“Raleigh’s clinical trials landscape overwhelmingly points to the dedication that the Duke University and University of North Carolina Health Systems have to the advancement of medicine through clinical research,” said Dr. Irfan Khan, CEO of Circuit Clinical. “We hope the findings we present today are of utility to everyone in need of, as well as providing, healthcare in the greater Raleigh area.”
Despite being ranked as the 24th-largest Designated Market Area (DMA) by Nielsen in 20173, 10,699 clinical trials have been conducted in the greater Raleigh area within the past fifteen years1. This places it ahead of several more highly-ranked markets, namely Tampa (with 9,597 trials over the same period of time, and ranked 11th by Nielsen), Phoenix (with 9,738 trials while being ranked 12th), Orlando (7,825, while ranked 18th), Sacramento (5,966 trials, ranked 20th), Charlotte (4,937 trials, ranked 22nd), and Pittsburgh (8,832 trials, ranked 23rd). Further, more trials have been conducted in Raleigh than other similarly-ranked cities, such as Portland (9,172 trials, ranked 25th), Indianapolis (7,351 trials, ranked 27th), and San Diego (9,776 trials, ranked 28th)1,3,4,5.
Raleigh’s clinical trial performance is even more impressive when population is taken into account; the population of the greater Raleigh area (which includes Durham, Chapel Hill. Cary, and cities as far north as Henderson, as seem in the map above) is 2,238,315, which is the least among the 21 cities covered in this series4,5. For reference, Columbus is Raleigh’s most immediate comparable with regards to study volume (with 11,053 conducted), even though its population is about 270,000 more than Raleigh’s 1,5. Furthermore, both Tampa and San Diego have populations nearly a million greater than Raleigh’s (3,091,399 and 3,140,399, respectively), and Phoenix’s population is more than twice that of Raleigh’s (4,737,270)4,5. Despite these figures, more clinical trials are conducted in Raleigh than in all of these cities1.
Clinical trials in the Raleigh area, however, are extremely concentrated among two health systems: Duke University Health System and University of North Carolina (UNC) Health Care System. Remarkably, these two systems accounted for about 89.2% of Raleigh’s active* clinical trials in 2018, with Duke alone accounting for more than half (53.4%). In terms of sheer trial count, Duke and UNC boasted 1,459 and 978 active trials in 2018, respectively; the next most active system (Wake Research) had an approximate 72, a difference of just greater than 900 trials between the second- and third-most active health systems. To round out the top five, Wake Research accounted for 2.6% of Raleigh’s active trials in 2018, followed by the United States Department of Veterans Affairs (1.7%) and WakeMed Health and Hospitals (1.4%)1.
It should come as no surprise, then, that the most active locations for clinical trials in Raleigh belong to either the Duke or UNC Health Systems. The most active clinical trial location in Raleigh is the Duke University Medical Center, with 1,142 active studies in 2018, and its cancer center supplementing another 102. While Duke University Health System accounted for 53.4% of active clinical trials in Raleigh in 2018, its flagship medical center alone accounted for 41.8%. Similarly, the UNC Medical Center had 638 active trials last year (accounting for 23.4% of Raleigh’s trials alone), with its Lineberger Comprehensive Cancer Center adding another 191. Beyond these four, the next most active locations include Wake Research Associates, the Durham VA Health Care System, Duke University Hospital, UNC REX Hospital, and the WakeMed Raleigh Campus1.
As the total amount of active trials in the greater Raleigh area have increased (from an estimated 1,671 in 2008 to 2,732 in 2018), so too has the amount at its major medical centers. In 2008, Duke University Medical Center had 637 active trials; this number increased to 1,142 in 2018. Over the same time span, UNC Medical Center nearly doubled from 327 trials to 638. Significant growth is also evident in the Duke University Hospital (from 6 trials in 2008 to 46 last year) and UNC REX Medical Center (6 trials in 2008 to 39 last year)1.
Like all cities in this series, Raleigh also has independent practices and research-dedicated facilities that are noteworthy pieces of its clinical trial landscape. The most active of these sites in Raleigh, by far, is Wake Research Associates, conducting 72 active trials last year and growing to that number from a total of 26 trials in 2008. The next most active of these sites include Raleigh Neurology Associates in Raleigh (28 active trials last year), Waverly Hematology Oncology (17 active trials in 2018 from 5 in 2008), and PMG Research of Raleigh (14 last year from 3 in 2008) and Cary (12 active trials last year from 2 in 2008)1.
Lastly, subsequent analyses were performed on the TrialJourney database to provide an overview of the most current state of Raleigh’s clinical trials landscape. These indicate that there are 3,024 clinical trials in the Raleigh area that are currently active; of these, 1,674 (55.5%) are currently recruiting patients for participation. At the health system level, these analyses revealed totals of 1,443 and 1,128 currently active trials for Duke University Health System and UNC Health Care System, respectively. 830 of Duke’s currently active trials (57.5% of its total) and 612 of UNC’s (54.3% of its total) are recruiting. These two health systems account for 47.7% and 37.3% of Raleigh’s active trials, as well as 49.6% and 36.6% of its recruiting trials, respectively. Further, 1,114 of Duke University Health System’s active trials (77.2%) are taking place at Duke University Medical Center (651, or 58.4%, of them recruiting), while 624 of UNC Health Care System’s 1,128 currently active trials (55.3%) are being conducted at the UNC Medical Center (374, or 59.9%, of them recruiting). The Duke University Medical Center astonishingly accounts for 36.8% of all currently active clinical trials and 38.9% of recruiting trials in Raleigh alone, while the UNC Medical Center accounts for 20.6% and 22.3% of active and recruiting trials in the area2.**
In a vacuum, Raleigh is performing admirably in the clinical trial industry, as it has conducted more trials than several cities with significantly higher populations. Virtually all of Raleigh’s success in this field can be attributed to its two major academic health systems, predominantly highlighting the focus of Duke and UNC on the advancement of medicine as the defining aspects of Raleigh’s clinical trials landscape. This concentration is not to discount Raleigh’s overall performance, however; it has still performed better than several larger markets.
*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)
**As part of our ongoing quality assurance process, we've enhanced and improved our trial accounting algorithm in order to capture clinical trials with inconclusive and/or unstated completion dates.