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Clinical Research and Development in the Pharmaceutical, Device and
Biotechnology Industry
Mr. Suhas Dabhade
Objectives• To understand the drug development
process• To understand the phases and components
of the clinical research process• To appreciate the history behind the
regulations in the clinical development process
• To understand the current regulations involved with the clinical research process
Healthcare Industry Players
PharmaceuticalIndustry
Patient
Care
Physician
Hospital
InsuranceCompany
Drug Discovery Process
CompoundSelection
Proof of ConceptOutcome2 – 4 Years
4 – 7 Years
Marketing Introduction
*Key variable guiding development time
Target SelectionTarget Validation
& lead optimization
Proof of ConceptClinical Trials
Pre-clinicalPhase
Clinical Phases I, IIIII, IIIB*
DrugRegistration
FDA Approval
Marketing (Phase IV
Clinical Trials)
(5,000 – 10,000) (250)
(5)(1)
Clinical Trials: What Are They?
• An organized research study designed to investigate new methods of preventing, detecting, diagnosing, or treating an illness or disease (such as cancer).
The Players in Clinical Research
SponsorInvestigator
SitePatient
CRO
SMO
IRB
RMO
Clinical Trials Process andAssociated Regulatory Process
Tasks Involved to Develop/Support Clinical Trials
• Protocol development• Volunteer recruitment• Clinical conduct (management)• Monitoring• Data management• Clinical statistics• Medical writing• Quality assurance
What is Involved in a Clinical Trial?
Clinical Trials Benefits & RisksPossible Benefits of TrialsPossible Benefits of Trials Possible Risks of TrialsPossible Risks of Trials
• Having access to potentially more Having access to potentially more effective therapies than those currently effective therapies than those currently availableavailable
• Receiving quality medical care from Receiving quality medical care from leading physiciansleading physicians
• Being closely monitored for possible Being closely monitored for possible negative effectsnegative effects
• Sometimes receiving treatment at a Sometimes receiving treatment at a reduced rate or free of chargereduced rate or free of charge
• Helping to further new research that may Helping to further new research that may result in significant medical advancesresult in significant medical advances
• For patients in cancer therapy trials For patients in cancer therapy trials assigned to control groups, they still assigned to control groups, they still receive the top standard therapy available receive the top standard therapy available todaytoday
• Patients may not receive the therapy Patients may not receive the therapy under investigation (may receive a under investigation (may receive a placebo – inactive pill – instead)placebo – inactive pill – instead)
• The new therapy may not be more The new therapy may not be more effective than the standard, thoroughly effective than the standard, thoroughly tested therapytested therapy
• In Phase I trails, not knowing the safety In Phase I trails, not knowing the safety consequences of the new therapy (risk is consequences of the new therapy (risk is less in Phase III trials)less in Phase III trials)
• New therapy may have unexpected, New therapy may have unexpected, possibly severe side effects or may be possibly severe side effects or may be less effective than standard of careless effective than standard of care
• Insurance companies may not cover all Insurance companies may not cover all costs of clinical trialscosts of clinical trials
Clinical Trial Standard Language
ProtocolProtocol The planned course of action for the clinical trial. The protocol is The planned course of action for the clinical trial. The protocol is established prior to the start of the trial and states the number of established prior to the start of the trial and states the number of participants, eligibility requirements, agents that will be used, participants, eligibility requirements, agents that will be used, dosages, duration, how data is collected, etc.dosages, duration, how data is collected, etc.
InvestigatorInvestigator A researcher in a clinical trial.A researcher in a clinical trial.
SponsorSponsor The part of parties responsible for funding the clinical trial.The part of parties responsible for funding the clinical trial.
Institutional Institutional Review Board Review Board (IRB)(IRB)
An independent board of scientists, physicians, and nurses who An independent board of scientists, physicians, and nurses who review the clinical trial protocol to ensure patient safety.review the clinical trial protocol to ensure patient safety.
Informed Informed ConsentConsent
A patient’s decision to participate in the clinical trial after being A patient’s decision to participate in the clinical trial after being informed of the potential benefits and risks of participation. informed of the potential benefits and risks of participation. Participants may withdraw their consent at any time and leave the Participants may withdraw their consent at any time and leave the trial.trial.
Double blindDouble blind Term used to describe a clinical trial in which neither the patient nor Term used to describe a clinical trial in which neither the patient nor the researcher knows which agents are being administered to the researcher knows which agents are being administered to which patients. This helps prevent bias.which patients. This helps prevent bias.
Invention groupInvention group The group of participants receiving the new preventive or treatment The group of participants receiving the new preventive or treatment agent that is being evaluated in the clinical trial.agent that is being evaluated in the clinical trial.
Clinical Trial Standard Language, continued
Control groupControl group The group of participants receiving a standard treatment or placebo The group of participants receiving a standard treatment or placebo (see below) that is being compared to the new agent in the clinical (see below) that is being compared to the new agent in the clinical trial.trial.
