“The Clinical Trials Landscape is an information series that is derived from the proprietary database transformation that www.TrialScout.com is built on,” said Dr. Irfan Khan, CEO of Circuit Clinical. “With these insights, we hope to increase awareness of clinical research as a care option to patients, as well as healthcare providers and administrators, and help them understand it as well.” Craig Lipset, the former Head of Clinical Innovation for Pfizer and a current board member of Empirican Group Inc. (which owns Circuit Clinical), adds "Pharmaceutical research is heavily reliant on tremendous amounts of data in selecting the locations at which multi-center clinical trials will be conducted. The TrialScout Clinical Trial Landscape Project provides novel insights for study planners that will improve decision-making and thus accelerate the development of new medicines." While Los Angeles gets significant contributions from a wide array of players in its clinical trials landscape, most notably UCLA Health, the clinical trial volume of the city as a whole shows room for growth considering its size.
In line with being the second-most populous Combined Statistical Area (CSA) in the country5 as well as being ranked as its second-largest Designated Market Area (DMA) by Nielsen3, the greater Los Angeles area is only bested in the U.S. clinical trial industry by New York City1,2. According to the TrialScout database, a total of 43,226 clinical trials have been conducted in Los Angeles since they have been recorded, significantly outpacing the totals of similarly-ranked DMAs (with the exception of New York)2,3. Chicago, ranked third by Nielsen, has a total of 24,610 clinical trials, while Philadelphia (ranked fourth) and Dallas (ranked fifth) have 22,308 and 14,309 respectively1,3. As can be seen below, the greater Los Angeles area is bound by Ventura and Lancaster to the north, Temecula and Palm Springs to the south, and the Arizona state line to the east; it thus encompasses notable cities such as Anaheim, Riverside, Santa Ana, Long Beach, Santa Monica, Thousand Oaks, and Oxnard among many others.
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Despite an objectively high trial count, population totals put a slight damper on Los Angeles’s overall clinical trial performance. The Los Angeles CSA has an estimated population of 18,764,814 residents, while the next-highest performing cities and their populations are as follows: Boston (8,233,270), Chicago (9,901,356), Philadelphia (7,206,807), Miami (6,832,588), San Jose (8,837,789), Detroit (5,336,286), and Washington D.C. (9,765,772). The population of the Los Angeles CSA more than doubles those of each aforementioned city besides Chicago and Washington, yet its trial volume does not quite line up in the same manner. When both trial volume and population totals for the comparison cities are doubled, both Boston (twice its actual total of 26,653 equaling 53,464) and Philadelphia (twice its actual total of 22,308 equaling 44,616) have more trials than Los Angeles does to date despite twice their populations still being less than Los Angeles’s actual population. Under the same circumstances, Miami’s doubled trial volume (twice its actual total of 21,625 equaling 43,250) becomes very comparable to Los Angeles’s actual output, while San Jose (20,934 x 2 = 41,868) and Detroit (20,877 x 2 = 41,754) are not far behind despite all three having populations less than half of Los Angeles’s1,5. Theoretically, then, it can be said that Los Angeles is outperformed in the clinical trial industry by Boston, Philadelphia, Miami, and Detroit while being relatively in line with San Jose, Washington D.C., and Chicago, and this is supported when trial volume is divided by population to determine a normalized index of clinical trial performance for each CSA:
|CSA||Number of Trials1||Population5||Number of Trials per 1000 Residents|
*Sorted by number of trials in descending order
As seen above, more clinical trials per person have been conducted in Boston, Philadelphia, Miami, and Detroit, as well as San Jose and Chicago in actuality, than Los Angeles1,2.
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UCLA Health is the predominant reason why Los Angeles has such a high trial volume in a vacuum, leading the way in its clinical trial industry with 1,235 active trials in 2018. This health system accounted for 16% of active trials in the Los Angeles CSA last year. Following UCLA Health are City of Hope (727 active trials last year, 9.4% of all in Los Angeles), Keck Medicine of USC (701 active trials last year, 9.1% of such trials in the CSA), Cedars-Sinai Health System (545 active trials in 2018, 7.1% of Los Angeles’s total), and Kaiser Permanente (537 active trials in 2018, 7% of all in Los Angeles). As a testament to the depth in Los Angeles’s clinical trials landscape, an additional nine health systems in the CSA had at least 100 active clinical trials in 2018: UCI Health (412 active trials), Children’s Hospital Los Angeles (284 active trials), Loma Linda University Health (255 active trials), the Los Angeles County Health Services Department (250 active trials), the U.S. Department of Veterans Affairs (195 active trials), St. Joseph Health System (160 active trials), Providence Health and Services (131 active trials), MemorialCare Health System (104 active trials), and Children’s Hospital of Orange County (104 active trials)1.
