How decentralised clinical trials can unlock Asia's research potential

For many patients across Asia, trial access has hinged on proximity, and not eligibility.

Asia is one of the most compelling frontiers for clinical research, with growing trial activity and significant unmet need. Southeast Asia for instance was the only World Health Organization (WHO) region not to see a decline in trial registrations since the peak of COVID-19.

Yet thousands fail to reach patients at scale. For example, Thailand's 12,781 studies from 1999 to 2024 show that whilst over 6,200 patients enrolled, each trial saw fewer than 100 participants.

The reason lies not in patient disinterest, but in geography, especially for those in rural areas, economics, and infrastructure gaps that traditional trial models cannot bridge. For many, repeated travel to centralised sites is not merely inconvenient, but unfeasible.

Whilst trial sites remain out of reach for many, mobile phones are not. Asia is home to one of the world's fastest-growing digital populations, with mobile technologies and services projected to contribute $1.4t to Asia Pacific’s economy by 2030 through 5G and artificial intelligence (AI) expansion.

To help bridge this gap, the region can build flexible trial models on existing digital infrastructure, bringing trials to patients rather than the other way around, whilst accelerating drug development.

Trial barriers to address
When patients are presented with the opportunity to join a trial, their questions rarely centre on the science. They centre on the practicalities: How far is the site, how long will each visit take, how much will it cost, and who will look after the children.

These factors add up quickly, creating what has been described as an "administrative toxicity" that compounds the clinical burden of participation. It covers the physical toll of traveling whilst managing disease symptoms, the financial strain of lost wages and transportation costs, and the emotional weight of repeated long journeys for what are often brief interactions.

Research sites have historically acted as central hubs, and the repeated journeys required by patients are a barrier that falls hardest on those in geographically dispersed regions in Asia. When underrepresented groups are structurally excluded, trial data fails to reflect the populations these treatments are ultimately meant to serve.

Asia infrastructure can be a silver bullet
Whilst these barriers exist, Asia is also uniquely positioned to overcome them. The region has already demonstrated its ability to leapfrog legacy infrastructure, most visibly in telehealth, driven by necessity rather than choice. Governments across the region are now actively investing in the digital health foundations that make a different model of trial delivery possible.

Singapore's Ministry of Health and Health Sciences Authority's Artificial Intelligence in Healthcare Guidelines (AIHGIe) 2.0 guides AI deployment to augment and empower healthcare professionals in enhancing care delivery, supporting the safe use of AI to benefit patients.

Beyond regulatory frameworks, there are also end-to-end, AI-powered solutions available, which can integrate patient engagement, remote monitoring, data capture, and adaptive analytics onto one platform, enabling researchers and sponsors to run hybrid and fully remote trials seamlessly across the region’s diverse geography.

This is not a future ambition. The infrastructure for flexible clinical trials models already exists in the region, and the opportunity now is for the industry to fully leverage it.

Flexibility without losing the human touch
For many patients across Asia, trial access has hinged on proximity, and not eligibility. Decentralised clinical trials (DCTs) change that by offering remote, hybrid, and in-clinic options, reducing the logistical burden that has historically been a barrier.

Whilst in-person visits keep trials high-touch, digital tools enable flexibility. Wearables, electronic Clinical Outcome Assessment (eCOA), remote monitoring, and mobile options shift trials to patients' familiar devices, and daily lives, whilst boosting data accuracy.

In central nervous system and rare diseases trials, this flexibility is critical as they can significantly improve participation and quality. For patients with neurological or neurodegenerative disorders like dementia and Alzheimer’s, memory loss represents a devastating erosion of identity, chipping away at a person’s sense of self before physical decline.

More than 3 billion people worldwide are affected by neurological disease, and in Asia, dementia is the seventh most prevalent health condition affecting older people. Yet a Phase III Alzheimer's trial averages US$370m ($475m) to run, may take up to eight years to complete, and carries a 95% failure rate.

This urgency is compounded by trial design challenges – such as complex and subjective endpoints, high screen failure rates, and high placebo response rates – alongside patient accessibility barriers including geography, mobility challenges and isolation from specialist care. DCTs remove the accessibility constraint, expanding the pool of patients who can realistically enrol.

What’s key to DCTs is putting patients at the centre of design from the start. Tools must function in local languages, on lower-end devices, and within existing patient behaviours. Underlying all of this, AI-enabled tools can quietly process the continuous data streams that these trials generate, flagging at-risk patients early and ensuring that flexibility does not come at the cost of data integrity.

Full decentralisation is not the goal, nor is it what patients want. Empathy and human connection remain critical, and the optimal model is hybrid, strategically removing unnecessary burden whilst preserving the essential in-person touchpoints that build trust. When patients feel genuinely supported, they stay enrolled longer.

Countries in Asia have the opportunity to design clinical trials that work for patients, not despite them. By leveraging decentralised models and digital infrastructure, the region can ensure that underrepresented populations, those in rural areas, with limited means, or managing complex diseases, are no longer excluded.

What’s clear is that when trials become more inclusive, more patients gain access, researchers gain representative data, and treatments reach those who need them most. This requires the industry to measure trial success differently, valuing inclusive design as a marker of rigour, not convenience.