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Theoretical or under-studied Liver enzyme changes community use guides recommend a baseline ALT/AST check and a recheck during long cycles

Looking Ahead What Sponsors Should Prepare For in 2026 Expect stronger focus on: Adaptive and Decentralized Trial Designs (DCTs) Digital endpoints and real-world evidence Inclusive recruitment strategies Clear dose-optimization rationale, especially in oncology At Tigermed EMEA, we continue to invest in innovative operational models, digital ecosystems, and regulatory intelligence to ensure our partners stay ahead of evolving global requirements.

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doi:10.1038/onc.2008.21

PIEDs also gained huge media attention across the Tasman in February 2013, when an Australian Crime Commission report linked organised crime to providing these substances to professional AFL and league players