THE UNIVERSITY OF NEW MEXICO ▪ HEALTH SCIENCES CENTER Clinical and Translational Science Center (CTSC) http://hsc.unm.edu/research/ctsc/ 4/2009 An exemption from the law which otherwise requires that a drug (biologic, device) be approved before it can be transported across state lines The standard for approval is evidence of safety and efficacy The IND exemption is granted for purposes of clinical investigation (research) Affirms a body of knowledge about the manufacturing, pharmacology, and toxicology of the drug to support its use in human testing Requires that the clinical investigation(s) be performed in accordance with Good Clinical Practice (GCP) Provides an additional level of protection through FDA oversight Any of: Article recognized in the U.S. Pharmacopeia, official Homeopathic Pharmacopeia of the US, or official National Formulary, or any supplement Article intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals Any of: Article (other than food) intended to affect the structure or any function of the body of man or other animals Article intended for use as a component of any article specified in clauses above Section 201(g) of the FD&C Act Any experiment in which a drug is administered or dispensed to, or used involving, one or more human subjects. For the purposes of this part, an experiment is any use of a drug except for the use of a marketed drug in the course of medical practice 21 CFR 312.3 In general: An IND is required when an unapproved drug (or biologic) is used in a clinical investigation No IND is needed when an approved product is used in the course of medical practice (even for an indication different from the approved indication) But an IND may be required when an approved products is used in a clinical investigation An IND is needed if: The clinical investigation is intended to be reported to FDA as a well-controlled study in support of a new indication or a significant change in the labeling of the drug The clinical investigation is intended to support a significant change in advertising for the product With the above caveats, clinical investigation of an approved product may be exempt from IND requirements if: The investigation does not involve a route of administration or dosage level or use in a patient population or other factor that significantly increases risks AND The investigation is conducted in accordance with IRB and informed consent requirements FDA has generally allowed the IRB to assess whether risk of an approved product is increased for a given protocol But FDA retains final authority for such determinations It is also important to note that shelf chemicals which bear the same “name” as an approved product are not considered as “lawfully marketed” equivalents of the approved product Approval is specific to dose, formulation, and applicant Drugs (CDER) Biological Products (CBER) (301) 827-0373 Medical Devices (CDRH) Drug Information Branch: (301) 827-4573 IDE Staff: (301) 594-1190 Food Safety (CFSAN): (202) 418-3126 GCP Regulations IND/IDE Regulations: 21 CFR Part 312/812 IRB Regulations: 21 CFR Part 56 Informed Consent Regs: 21 CFR Part 50 All are accessible at: www.fda.gov/oc/gcp IND Forms Available on-line through: (ADD LINK) General Investigation Plan Investigator’s Brochure Protocol(s): Later protocols submitted as amendments Chemistry, manufacturing and control information Animal pharmacology and toxicology information Previous human experience Additional information Dependence and abuse potential Plans for pediatric studies Amount of information required in each section depends on novelty of the drug, extent studied, and known or suspected safety concerns IND sponsors are required to obtain a signed FDA Form “1572” from each clinical investigator, containing: Name and address of CI Name and code number of any protocol(s) Name and address of research facility and any clinical labs Name and address of responsible IRB Names of co-investigators Signed commitment by the investigator Personally conduct or supervise investigations Ensure all persons assisting in conduct of studies are informed of their obligations Ensure informed consent (21 CFR 50) and IRB review, approval , and reporting (21 CFR 56) requirements are met *(Form FDA 1572: #9. Commitments) Conduct studies according to relevant, current protocol Make changes in a protocol only after notifying the sponsor Maintain adequate and accurate records Make records available for inspection Agree to comply with all other requirements in 21 CFR 312 *(Form FDA 1572: #9. Commitments) FDA also has responsibilities under GCP The focus of FDA’s IND Review is on safety for human research subjects and ensuring that the studies will produce useful information to assess safety and efficacy of the test product Medical Officer Consumer Safety Officer/Project Manager Statistician Chemist Pharmacologist Human Biopharmaceutics (Microbiologist) Review team has 30 days to review Focus of review is always on safety/ human subject protection No News = Good News “Clinical Hold” Legal order to delay or stop the study in the U.S. Subjects may not be given the investigational drug May be imposed if: Exposure of subjects to unreasonable risk (includes manufacturing problems) Investigator brochure is misleading, erroneous, or materially incomplete Investigator is not qualified Review Team Monitors New Protocols (IND amendments) Safety reports Annual reports Additional chemistry, animal toxicology, microbiology data Review team is available to consult/meet with sponsors: advise on protocol design, advise on drug development plan Studies performed outside of the U.S. may be conducted with or without IND With an IND: Test article can be exported from the U.S. Study must conform to U.S. IND regulations (including U.S. IRB and informed consent rules) Studies performed outside of the U.S. may be conducted with or without IND Without an IND May be acceptable for FDA review in support of a marketing application Export of the test article from the U.S. must conform to FDA regulations Mechanisms (21 CFR 312.110) FDA authorization of a written request from the person that seeks to export Adequate information; investigational purposes only; can be legally used in the importing country for investigation; specifies quantity/frequency of shipment FDA authorization of a formal request from the government of the receiving country 1996 law also allows drug export for investigational use without prior FDA approval if intended for use in one of 25 countries Australia; Canada; Israel; Japan, New Zealand; Switzerland; European Union Member States (15), Iceland, Norway, and Liechtenstein Center for Drugs ODE I Cardio-Renal (110) 301-594-5300 Center for Drugs ODE II Neuropharm (120) 301-594-2850 Oncology (150) 301-594-2473 Anesthetic, Critical Care & Addiction (170) 301-827-7410 Metabolic/Endocrine (510) 301-827-6430 Pulmonary (570) 301-827-1050 Center for Drugs ODE III Medical Imaging & Radiopharm (160) Center for Drugs ODE IV 301-827-2120 301-827-7510 GI & Coagulation (180) 301-827-7310 Repro/Urologic (580) 301-827-4260 Anti-Infective (520) Antiviral (530) 301-827-2330 Special Pathogens & Immunologic (590) 301-827-2336 Center for Drugs ODE V Derm/Dental (540) 301-827-2021 Anti-Inflammatory, Analgesic & Ophthalmic (550) 301-827-2040 Over-the-Counter (OTC) (560) 301-827-2222 Center for Biologics (CBER) Office of Vaccines Research and Review (301) 827-0654 Office of Blood Research and Review (301) 827-3524 Office of Therapeutics Research and Review (301) 827-5099 OGD Regulatory Support Branch (301) 827-5862 Center for Devices and Radiological Health (CDRH) General, Restorative, and Neurological Devices: (301) 594-1184 Clinical Laboratory Devices: (301) 5943084 Cardiovascular and Respiratory Devices: (301) 443-8320 Center for Devices and Radiological Health (CDRH) Ophthalmic and ENT Devices: (301) 594-2205 Reproductive, Abdominal, and Radiological Devices: (301) 594-5072 Dental, Infection Control, and General Hospital Devices: (301) 443-8879 IND sponsors/researchers are required to report serious non-compliance But anyone can report complaints in FDAregulated clinical trials to FDA FDA’s GCP website (www.fda.gov/oc/gcp) highlights where to report complaints in clinical trials