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A recent webinar series organized by the IHI-funded RealiseD project engaged over 1,150 participants to discuss the challenges in designing and conducting clinical trials for rare diseases. The discussions highlighted the need for improved trial methodologies to better reflect biological realities and regulatory expectations.
But why, with so many affected, are there still so few therapies for rare diseases? While scientific advances continue to identify new conditions, progress in developing and evaluating treatments has been far slower—raising difficult questions about how clinical trials are designed, conducted, and assessed. A recent webinar series organised ... But why, with so many affected, are there still so few therapies for rare diseases? While scientific advances continue to identify new conditions, progress in developing and evaluating treatments has been far slower—raising difficult questions about how clinical trials are designed, conducted, and assessed. A recent webinar series organised by the IHI-funded RealiseD project brought together over 1,150 participants—including patients, regulators, clinicians, academics, and industry representatives—to examine where rare disease clinical trials are falling short, and how they might be redesigned to better reflect biological reality, regulatory expectations, and lived experience. At the heart of the challenge lies scale—or the lack of it. Rare disease trials typically involve small, geographically dispersed patient populations, making recruitment slow and conventional statistical power difficult, if not mathematically impossible, to achieve. At the same time, genetic and clinical heterogeneity means that patients with the “same” diagnosis may experience markedly different symptoms, disease trajectories, and treatment responses. A webinar series organised by the Innovative Health Initiative (IHI) funded project RealiseD, spotlights the unique challenges for clinical trials in rare diseases and explores innovative, patient-centered solutions. With traditional two arm randomised controlled trials (RCT) often proving not feasible in the context of rare diseases due to ethical, logistical, or recruitment constraints, a later session explored what alternatives might look like in practice. Single arm trials, RCTs, Bayesian approaches, and the use of real-world evidence were all discussed as potential tools—provided their limitations are clearly understood. Single arm trials, for example, could be appropriate when treatment effects are substantial or placebo use would be unethical, but they also pose challenges for causal interpretation.
Original title: “Rare Disease Day 2026: Where are clinical trials for rare conditions headed next? | Research Communities by Springer Nature”