Upload
brendan-cummings
View
218
Download
0
Tags:
Embed Size (px)
Citation preview
Regulatory Authority Governing Clinical Trials
Anthony J. Minisi, MD
Director, Cardiology Fellowship Program
Regulatory Authority Governing Clinical Trials
Current trials governed by: Good Clinical Practices Good Laboratory Practices Good Manufacturing Practices
Good Clinical Practices
“A standard for the design, conduct, performance, monitoring, auditing, recording, analysis, and reporting of clinical trials that provides assurance that the data and reported results are credible and accurate, and that the rights, integrity, and confidentiality of trial subjects are protected.”
ICH-GCP [1.24]
Good Laboratory Practices
An array of standards and regulations to guide the planning, performance, monitoring, recording, reporting, and archiving of laboratory studies
Designed to assure that data are reliable and can be used
Good Manufacturing Practices
A collection of standards regulating the manufacturing, processing, packaging, and storage of drugs or devices
Designed to assure that these processes are consistent and reproducible
US Food, Drug, and Cosmetic Act--1938
Developed in response to elixir of sulfanilamide tragedy First statutory regulation of cosmetics
and therapeutic devices Required drug manufacturers to provide
scientific proof that new products were safe
Provided specific authority for factory inspections
Nuremburg Code--1947
Developed in response to unethical medical experimentation on human subjects by German scientists during WW II
First set of standards for the review and conduct of human research requiring: Voluntary consent of subjects Justifiable reason for experimentation Protection of participants
US Kefauver-Harris Drug Amendment--1962
Developed in response to thalidomide tragedy requiring: Manufacturers prove efficacy as well as
safety before marketing a new product Informed consent be obtained from all
participants Outlined a process for clinical testing
that still applies today
Declaration of Helsinki--1964
Defined ethical standards for the conduct of human research Research in humans should be based on
results of laboratory and animal experimentation
Research protocols should be reviewed by an independent committee prior to initiation
Risks should not exceed benefits
Declaration of Helsinki--1964
Defined ethical standards for the conduct of human research Informed consent should be obtained in
all research subjects Only medically and/or scientifically
qualified individuals should conduct human research
US National Research Act--1974
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research Defined basic ethical principles for the
conduct of human research Formulated guidelines to ensure that human
research is conducted in accordance with these ethical principles
Required establishment of an IRB at all institutions conducting human research
The Belmont Report--1979
Outlines basic ethical principles developed by the National Commission Respect for persons Beneficence Justice
Addresses distinction between medical practice and research
The Belmont Report--1979
Respect for Persons Individuals should be treated as
“autonomous agents” whose freedom to act on opinions, choices, and considered judgments should be given priority
Individuals with diminished autonomy are entitled to additional protections
The Belmont Report--1979
Beneficence Obligation to conduct research in a
manner that maximizes potential benefits and minimizes possible risks
Justice Selection of subjects should be
equitable and the burdens of research should be borne by those most likely to benefit from the research results
International Conference on Harmonisation (ICH)--1990
Convened to devise a unified standard governing clinical research in the US, European Union, and Japan
Designed to facilitate the mutual acceptance of data generated from clinical trials by regulatory authorities in each jurisdiction
ICH Principles
Studies should be conducted in accordance with the Declaration of Helsinki
Risks and benefits should be carefully scrutinized
Rights, safety, and well-being of study subjects of paramount importance
ICH Principles
Information from preliminary studies of the investigational product should support the study
Studies should be scientifically rigorous and outlined in a formal protocol
All studies should be reviewed and approved by a convened IRB
ICH Principles
A qualified physician should be responsible for all medical care and decisions
All study staff should have appropriate education, training, and experience
All study subjects should freely give informed consent prior to participation
ICH Principles
Study data should be recorded and stored in a manner that allows its accurate reporting, interpretation, and verification
Confidentiality of records should be protected
Investigational products should be manufactured, handled, and stored in accordance with GMP
QA procedures should be in place
Investigator Responsibilities
Hire study staff with appropriate qualifications
Delegate study tasks appropriately
Use investigational product per protocol
Comply with GCP and other regulatory requirements
Participate in data monitoring, auditing, and site inspection
Provide sufficient resources
Provide medical care Conduct study
procedures per protocol Obtain IRB approval Obtain informed consent Maintain records and
submit reports Safety reporting
Investigator Responsibilities
FDA Form 1572—Section 9 “Commitments” I agree to conduct the study in accordance with the
protocol and will only make changes to the protocol after notifying the sponsor, except when necessary to protect the safety, rights, or welfare of subjects
I agree to personally conduct or supervise the described investigation
I agree to inform any study subjects that the drugs are being used for investigational purposes and I will ensure that the requirements related to obtaining informed consent and IRB review and approval are met
FDA Form 1572--Commitments
I agree to report to the sponsor adverse experiences that occur in the course of the study
I have read and understand the information in the Investigator’s Brochure, including the potential risks and side effects of the drug
I agree to ensure that all study staff are informed in meeting the above commitments
I agree to maintain adequate and accurate records and to make those records available for inspection
FDA Form 1572--Commitments
I agree that an IRB will be responsible for the initial and continuing review and approval of the clinical investigation
I agree to promptly report to the IRB all changes in the research activity and all unanticipated problems involving risks to human subjects or others
I will not make any changes in the research without IRB approval, except where necessary to eliminate hazards to human subjects
WARNING: A willfully false statement is a criminal offense USC Title 18, Sec 1001
Sponsor Responsibilities
QA and QC Medical expertise Trial management Selection of
investigators Financial support Compliance with
regulatory issues Protocol generation and
amendment
Confirmation of IRB review and approval
Supply investigational product with appropriate information
Case report forms Safety monitoring Data monitoring Site audit/inspection Report submission