How Digital Endpoints Are Redefining Clinical Research Strategies

Digital health is reshaping clinical research and care delivery by offering more comprehensive insights into patient health. In traditional clinical trials, endpoints — measurable outcomes such as lab results, imaging studies or clinical assessments — are collected during scheduled visits at the clinic.

In contrast, digital endpoints are derived from data captured continuously or intermittently through digital health technologies (DHTs), often outside of a clinical setting. These endpoints include data collected by wearable sensors, smartphones or other connected devices, providing a realistic picture of a patient’s daily health and functioning.

For example, a wearable activity tracker can monitor a patient’s gait, step count or even nocturnal activity, offering a continuous measure of mobility that could be more robust than traditional, infrequent assessments.

Similarly, digital biomarkers can monitor cognitive function in patients with neurodegenerative diseases or track heart rate and blood oxygen levels in real time. These approaches have already been implemented in clinical trials for conditions such as Parkinson’s disease, diabetes and cardiovascular disease.

Recent analyses indicate that the adoption of digital endpoints is on the rise. According to industry data, over 130 pharma and biotech organizations now incorporate digital endpoints into their clinical trials, with connected sensors and continuous glucose monitors being the most common technologies used.

Studies have shown that incorporating digital endpoints can reduce trial durations by several months and decrease the number of participants required, which not only speeds up the development of new therapies but also significantly cuts costs. Moreover, evidence suggests that trials leveraging digital endpoints yield substantial returns on investment, with Phase III trials showing a potential financial gain in the tens of millions of dollars.

In this Xtalks Clinical Edge™ interview, Sarah Valentine, Partnerships Lead for Life Sciences at the Digital Medicine Society (DiMe), outlined how digital endpoints are paving the way for faster, more efficient clinical trials. By capturing detailed, patient-centric data from real-world environments, digital endpoints are transforming how clinical outcomes are measured and how therapeutic decisions are made.

Xtalks Clinical Edge™: Issue 4 — DiMe’s Approach for Digital Endpoints in Clinical Trials

Xtalks Clinical Edge™ is a magazine for clinical research professionals and all who want to be informed about the latest trends and happenings in clinical trials. This magazine immerses you in a world where industry leaders, patient advocates and top researchers converge to provide the most insightful perspectives on clinical trials.

The Value Framework for Digital Endpoints

DiMe’s approach centers on a robust value framework that not only captures the scientific benefits of digital endpoints but also quantifies their economic impact. Early frameworks, such as the Digital Clinical Measures Playbook released in 2020, laid the foundation by outlining how sensor-based data could be harnessed to assess disease states more comprehensively.

More recent collaborations — most notably with the Tufts Center for the Study of Drug Development — have underscored that integrating digital data can yield both richer insights into patients’ real-world experiences and measurable cost savings. These initiatives have demonstrated that digital endpoints can significantly reduce the number of patients needed to reach statistical significance, leading to shorter trial timelines and ultimately lower overall trial costs.

According to Valentine, the key benefits of digital endpoints include:

Enhanced Data Collection: By capturing data continuously in a patient’s everyday environment, digital endpoints provide a dynamic, real-world snapshot that transcends the limitations of in-clinic measurements.
Efficiency Gains: The robustness of digital data means that trials could operate with smaller sample sizes while still achieving the desired statistical power.
Cost Reduction and Speed: Shorter trial durations not only accelerate the delivery of therapies to market but also translate into substantial cost savings.

“By introducing digital endpoints, we can not only assess these things in real-world environments, but we can also assess things with fewer patients because of the robustness of the data, we don’t need as much in order to actually come to statistical significance,” explains Valentine.

This underscores how early integration of digital endpoints can enhance resource allocation and simplify the drug development process. By capturing high-quality, continuous data, digital endpoints serve as a strategic asset that promotes both scientific discovery and economic efficiency across the clinical research spectrum.

Early Integration for Maximum Impact

According to Valentine, the greatest value of digital endpoints emerges when they are integrated early in the drug development process. Embedding digital measures during the discovery and preclinical phases helps organizations create a comprehensive map of both traditional and novel metrics, revealing previously unrecognized aspects of disease biology. This early approach helps teams identify and validate meaningful health parameters in line with regulatory guidance, ensuring that subsequent clinical trials are built on robust, actionable data.

Moreover, early integration fosters a “fail fast” culture, where less promising therapeutic avenues are quickly identified, and resources are reallocated toward the most impactful programs.

“I personally think that there’s a lot of value to be gleaned in early stages. I know a lot of people kind of see Phase III studies, primary endpoints as the holy grail, but at DiMe we kind of work at the intersection of healthcare and technology and in tech, there’s this concept of failing fast that I don’t think we’ve truly embraced on the healthcare side of things.”

This proactive strategy is especially critical when planning large-scale Phase III studies. By integrating digital endpoints early, organizations can mitigate risk and optimize resource allocation, ultimately leading to more efficient and cost-effective trials. Incorporating early not only accelerates decision-making but also creates a more solid foundation for transformative patient outcomes later in the development cycle.

