of those therapies into the platform as possible.”
How do you manage safety when introducing different drug classes?
AP: “Every new drug class has its own safety profile. In eczema we’ve seen classes like JAK inhibitors come along with a very different set of side effects compared to traditional immunomodulators.
“In BEACON we’re using licensed drugs, which gets around some of the safety concerns you’d have in early phase work. But we still have drug specific inclusion and exclusion criteria within the platform, and that’s really important for the longevity of the study.
“It does get more complicated, but that’s part and parcel of running a long term platform.”
You place a lot of emphasis on patient reported outcomes. Why is that important?
AP: “In conditions such as eczema, whilst objective measures, like the appearance of the skin, are important, patient reported outcomes, like itch, are also very important and impactful on life. We therefore try to ensure that we’re capturing a broad spectrum of patient reported outcomes including symptoms, quality of life, mood and anxiety, but also acceptability in terms of practicality and tolerability.
“Often, it’s not the headline adverse events that determine whether a drug is workable in practice, it’s the niggles, so we’ve really focused on trying to capture those as best we can.”
How do you see AI affecting clinical trials, particularly from a delivery perspective?
AP: “Whilst I certainly wouldn’t declare myself an expert in AI, I try to stay abreast of progress and be open minded. In the trial space, there’s enormous potential for improvement. That might be through finding participants, flagging appropriate trials to appropriate participants, enhancing efficiency of feasibility or contractual processes, (because a lot of that work is repetitive) note-taking, data capture and syncing that with trial databases. AI could massively shorten timeframes.
“The really exciting thing for me is recruitment. We now have enormous datasets from primary and secondary care. If we can efficiently identify patients who meet trial criteria, and bring that opportunity to them, that would be transformational. There are even AI programmes now in development that can pre-screen patients and ask eligibility questions, which means people don’t waste time coming in if they are unlikely to be eligible for a study if they’re a non-starter.”
How can trials be delivered faster without compromising quality?
AP: “As investigators, we want to go from concept to recruitment as fast as possible, and once recruitment opens, we want it to be rapid and efficient, all within a robust framework that ensures quality and safety.
“Things changed dramatically during COVID, which really demonstrated what is achievable. Much of that has continued and there is a real national focus on expediting trials the administrative elements of approvals, set up and recruitment with the new 150-day target in the UK from point of submission of a trial to first recruit. There are areas where we can continue to dramatically improve this, for example by more routinely running processes in parallel rather than in sequence. Embracing innovative and efficient trial designs and technological advances will only speed up trial delivery further.”
Q: How have you built commercial trials capability over time?
AP: “When I started in my role here, we weren’t very commercially research active but there was a huge opportunity for that to change given the explosion in therapeutics across dermatology.”
“We started with one nurse and I spent time visiting trials units around the world making note of what worked well and what might work well here in our healthcare system. Over time we brought in more research nurses, clinical trial practitioners, trial administrators, and developed a clear roadmap from feasibility through to archiving.
“Now we have a core team of around six commercial staff, and it’s a very efficient machine. That has enabled more than ten new PIs to come on board and get involved in commercial research in a way that’s easy and supported.”
Why is access to diverse patient populations so important?
AP: “One of the initiatives we brought into BEACON was self‑referral through the trial website. If patients are interested and think they are eligible, they can enter their details and are contacted very quickly.
“Our trial demographics in BEACON almost exactly match the demographics of our local population in South London, which is something that we’re really proud of.
“When BEACON goes live on platforms like Be Part of Research, we see a huge surge in self‑referrals. It demonstrates that when patients are made aware of opportunities, they often want to take part.”
What drives your passion for this work?
AP: “When you’re sitting in clinic and you have insufficient evidence or treatment it is frustrating. You want to know what would work best for the patient in front of you.
“I developed a real passion for trial work because it incorporates so much including innovative designs, mechanistic science, qualitative research – trials provide a structure for truly holistic research.”