Artificial intelligence in clinical trials: A comprehensive review of opportunities, challenges, and future directions

Background

Clinical trials face unprecedented challenges including recruitment delays affecting 80% of studies, escalating costs exceeding $200 billion annually in pharmaceutical R&D, success rates below 12%, and data quality issues affecting 50% of datasets. Artificial intelligence (AI) offers transformative solutions to address these systemic inefficiencies across the clinical trial lifecycle.

Objective

To evaluate the current state, future potential, and implementation challenges of AI technologies in clinical trials, providing evidence-based guidance for responsible AI integration while maintaining patient safety and scientific integrity.

Method

Comprehensive narrative review following established guidelines for literature synthesis. Systematic search of PubMed, Embase, IEEE Xplore, and Google Scholar databases from January 2015 to December 2024. Data extraction and narrative synthesis organized thematically according to clinical trial lifecycle stages.

Results

Analysis of relevant studies demonstrated substantial AI benefits: patient recruitment tools improved enrollment rates by 65%, predictive analytics models achieved 85% accuracy in forecasting trial outcomes, and AI integration accelerated trial timelines by 30–50% while reducing costs by up to 40%. Digital biomarkers enabled continuous monitoring with 90% sensitivity for adverse event detection. However, significant implementation barriers emerged, including data interoperability challenges, regulatory uncertainty, algorithmic bias concerns, and limited stakeholder trust.

Conclusion

AI represents a transformative force in clinical research with proven capabilities to enhance efficiency, reduce costs, and improve patient outcomes. Realizing this potential requires addressing technical infrastructure limitations, developing explainable AI systems, establishing comprehensive regulatory frameworks, and fostering collaborative efforts between technology developers, clinical researchers, and regulatory agencies to ensure responsible implementation.