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Clinical Study and Trial Definitions


Approved drugs
In the U.S., the Food and Drug Administration (FDA) must approve a substance as a drug before it can be marketed. The approval process involves several steps including pre-clinical laboratory and animal studies, clinical trials for safety and efficacy, filing of a New Drug Application by the manufacturer of the drug, FDA review of the application, and FDA approval/rejection of application.

Any of the treatment groups in a randomized trial. Most randomized trials have two "arms," but some have three "arms," or even more.

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(1) Information gathered at the beginning of a study from which variations found in the study are measured;
(2) A known value or quantity with which an unknown is compared when measured or assessed;
(3) The initial time point in a clinical trial, just before a participant starts to receive the experimental treatment which is being tested.
At this reference point, measurable values such as CD4 count are recorded. Safety and efficacy of a drug are often determined by monitoring changes from the baseline values.

In clinical studies, bias is controlled by blinding and randomization. When a point of view prevents impartial judgment on issues relating to the subject of that point of view.

Blinded study
In clinical studies, a randomized trial is "blind" if the participant is not told which arm of the trial they are on. A clinical trial is "blind" if participants are unaware on whether they are in the experimental or control arm of the study; also called masked.

In clinical studies, an attempt to eliminate bias in the interpretation of clinical trial outcomes. It indicates that at least one party involved in the clinical trial is unaware of which patients are receiving the experimental treatment and which are receiving the control substance. Trials may be either single-blind (patients do not know which treatment they are receiving) or doubled-blind (neither the examining physicians nor the patients know which treatment each patient is receiving).

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Pertaining to or founded on observation and treatment of participants, as distinguished from theoretical or basic science.

Clinical endpoint
(See: Endpoint)

Clinical findings
Observations made during a medical exam indicating a change or impairment in mental or physical functions.

Clinical investigator
A medical researcher in charge of carrying out a clinical trial's protocol.

Clinical trial
A clinical trial is a research study to answer specific questions about vaccines or new therapies or new ways of using known treatments. Clinical trials (also called medical research and research studies) are used to determine whether new drugs or treatments are both safe and effective. Carefully conducted clinical trials are the fastest and safest way to find treatments that work in people. Trials are in four phases: Phase I tests a new drug or treatment in a small group; Phase II expands the study to a larger group of people; Phase III expands the study to an even larger group of people; and Phase IV takes place after the drug or treatment has been licensed and marketed.
(See: Phase I, II, III, and IV trials)

Community-based clinical trial (CBCT)
A clinical trial conducted primarily through primary-care physicians rather than academic research facilities.

(See: Recruitment status)

Confidentiality regarding trial participants
Refers to maintaining the confidentiality of trial participants including their personal identity and all personal medical information. The trial participants' consent to the use of records for data verification purposes should be obtained prior to the trial and assurance must be given that confidentiality will be maintained.

A control is the nature of the intervention control.

Control group
The standard by which experimental observations are evaluated. In many clinical trials, one group of patients will be given an experimental drug or treatment, while the control group is given either a standard treatment for the illness or a placebo.
(See: Placebo)

Controlled study
A clinical trial that compares the outcome of a group of randomly-assigned patients who receive the experimental treatment to the outcome of a group of randomly-assigned patients who receive a standard treatment or inactive placebo.

Controlled trials
Control is a standard against which experimental observations may be evaluated. In clinical trials, one group of participants is given an experimental drug, while another group (i.e., the control group) is given either a standard treatment for the disease or a placebo.

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Data Safety and Monitoring Board (DSMB)
An independent committee, composed of community representatives and clinical research experts, that reviews data while a clinical trial is in progress to ensure that participants are not exposed to undue risk. A DSMB may recommend that a trial be stopped if there are safety concerns or if the trial objectives have been achieved.

Diagnostic trials
Refers to trials that are conducted to find better tests or procedures for diagnosing a particular disease or condition. Diagnostic trials usually include people who have signs or symptoms of the disease or condition being studied.

Dose-ranging study
A clinical trial in which two or more doses of an agent such as a drug are tested against each other to determine which dose works best and is least harmful.

Double-blind study
A clinical trial design in which neither the participating individuals nor the study staff knows which participants are receiving the experimental drug and which are receiving a placebo (or another therapy). Double-blind trials are thought to produce objective results, since the expectations of the doctor and the participant about the experimental drug do not affect the outcome; also called double-masked study.