Aligning Stakeholders and Overcoming Implementation Challenges

One of the most demanding aspects of incorporating digital health solutions is aligning the diverse perspectives of regulators, sponsors and clinicians. Valentine emphasized that bringing these stakeholders together to agree on common definitions and best practices is essential, as misalignment can hinder progress and compromise the scalability of digital innovations.

For instance, detailed discussions — even on seemingly minor issues like the distinctions between “scratch” and “itch” — can lay the groundwork for a shared language and unified strategies.

Common challenges of implementing digital endpoints in clinical research include:

Fragmented Initiatives: Repeated pilot studies conducted in isolation without a coherent, scalable strategy can lead to redundant efforts and missed opportunities for integration.
Organizational Silos: Difficulties in embedding digital innovation into established processes often arise from rigid internal structures, hindering collaboration and the smooth implementation of new technologies.
User-Centric Design: Ensuring that digital health solutions are accessible and user-friendly is critical, especially when patients and caregivers face practical challenges with digital devices.

“If we are all developing algorithms and submitting those algorithms to different review divisions within FDA, it’s important that we align upon the language that we’re using, that we’re not talking past each other, that we are kind of coming into it with a shared front so that we can continue to build on work that already exists,” explains Valentine.

A coordinated strategy based on pre-competitive collaborations is crucial for overcoming these barriers. By pooling resources, sharing lessons learned and fostering a community-oriented approach to innovation, organizations can break down silos and establish a unified framework that benefits all stakeholders involved. This alignment not only streamlines regulatory approval processes but also paves the way for broader and more impactful digital health initiatives.

Advancing Alzheimer’s Research Through DHTs

Advancing Alzheimer’s research through DHTs is transforming the way clinical trials are conducted in this challenging field. Alzheimer’s studies typically struggle with issues such as prolonged recruitment periods and extended trial durations, which in turn drive up costs and delay the availability of new therapies.

DHTs address these challenges by enabling continuous, real-world data collection. For example, wearable sensors can monitor sleep quality, daily activity levels and even subtle changes in mobility, providing a level of detail that traditional, intermittent clinical assessments cannot match.

In practical terms, these technologies allow researchers to conduct studies with significantly fewer participants while still achieving robust statistical power. This efficiency is particularly valuable in Alzheimer’s trials, where recruitment is often difficult and the cost of prolonged studies is high.

“I think it really helped us to understand what matters to patients and think through how can we actually measure those things objectively,” says Valentine.

This emphasizes that the objective measurement of daily activities — such as how patients move at home or how they sleep — offers critical insights that were previously unavailable.

Several key projects at DiMe illustrate this integrated approach. For instance, DiMe Core Measures — Alzheimer’s Disease and Related Dementias highlights DiMe’s effort to develop a conceptual framework for Alzheimer’s research through mixed-method research, including global surveys and in-depth interviews with patients and caregivers from diverse regions.

Similarly, the DiMe Integrated Evidence Plans for Digital Health Products initiative demonstrates how comprehensive landscape reviews combined with stakeholder input help standardize digital endpoints and inform both clinical and economic decision-making across geographies.

In addition, the DiMe Library of Digital Endpoints serves as a living resource, documenting various digital endpoints used in Alzheimer’s research. It reflects DiMe’s ongoing commitment to gathering global data and driving innovation.

These projects collectively demonstrate how DiMe has effectively integrated mixed-method research and landscape reviews to capture diverse perspectives, ultimately creating frameworks that enhance both clinical progress and economic efficiency in Alzheimer’s research.

Future Perspectives: Rare Diseases, Neuropsychiatry and Beyond

Looking ahead, digital innovations are poised to transform clinical research across several therapeutic areas beyond Alzheimer’s.

In rare disease clinical research, digital endpoints can substantially lower expenses while enabling studies to operate with fewer participants. Continuous data capture via wearable sensors and ambient devices could help provide precise, real-world measurements that could have previously required much larger cohorts. As Valentine explains, “I think there’s a huge opportunity to leverage digital endpoints to reduce the cost of those rare disease trials.”

Valentine also believes that neuropsychiatry is a field where digital measures can effectively address a critical gap. Traditional clinical assessments in mental health often rely on subjective instruments that may not fully capture the subtle changes in behavior or cognition over time. Digital tools such as speech analysis algorithms, smartphone-based assessments and digital phenotyping can offer objective, granular data that lead to more accurate evaluations of treatment effects in conditions like major depressive disorder (MDD) or other neuropsychiatric illnesses.

Moreover, the future of clinical research may increasingly rely on personalized digital measures. By establishing individual baselines through continuous monitoring, n=1 studies could be designed to tailor treatments to the unique profiles of each patient. This approach may not only enhance the precision of clinical trials but may also pave the way for truly individualized treatment strategies.

Collectively, these advancements underscore the necessity for broader collaboration among stakeholders — including academic institutions, regulatory bodies, industry partners, patient advocacy groups and organizations like DiMe — to share resources, standardize methodologies and drive scalable, impactful digital strategies.