RandomizationRandomization Assigning participants by chance to either the intervention group or Assigning participants by chance to either the intervention group or the control group. Randomization is often done with a computer.the control group. Randomization is often done with a computer.
PlaceboPlacebo An inactive substance that may be given to participant sin a clinical An inactive substance that may be given to participant sin a clinical trial. Sometimes called a sugar pill.trial. Sometimes called a sugar pill.
Fol low-upFollow-up Monitoring of participants for a specified time after the clinical trial Monitoring of participants for a specified time after the clinical trial is completed.is completed.
Prospective Prospective studystudy
A study of a group of patients that is conducted as they are A study of a group of patients that is conducted as they are undergoing a treatment or preventive measure.undergoing a treatment or preventive measure.
Retrospective Retrospective studystudy
A study of a group of patients after they have already undergone a A study of a group of patients after they have already undergone a treatment or preventive measure. “Recall bias,” unintentional treatment or preventive measure. “Recall bias,” unintentional inaccurate reporting of certain information, can sometimes inaccurate reporting of certain information, can sometimes influence a retrospective study.influence a retrospective study.
History Behind Regulations of Clinical Trials
• Regulations often result in response to abuse of human research subjects and concerns about the validity of data and conclusions from clinical trials.
• The primary vehicles for human subject protection are IRBs and informed consent.
• The Declaration of Helsinki and the Belmont Report are critical documents for the protection of human subjects in research.
• The FDA, by means of PDUFA and FDAMA, has made significant gains in speeding the process of making new drugs available for patients who need them.
• Current problems with clinical trials and trial oversight may well lead to increased regulation.
Regulations for Clinical Trials• The FDA regulations pertaining to clinical trials
are found in 21 CFR Parts 11, 50, 54, 56, 312 and 314.
• The ICH Guidelines for Good Clinical Practice should be followed in clinical trials.
• The FDA publishes many guidelines and information sheets pertaining to the appropriate conduct of clinical trials.
• Good clinical practices are the ethical and clinical standard for designing, conducting, analyzing, monitoring and reporting on clinical trials.
Health Outcomes
• Health outcomes studies examine the clinical, economic and quality-of-
life outcomes of pharmacotherapy.
• Health outcomes research expands upon the FDA-mandated efficacy
and safety endpoints to give a fuller picture of the outcomes
experienced by a patient. It is a relatively new discipline that combines
a number of fields of study, including medicine, epidemiology, statistics,
economics and psychometrics.
• Early in development, companies may be interested in documenting the
epidemiology and cost burden of a particular disease state.
Health Outcomes
• As a compound moves through to Phase II and II, behavioral, humanistic
and economic endpoints may be incorporated into registration trials.
• Concurrently, economic models may be created to quantify the economic
benefit of the new therapy.
• Once a compound is launched, a variety of research services may be
utilized, including registries, Phase IIIb/IV comparative studies and claims
analyses.
From Lab
to Market
New Drug Development is...
… and what will the Marketing outcome be?
Expensive 500 Million US $
Cumbersome 1 out of 10,000 NCE becomes a marketable drug
Time consuming 12 years
1. Disease Targeting
CNS
Infectious Diseases
Oncology
Metabolic Diseases
Ophthalmology
Urology
Women’s Health
Inflammation
2. Lead Compound Selection
15-35 M US$15-35 M US$
Random Screening
Combinatorial Chemistry & High Throughput Screening
Targeted Synthesis
Drug Modeling
Human Genome Mapping
3. Discovery Testing
20-40 M US$20-40 M US$
Does it work? - Animal testing
Is it long or short acting?
How does it work? - Specificity of action
Is oral administration possible?
4. Chemical Synthesis Scale-Up
80-110 M US$80-110 M US$
Large-scale manufacturing / bulk and formulations
Safety of environment and people involved in manufacturing
Manufacturing Patent issues
Financial considerations (new investments in manufacturing facilities
vs profit projections)
5. Stability and Formulation Development
40-60 M US$40-60 M US$
Is chemically stable on exposure to light, moisture, temperature etc.
Can be formulated into small tablets and capsules
Is dispersible
6. Safety Testing: Animal Studies
65-90 M US$65-90 M US$
Pharmacokinetics and Pharmacodynamics
Side effects and toxicities
Correct early absorption and toxicity problems
Submit an Investigational New Drug (IND) application to FDA
Steps 1 to 6
7. Human Trials
Phase I
Phase II
Phase III
Not Successful
Not Successful
Approval
Successful
Successful
Successful
Not Successful
Regulations for Research in Humans
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 the trial subjects are protected.
