“…15 Further more, the concept of adaptive trial design is a strategy increasingly being used to make clinical investi - gations more flexible and more efficient, 16 as well as de centrali sed trials. 17 New approaches are also being im plemented for clinical investigation endpoints: While composite end points were routinely used in the past, 12 hierarchical composite endpoints are a new category defined by various disparate endpoints that are combined and are neither equivalent in severity nor assessed on the same scale. 18 Lastly, and most importantly, as for medicinal products, patient centricity is becoming more important.…”