Aernoud Fiolet

36 Chapter 1 Drug repurposing comes with important challenges: due to the high costs and duration of clinical research, and the expired (or never existing) patents, the financial incentive for investigating other purposes of a drug is limited, impeding drug rediscovery. 126 The aforementioned drug colchicine is exemplary of such a scientific conundrum; while from a biological perspective the drug is expected to be of good use in multiple diseases, the absence of patents and high costs of clinical research make it less attractive for research by innovative pharmaceutical companies. To investigate a drug with high potential, such as colchicine, one needs to utilize a trial design that is cost-effective. Well-known drugs come with the benefit of widely available knowledge on safety profile. By also using a lean model of trial conduct, operational costs can be reduced. This provides opportunities for funders with limited budgets, such as academic or governmental institutions, to sponsor these clinical trials. Improvements in the efficiency of trial conduct can be made in all parts of the clinical experiment. The high burden of morbidity in our ever-growing population, the rising costs of drug research, and the under-investigated nature of repurposing “old” drugs obligates the scientific community to introduce new, sustainable methods of research. The ultimate goal should be to conduct an investigator-initiated clinical trial that evaluates the repurposing of an established “old” drug with the same scientific fidelity as a pharmaceutically sponsored clinical trial evaluating an innovative “new” drug. This format can function as a model for all future research on drug rediscovery. By applying this approach one ultimatelyuseswhat is available to enable the sustainable.