Review Article Dermatology 2020;236:375–382 Virtual Clinical Trials: Perspectives in Dermatology Zarqa Ali a John Robert Zibert b Simon Francis Thomsen a, c a Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark; b LEO Innovation Lab, Copenhagen, Denmark; c Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark Received: August 6, 2019 Accepted after revision: February 10, 2020 Published online: March 3, 2020 Zarqa Ali, MD, PhD Department of Dermatology, Bispebjerg Hospital Bispebjerg Bakke 23 DK–2400 Copenhagen NV (Denmark) zarqa_ali @hotmail.com © 2020 S. Karger AG, Basel karger@karger.com www.karger.com/drm DOI: 10.1159/000506418 Keywords Virtual clinical trials · Decentralized clinical trials · Remote trials Abstract Background: The cost of developing a new drug is approxi- mately USD 2.6 billion, and over two-thirds of the total cost is embedded in the clinical-testing phase. Patient recruit- ment is the single biggest cause of clinical trial delays, and these delays can result in up to USD 8 million per day in lost revenue for pharmaceutical companies. Further, clinical tri- als struggle to keep participants engaged in the study and as many as 40% drop out. To overcome these challenges pharmaceutical companies and research institutions (e.g., universities) increasingly use an emerging concept: virtual clinical trials (VCT) based on a remote approach. Summary: VCT (site-less) are a relatively new method of conducting a clinical trial, taking full advantage of technology (apps, mon- itoring devices, etc.) and inclusion of web platforms (recruit- ment, informed consent, counselling, measurement of end- points, and any adverse reactions) to allow the patient to be home-based at every stage of the clinical trial. Studies have shown that VCT are not only operationally feasible, but also successful. They have higher recruitment rates, better com- pliance, lower drop-out rates, and are conducted faster than traditional clinical trials. The visual nature of dermatological conditions, the relative ease in evaluating skin diseases virtu- ally, and the fact that skin diseases often are not life-threat- ening and rarely require complex examinations make VCT very attractive for dermatological research. Further, making correct diagnoses based on photographs and patient symp- tomatology has always been part of the dermatologist’s rou- tine. Thus, VCT are in many ways made for dermatology. Herein we describe VCT and their implications in dermato- logical research. © 2020 S. Karger AG, Basel Introduction Clinical drug development is a time-consuming and complex process that takes around 6–15 years [1]. The cost of developing a new drug, from research and devel- opment to marketing approval, is approximately USD 2.6 billion [2]. Approximately 85% of therapies fail through early clinical development, and only half of those reach- ing phase 3 are approved [3]. Over two-thirds of the total cost, in both money and time, of the discovery and devel- opment of a new drug is embedded in the clinical-testing phase [4]. Patient recruitment is the single biggest cause of clinical trial delays, and 30% of phase 3 study termina-