[Data will be rejected if GCP is not followed]
7.1 Phase I Studies
10-20 M US$10-20 M US$
Study population 30-50 normal, healthy human volunteers
Aim to ascertain safety to identify range of doses tolerated to look at
absorptiondistributionmetabolism andexcretion
Does the drug really work, is it safe, how does it behave in humans ?
8-10 testsScope
7.2 Phase II studies
20-40 M US$20-40 M US$
Study population 200-300 patients suffering from target illness
Design • Placebo controlled• Randomised• Double blind
At select medical research centers
Is the drug really efficacious in patients ?
Two yearsGo / No Go decision
Scope
Aim to have a first look at efficacy
7.3 Phase III studies
100-150 M US$100-150 M US$
Study population 2000-3000 patients
Design • Randomised• Controlled (Placebo or control drug)• Double blind
At several major hospitals, pivotal studies are often multinational
May take up to 3 yearsScope
Aim To establish Safety and efficacy in a large patient group
8. New Drug Application
Answer not necessarily ‘yes’ or ‘no’
Approval: Indications, Limitations, Phase IV studies, Chemical testing
NDA contains up to 120,000 pages of data(Electronic submissions in USA)
FDA takes up to 12 months to review
New Drug Development - New Drug Development - SummarySummary
Human Trials
Animal Studies (Safety Testing)
Stability & Formulation Development
Chemical Synthesis Scale-up
Discovery Testing
Lead Compound Selection
Market
Laboratory
12345789101112
years
10,000
1
NCE’s $$$
0
500 M
Drug Discovery and Development Process
Target Identification
LeadIdentification
Lead Optimization
PreclinicalStudies
ClinicalTrials
ClinicalTrials
PreclinicalStudies
RelevantScience
Large ScaleTrials
Expensive, Time consuming, numerous bottlenecks
Economical, Time sparing, least bottlenecks
REVERSE PHARMACOLOGY
Drug toMarket
Drug toMarket
Patent Protection
Only 1 out of every 12 marketed drugs recoups the investment
Prolong patents by developingnew formulations and/or new indications
Patent granted for 20 years from application
12 years to develop the drug
8 years to sell it exclusively
Invest 500 Million US$ Recoup the investment
Conducting a Clinical Trial
According to GCP
Good Clinical Practicesafeguards the interest of
Patient Investigator Sponsor Society
Definition of Responsibilities of Investigators, Sponsors, Ethics Committees
Protection of trial subjects (Informed consent, Safety reporting) Data Quality / Study documents / record keeping Quality Assurance /Audit
Ensuring that only quality clinical trials are performed Provide reliable support for regulatory approval of new drugs
The Parties in a Clinical Trial
Sponsor
Investigator Patient
Regulatory Authorities
Ethics Committee
ClinicalTrial
Investigator’s Responsibilities
Follow the protocol in all aspects Record data accurately Take informed consent from all trial
subjects Fully inform the patient of all aspects of the study Answer questions Obtain signed and dated consent Provide the patient with a copy Provide updates to patient (if applicable)
Account for investigational products Report safety issues File and archive properly
Sponsor’s Responsibilities
• To investigator - selection, IB, monitoring, medical expertise, investigational products, new information, insurance/indemnification
• To patients - insurance/compensation, direct access tomedical records
• To authorities - clinical trial permission, safety reporting
• In the company - SOPs, quality control and quality assurancesystems, resources for trial design,monitoring, data handling, statistical analysis, reporting and record retention
Stages of a clinical trial
Planning & Resourcing
Recruiting & keeping patients
Documenting & generating data
Analyzing & publishing results
Archiving
Get a Clinical Study Going
Identify the Resources
PersonnelPatients
Equipment
TimeSpace
Money Form and train the study team
Identify potential patients
Set up procedures
Organize the Resources
Patients - How to Find, Recruit & Keep Them
Medical Records / Databases
Colleagues
Primary Care Physicians
Motivation
Patient Information
Attention
Reimbursement
Information
Convenience
Education
Support
Data in a Clinical TrialAll data generated throughout the clinical trial must be
documented clearly and accurately
Other
Documentation
Essential
Permit evaluation of trial conduct & the quality of data
Demonstrate compliance with standards.
Trial File, CRF, IC
Source
Original documents, data and records, clinical and office charts, Lab notes, diaries, x-rays, records
Patient’s Hospital File
“Good Documentation Practice”
“If it is not written,
it does not exist!”
Dr. Lisook (FDA)Div. of Scientific Investigations
Office of Compliance
Document ! Document ! Document !
The Importance of DataAccurate data are the key to a successful trial !
measured
Data must be accurately
RecordedEntered in CRF verified
archived publishedanalyzed
The Monitor - Curse or Blessing?
They should be regarded as a resource They will provide advice and practical support
Checking the data is essential to ensure quality of data and adherence to protocol
Monitors are there to help: Ask for the help you need and you
will get it!
Monitors need some of your time, space and attention
Together . . .
… we wil l make it!
The way may be cumbersome, but