Clinical trials in the Eastern Mediterranean Region: a ten-year landscape analysis

Background: In 2022, the World Health Organization (WHO) called on countries to strengthen their capacities for the conduct of impactful clinical trials and generating high-quality evidence on health interventions. The Eastern Mediterranean Region (EMR) faces challenges in this regard, with research output concentrated in a few countries and institutions. Methods: We analysed the registration data of clinical trials from the WHO International Clinical Trials Registry Platform for all 22 countries and territories of the EMR from 2013 to 2023. Following data cleaning, deduplication, and intervention classification, we descriptively analysed the trials across time, countries, intervention types, phase, sample size, sponsorship, and participant demographics. Results: We identified 49,529 interventional trials, representing a three-fold increase in annual registrations over the decade. Most studies conducted in 2023 originated from only a few countries: Iran (57%), Egypt (23%), and Pakistan (14%), followed by Saudi Arabia (1.5%), Iraq (1.4%), and Tunisia (1.2%). Despite the increase in absolute numbers, the proportion of clinical trials with pharmacological interventions declined from 61.5% in 2013 to 42.4% in 2023. While the findings demonstrate significant growth in regional clinical trial activity, they also highlight persistent challenges, as interventional studies with small sample sizes remain common. Conclusions: Although our analysis reveals substantial growth in clinical trial registrations across the EMR over the past decade, persistent disparities in research capacity remain, while the role of industry remains limited. Coordinated efforts are required to increase multi-centre and multi-country studies in order to address the key health priorities and contribute more effectively to the development of solutions that address regional needs.