The Ronald Reagan UCLA Medical Center was the most active individual location in the Los Angeles CSA in 2018 with 786 active clinical trials, accounting for 63.6% of UCLA Health’s active trials as well as 10.2% of all active trials in the area last year alone. Following this medical center are Cedars-Sinai Medical Center (470 active trials), City of Hope National Medical Center in Duarte (464 active trials), the USC Norris Comprehensive Cancer Center (309 active trials), and Children’s Hospital Los Angeles (284 active trials). Outside of Los Angeles’s top five, eight additional locations had at least 100 active trials in 2018: the USC Health Sciences Campus (251 active trials), University of California Irvine Medical Center (217 active trials), Loma Linda University Medical Center (185 active trials), City of Hope Comprehensive Cancer Center in Duarte (136 active trials), Los Angeles County and USC Medical Center (121 active trials), UCLA Jonsson Comprehensive Cancer Center (108 active trials), Children’s Hospital of Orange County’s main campus (104 active trials), and Kaiser Permanente Los Angeles Medical Center (101 active trials). To further speak to Los Angeles’s depth, a total of 58 individual locations in the area had at least 30 active clinical trials last year1.
The Los Angeles CSA has doubled in active trial output over the past decade; in 2008, there were 3,833 total active clinical trials in the area, and this jumped to 7,708 in 2018. Unsurprisingly, most of this growth is accounted for by the top performers in the CSA. The Ronald Reagan UCLA Medical Center leads the way in this department as well, with a total growth of 453 active trials (333 in 2008 to 786 in 2018). The City of Hope National Medical Center has grown from 141 active trials in 2008 to 464 in 2018 for a total growth of 323, while the Cedars-Sinai Medical Center has grown from 170 active trials in 2008 to 470 in 2018 for an overall growth of 300. Further, Children’s Hospital Los Angeles grew from totals of 143 active trials in 2008 to 284 in 2018, and the USC Health Sciences Campus has grown from 112 active trials in 2008 to 251 last year. Beyond the aforementioned top performers, significant growth is seen for several other locations, including St. Joseph Health’s St. Jude Medical Center (16 active trials in 2008 to 99 in 2018), Keck Hospital of USC (18 active trials in 2008 to 97 in 2018), UCLA Medical Center in Santa Monica (from nine active trials in 2008 to 64 last year), and the UCLA Oncology Center in Westwood (17 active trials in 2008 to 71 last year) among others1.
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Los Angeles also has several alternative clinical trial sites that make significant contributions to its clinical trials landscape, and several of them have grown demonstrably over time as well. The most active of these locations last year was LA BioMed at the Harbor-UCLA Medical Center, with 80 active clinical trials (from 32 in 2008). LA BioMed is followed in this department by the American Institute of Research in Whittier (57 active trials last year, up from a single trial in 2008), Anaheim Clinical Trials (53 active trials in 2018, growing from 31 in 2008), the Angeles Clinic and Research Institute’s West Los Angeles office (52 active trials last year, from 15 in 2008), and CNS Network’s Orange County Headquarters (44 active trials last year, growing from 13 in 2008). Outside of the top five, other alternative clinical trial sites in Los Angeles making their mark on the city’s landscape include the Inland Empire Liver Foundation (39 active trials last year, from four in 2013), Sarcoma Oncology Center (38 active trials last year, up from 13 in 2008), Syrentis Clinical Research (33 active trials in 2018, from two in 2013), and Facey Medical Group in Mission Hills (32 active trials last year, from six in 2008) among many others1.
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More recent analyses of the TrialScout database reveal that there are currently 9,786 active clinical trials in the Los Angeles CSA; of these, 5,357 (54.7%) are currently recruiting for participation. UCLA Health is still the most active health system in the area at the moment with 1,215 currently active clinical trials (679, or 55.9%, of which are recruiting); this system accounts for 12.4% of Los Angeles’s active trials as well as 12.7% of the area’s recruiting trials. In addition, the Ronald Reagan UCLA Medical Center is still the single-most active clinical trial location in the CSA, with 729 active trials (418, or 57.3%, of which are recruiting); it currently comprises 60% of UCLA Health’s active trials and 61.6% of its recruiting trials, as well as 7.4% and 7.8% of all active and recruiting trials in Los Angeles alone. In a new development, Kaiser Permanente is now Los Angeles’s second-most active health system for clinical trials, with 1,080 currently active trials in the CSA (542, or 50.2%, of which are recruiting). This system accounts for 11% of active trials in Los Angeles as well as 10.1% of its recruiting trials. City of Hope is the next-most active health system in the area with 929 active trials at present (486, or 52.3%, of which are recruiting), making up 9.5% of Los Angeles’s active trials as well as 9.1% of its recruiting trials. Following City of Hope is Keck Medicine of USC, with 783 active trials (447, or 57.1%, of them recruiting); these totals comprise 8% of active trials in the Los Angeles CSA along with 8.3% of its recruiting trials. Rounding out the top five in Los Angeles is the Cedars-Sinai Health System, which currently has 569 active clinical trials (316, or 55.5%, of which are recruiting). This health system accounts for 5.8% of Los Angeles’s active trials as well as 5.9% of its recruiting trials2.
While Los Angeles is the second-largest contributor to the clinical trials landscape of the entire U.S., population figures and their relation to trial output suggest that it should be ahead of where it stands. This is not to discount the CSA’s contributions as a whole, however, as its widespread contributions and depth in performance make it a lynchpin in the industry, and this will not change.
To follow the clinical trial landscape series, visit the TrialScout Clinical Trials Landscape
*Active in 2018 = Active at any point in 2018 (Start date of study is before 12/31/2018 and end date is after 1/1/2018)