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MODULE B:. Overview of the Clinical Trial & Protocol Jane Fendl March 31, 2010. Phases of the Clinical Trial . Phase 1 – “human pharmacology trials” First time tested in man Healthy normal volunteers

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Module b

MODULE B:

Overview of the Clinical Trial & Protocol

Jane Fendl

March 31, 2010

Version: Final 31- Mar-2010


Phases of the clinical trial

Phases of the Clinical Trial

Phase 1 – “human pharmacology trials”

  • First time tested in man

  • Healthy normal volunteers

  • To gather information about the drug’s safety and the effect of the drug on the human body

  • Pharmacokinetic evaluation – how the drug is absorbed the way it is absorbed, distributed in the body, metabolized and excreted

  • Dose is progressively increased until a tolerable toxicity level is achieved

  • Measures AEs

  • Determine maximum tolerable dose

    21 CFR 312.21

Version: Final 31- Mar-2010


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Phase 2 – “therapeutic exploratory trials”

  • Volunteers with targeted disease state

  • Testing for safety and efficacy

  • To determine the potential effectiveness

  • Identify common adverse events

  • Ensure the drug has suitable risk to benefit ratio

  • To determine the optimal effective dose

  • To prove efficacy by evaluating an objective or comparative measurement such as:

    • Positive change in the disease process

    • Improvement in quality of life

    • Reduction in mortality

    • Improvement in symptomatology

      21 CFR 312.21

Version: Final 31- Mar-2010


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Phase 3a – “therapeutic confirmatory trials”

To evaluate safety and efficacy in a large number of

subjects

Emphasis on assessing the tolerance to the drug

Additional gathering of information about drug

interactions and addiction potential

Potential effectiveness of the product

Identify common adverse events within a

heterogeneous population

Expanded number of subjects with specific problem

or indication

21 CFR 312.21

Version: Final 31- Mar-2010


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  • Phase 3b – “therapeutic use trials”

  • Further safety and efficacy as well as new indications

  • More subjects

  • Longer period of time

  • Tested for long-term effects

  • Understand how the product is prescribed

  • May include thousands of subjects

  • Subjects with different stratifying characteristics

  • such as age, race & concomitant medications

  • Gather information such as:

    • Response to product

    • Safety in general population

    • Safety for subjects with certain characteristics

    • Safety in association with other drug

    • Affect on Subject’s quality of life

    • 21 CFR 312.21

Version: Final 31- Mar-2010


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  • Phase 4 – “post-marketing trials”

  • May be at the request of regulatory authorities as

  • a condition of approval

  • Sponsor may wish to compare the drug with other

  • active agents for:

    • Marketing reasons

    • Cost-benefit ratio for insurance/managed health care

    • purposes

  • Investigate new indications or formulations

  • Interested in surveying safety data in large

  • populations

Version: Final 31- Mar-2010


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Version: Final 31- Mar-2010


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What is a protocol?

  • Recipe or overall master plan for the trial

  • Guide or road map for the Investigator, site

  • staff, and the IRB to follow

What is the purpose?

  • Provides consistency of processes across all

  • sites involved

  • Helps ensure consistent collection of data

Version: Final 31- Mar-2010


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What questions does it answer?

  • What is the trial purpose?

  • What will be proven?

  • How and why the trial is being conducted?

  • How many subjects?

  • Who will be the subjects?

  • What is the qualifying criteria?

  • How long will it last?

  • ICH GCP 1.44

Version: Final 31- Mar-2010


What should be included in the protocol

What should be included in the protocol?

  • General information

  • Background information

  • Trial objectives and purpose

  • Trial design

  • Selection and withdrawal of subjects

  • Treatment of subjects

  • Assessment of efficacy

  • Assessment of safety

  • Statistics

  • Direct access to source data and documents

  • Ethics

  • Data handling and record keeping

  • Financing and insurance

  • Publication policy

  • Supplements

    ICH GCP 6.0

What is not included in the protocol can be referenced in the Investigators Brochure