Double-masked study
(See: Double-blind study

(See: Data Safety and Monitoring Board)

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Efficacy of a drug or treatment
The maximum ability of a drug or treatment to produce a result regardless of dosage. A drug passes efficacy trials if it is effective at the dose tested and against the illness for which it is prescribed. In the procedure mandated by the FDA, Phase II clinical trials gauge efficacy, and Phase III trials confirm it.

Eligibility criteria
Summary criteria for participant selection; includes Inclusion and Exclusion criteria.

The act of signing up participants into a study. Generally this process involves evaluating a participant with respect to the eligibility criteria of the study and going through the informed consent process.

Exclusion/Inclusion criteria
(See: Inclusion/Exclusion criteria)

Expanded access
Refers to any of the FDA procedures, such as compassionate use, parallel track, and treatment IND that distribute experimental drugs to participants who are failing on currently available treatments for their condition and also are unable to participate in ongoing clinical trials.

Expanded Disability Status Scale (EDSS)
A part of the Minimal Record of Disability that summarizes the neurologic examination and provides a measure of overall disability. The EDSS is a 20-point scale, ranging from 0 (normal examination) to 10 (death due to MS) by half-points. A person with a score of 4.5 can walk three blocks without stopping; a score of 6.0 means that a cane or a leg brace is needed to walk one block; a score over 7.5 indicates that a person cannot take more than a few steps, even with crutches or help from another person. The EDSS is used for many reasons, including deciding future medical treatment, establishing rehabilitation goals, choosing subjects for participation in clinical trials, and measuring treatment outcomes. This is currently the most widely used scale in clinical trials.

Experimental drug
A drug that is not FDA licensed for use in humans, or as a treatment for a particular condition.
(See: Off-label use)

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Food and Drug Administration (FDA)
FDA is an agency within the U.S. Department of Health and Human Services that is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation. The FDA is also responsible for advancing the public health by helping to speed innovations that make medicines and foods more effective, safer, and more affordable; and helping the public get the accurate, science-based information they need to use medicines and foods to improve their health. Pertaining to this website, it's responsible for enforcing governmental regulations pertaining to the manufacture and sale of drugs and to prevent the sale of impure or dangerous substances. Any new drug that is proposed for the treatment of MS in the U.S. must be approved by the FDA.

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Inclusion/Exclusion criteria
The medical or social standards determining whether a person may or may not be allowed to enter a clinical trial. These criteria are based on such factors as age, gender, the type and stage of a disease, previous treatment history, and other medical conditions. It's important to note that inclusion and exclusion criteria are not used to reject people personally, but rather to identify appropriate participants and keep them safe.

Informed consent
The process of learning the key facts about a clinical trial before deciding whether or not to participate. It is also a continuing process throughout the study to provide information for participants. To help someone decide whether or not to participate, the doctors and nurses involved in the trial explain the details of the study.

Informed consent document
A document that describes the rights of the study participants, and includes details about the study, such as its purpose, duration, required procedures, and key contacts. Risks and potential benefits are explained in the informed consent document. The participant then decides whether or not to sign the document. Informed consent is not a contract, and the participant may withdraw from the trial at any time.

Institutional review board (IRB)
(1) A committee of physicians, statisticians, researchers, community advocates, and others that ensures that a clinical trial is ethical and that the rights of study participants are protected. All clinical trials in the U.S. must be approved by an IRB before they begin.
(2) Every institution that conducts or supports biomedical or behavioral research involving human participants must, by federal regulation, have an IRB that initially approves and periodically reviews the research in order to protect the rights of human participants.

Intent to treat
Analysis of clinical trial results that includes all data from participants in the groups to which they were randomized even if they never received the treatment.

Investigational new drug
A new drug, antibiotic drug, or biological drug that is used in a clinical investigation. It also includes a biological product used in vitro for diagnostic purposes.

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The knowledge of intervention assignment.
(See: Blinded study)

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New drug application (NDA)
An application submitted by the manufacturer of a drug to the FDA - after clinical trials have been completed - for a license to market the drug for a specified indication.

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Off-label use
A drug prescribed for conditions other than those approved by the FDA.

Open-label study
A preliminary (Phase I) clinical trial in which all patients receive the experimental treatment.

Open-label trial
A clinical trial in which doctors and participants know which drug or vaccine is being administered.

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Peer review
Review of a clinical trial by experts chosen by the study sponsor. These experts review the trials for scientific merit, participant safety, and ethical considerations.

Phase I trials
Initial studies to determine the metabolism and pharmacologic actions of drugs in humans, the side effects associated with increasing doses, and to gain early evidence of effectiveness; may include healthy participants and/or patients.

