30/07/2026
The comparator arm was built from published treatment guidelines.
The problem was that investigators at the target sites in Southeast Asia were following a different protocol in clinical practice, a variation from the standard guideline that had become routine at those institutions. If the comparator arm had gone into the study as written, the sponsor would have been measuring the investigational product against a comparator that patients in the study weren't consistently receiving.
This was found during investigator engagement, four weeks before the protocol was scheduled to lock.
The fix was straightforward once the discrepancy was visible: revise the comparator arm definition before lock. A protocol amendment after enrolment would have required regulatory resubmission, ethics review, and a delay that adds months to the timeline, with the compounding cost of a multi-site study running against a protocol that needed correction.
Early site engagement finds this kind of problem because it asks the right questions at the right time. Not a feasibility questionnaire sent to site coordinators, but a substantive conversation with investigators about what the study would actually look like at their site, the patients, the practice patterns, the comparators in use.
The specifics of what investigator engagement catches, and what it doesn't, are covered in detail here: https://credevo.com/articles/2025/05/15/why-early-site-engagement-matters-insights-into-soc-comparator-arms-and-site-interest/
If your protocol is approaching lock and hasn't been reviewed against actual investigator practice in the target markets, we're here: https://credevo.com/contact