Version: Final 31- Mar-2010


Sections of the protocol

Sections of the Protocol

  • General Information

  • Background Information

  • Trial Objectives & Purpose

  • Trial Design

  • Selection and Withdrawal of Subjects

  • Inclusion Criteria

  • Exclusion Criteria

  • Withdrawal Criteria

  • Treatment

  • Efficacy

  • Safety

  • Analysis & Statistics

  • Direct Access to Source Data & Documents

  • Ethics

  • Data Handling & Record Keeping

  • Financing & Insurance

  • Publication Policy

  • Appendices/Supplements

  • Signature & Agreement

Version: Final 31- Mar-2010


General information

General Information

Protocol title, number & date

Sponsor information

Name & title of the person authorized to sign the

protocol & amendments

Name, title, address & telephone numbers of

Sponsor’s medical experts

Version: Final 31- Mar-2010


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Background Information

  • Describe the investigational product

  • Mechanism of Action

  • Summaries of findings from previous studies

  • Risks and benefits of investigational product

  • Population to be studied

  • Description of the justification for the route of

  • administration, dosage, & regimen

Trial Objectives & Purpose

  • Objectives should describe what the trial is

  • trying to prove

  • Objectives should correlate with the trial

  • design and what data will measure

Version: Final 31- Mar-2010


Trial design

Trial Design

  • Primary endpoints – focus of the trial

  • Secondary endpoints – any other items that the trial may measure

  • Description of design and measures to minimize bias

  • Randomization – how maintained & procedures for breaking the code

  • Trial treatments & dose, the form, regimen, packaging & labeling

  • Length of subject participation, description of sequence & duration of all trial periods (visits)

  • Drug accountability

  • Rules for discontinuing the investigational product and withdrawing the subject

  • Criteria for stopping parts of the trial or ending the trial

  • What is considered source data

Version: Final 31- Mar-2010


Inclusion criteria

Statements which describe the qualification or conditions that a subject must meet to participate in the trial

Inclusion Criteria

Specific conditions that disqualify a subject from participating

Exclusion Criteria

Version: Final 31- Mar-2010


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Withdrawal Criteria

  • When & how the investigational product must be

  • stopped & subjects withdrawn from the trial

    • Product may be tapered

  • The conditions under which the Investigator

  • should terminate a subject

    • Missed visits

  • How the data is to be collected

    • Have the subject return, complete which visit

  • The type of information that is to be collected

    • Reason discontinued

  • Information regarding replacement of subjects

    • Number of subjects needed to complete

  • Version: Final 31- Mar-2010


    Treatment

    Treatment

    Name of all products

    Dose – milligrams, grams, ounces, etc

    Dosing schedule – BID, TID, QID, PRN

    Route or mode of administration – IV, oral, inhaler

    Treatment periods – length of time on product

    Medications or treatments permitted and those that

    are not permitted – treatments known to interfere

    with the action of the product

    Procedures for monitoring compliance – site staff is

    to count used and unused product to determine if

    subject took the product as directed

    Version: Final 31- Mar-2010


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    Efficacy

    • Methods and measures to determine if the investigational product is effective

      Example - Blood pressure decreases as predicted

    • How the efficacy measures will be recorded and analyzed

    Safety

    • How and when to measure for the safety of the investigational product

    • How to capture, record and report adverse events, serious adverse events and concurrent illness

    • Type and duration of follow-up for subjects who experience AEs or SAEs

    Version: Final 31- Mar-2010


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    Analysis & Statistics

    • Statistical methods used to analyze the information

    • that is gathered from the data

    • Number of subjects to be enrolled

    • If multi-center study may include # of subjects/site

    • Justification of sample size

    • Statistical level of significance

    • Criteria for termination of the trial

    • Procedures for accounting for missing, unused &

    • false data

    • Procedures for reporting deviations from the original SAP

    • Selection of subject to included in the analyses

    • Any planned interim analyses

    Version: Final 31- Mar-2010


    Source documents documents

    Source Documents & Documents

    Ethics

    Describes any ethical considerations relating to the trial

    Specifies that the Sponsor or delegates should be permitted access to all documents relating to the trial for the purpose of monitoring, auditing, IRB review and regulatory inspections

    Version: Final 31- Mar-2010


    Data handling record keeping

    Data Handling & Record Keeping

    Methods used to collect, monitor, and maintain

    source documents and files

    • Investigators’ responsibility for ensuring confidentiality and rules for disclosure of data

    • How long data and records should be retained

    • Rules for the accessibility of trial information for Sponsor, IRB or inspectors

    • How data is maintained in the source documents and Case Report Forms

    Version: Final 31- Mar-2010


    Publication policy

    Publication Policy

    Appendices/Supplements

    Includes documents that are referenced in the protocol.

    Signature & Agreement

    Investigator signs and dates the “Signature Page” or “Investigator’s Statement” signifying he/she will conduct the trial according to the protocol and will not deviate from the protocol.

    May be included – deals with the requirement of Sponsor permission and approval to disclosure data collected by the site and Investigator.

    Version: Final 31- Mar-2010


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