Phase II trials
Controlled clinical studies conducted to evaluate the effectiveness of the drug for a particular indication or indications in patients with the disease or condition under study and to determine the common short-term side effects and risks.

Phase III trials
Expanded controlled and uncontrolled trials after preliminary evidence suggesting effectiveness of the drug has been obtained, and are intended to gather additional information to evaluate the overall benefit-risk relationship of the drug and provide and adequate basis for physician labeling.

Phase IV trials
Post-marketing studies to delineate additional information including the drug's risks, benefits, and optimal use.

Pilot study
In clinical trials, an early, small-to-moderate-sized study (also known as Phase II) that follows the Phase I ("safety study") and is designed to begin determining the effectiveness of the experimental treatment.

A placebo is an inactive pill, liquid, or powder that has no treatment value. In clinical trials, experimental treatments are often compared with placebos to assess the treatment's effectiveness.

Placebo controlled study
A method of investigation of drugs in which an inactive substance (the placebo) is given to one group of participants, while the drug being tested is given to another group. The results obtained in the two groups are then compared to see if the investigational treatment is more effective in treating the condition.

Placebo effect
A physical or emotional change, occurring after a substance is taken or administered, that is not the result of any special property of the substance. The change may be beneficial, reflecting the expectations of the participant and, often, the expectations of the person giving the substance.

Refers to the testing of experimental drugs in the test tube or in animals - the testing that occurs before trials in humans may be carried out.

Prevention trials
Refers to trials to find better ways to prevent disease in people who have never had the disease or to prevent a disease from returning. These approaches may include medicines, vaccines, vitamins, minerals, or lifestyle changes.

A study plan on which all clinical trials are based. The plan is carefully designed to safeguard the health of the participants as well as answer specific research questions. A protocol describes what types of people may participate in the trial; the schedule of tests, procedures, medications, and dosages; and the length of the study. While in a clinical trial, participants following a protocol are seen regularly by the research staff to monitor their health and to determine the safety and effectiveness of their treatment

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Quality of life or Supportive care trials
Refers to trials that explore ways to improve comfort and quality of life for individuals with a chronic illness.

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A method based on chance by which study participants are assigned to a treatment group. Randomization minimizes the differences among groups by equally distributing people with particular characteristics among all the trial arms. The researchers do not know which treatment is better. From what is known at the time, any one of the treatments chosen could be of benefit to the participant.

Randomized trial
A study in which participants are randomly (i.e., by chance) assigned to one of two or more treatment arms of a clinical trial. Occasionally placebos are utilized.

The period during which a trial is attempting to identify and enroll participants. Recruitment activities can include advertising and other ways of soliciting interest from possible participants.

Recruitment status
Indicates the current stage of a trial, whether it is planned, ongoing, or completed. Possible values include:
Not yet recruiting: participants are not yet being recruited or enrolled
Recruiting: participants are currently being recruited and enrolled
Enrolling by invitation: participants are being (or will be) selected from a predetermined population
Active, not recruiting: study is ongoing (i.e., patients are being treated or examined), but enrollment has completed
Completed: the study has concluded normally; participants are no longer being examined or treated (i.e., last patient's last visit has occurred)
Suspended: recruiting or enrolling participants has halted prematurely but potentially will resume
Terminated: recruiting or enrolling participants has halted prematurely and will not resume; participants are no longer being examined or treated
Withdrawn: study halted prematurely, prior to enrollment of first participant

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Screening trials
Refers to trials which test the best way to detect certain diseases or health conditions.

Single-blind study
A study in which one party, either the investigator or participant, is unaware of what medication the participant is taking; also called single-masked study.

Single-masked study
(See: Single-blind study)

Statistical significance
The probability that an event or difference occurred by chance alone. In clinical trials, the level of statistical significance depends on the number of participants studied and the observations made, as well as the magnitude of differences observed.

Study endpoint
A primary or secondary outcome used to judge the effectiveness of a treatment.

Study type
The primary investigative techniques used in an observational protocol; types are Purpose, Duration, Selection, and Timing.

(See: Recruitment status)

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(See: Recruitment status)

Treatment IND
IND stands for Investigational New Drug application, which is part of the process to get approval from the FDA for marketing a new prescription drug in the U.S. It makes promising new drugs available to desperately ill participants as early in the drug development process as possible. Treatment INDs are made available to participants before general marketing begins, typically during Phase III studies. To be considered for a treatment IND a participant can't be eligible to be in the definitive clinical trial.

Treatment trials
Refers to trials which test new treatments, new combinations of drugs, or new approaches to surgery or radiation therapy.

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(See: Recruitment status)

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