Amended Schedule Y Dr Arun D Bhatt MD (Med) FICP (Ind) Member Faculty of Pharmaceutical Medicine (Royal College UK) President ClinInvent Research India Pvt Ltd 1 Changes in Schedule Wh(Y)? § Schedule Y 1988 relevant to predominantly generic industry § GCP trials since 1995, and arrival of IPR regime in 2005 § Integration of India in global clinical development § Legal support to GCP guidelines § Improvements in quality of clinical trials 2 Amended SCHEDULE Y Regulations and Guidelines for permission for development (preclinical and/or clinical), import and manufacture of New Drugs for Marketing in India 3 Significant Changes § Clinical trials – definition, conduct § Responsibilities of Ethics Committee (EC), Investigator and Sponsor § Formats for critical documents 4 Definition of Clinical Trial “Clinical trial” means a systematic study of new drug(s) in human subject(s) to generate data for discovering and / or verifying the clinical, pharmacological (including pharmacodynamic and pharmacokinetic) and /or adverse effects with the objective of determining safety and / or efficacy of the new drug”. 5 Clinical Trials § § § § § Definition of Phases I – IV Concurrent Phase II-III Central lab and trial samples Compliance to GCP / GLP Flexibility in data requirements for new drugs for life threatening / serious conditions or disease of relevance to India 6 Clinical Trials : Special Studies § Clinical trials required if the indication is relevant to special population e.g. pediatrics, geriatrics, pregnancy § EC for paediatric trials to include members knowledgeable about paediatric, ethical, clinical and psychosocial issues § Mature minors and adolescents to sign an assent form § Other – Post-marketing surveillance, BA/BE 7 Responsibility of Sponsor § Quality assurance to ensure compliance to GCP guidelines of CDSCO § Submission of status report at prescribed periodicity; reasons for premature termination to be communicated § Serious adverse event to be communicated promptly (within 14 calendar days) to DCGI and other investigators 8 Responsibilities of Investigator § Responsible for conduct of trial according to protocol and GCP § Compliance as per undertaking format (Indian version of FDA form 1572) § Medical care for AEs § SAE reporting to § Sponsor within 24 hrs § EC within 7 days § Informed consent 9 Responsibilities of EC § Safeguard rights, safety, wellbeing of subjects § Special care for vulnerable subjects § Ongoing review § Reason’s for revoking approval and information to investigator / regulatory authority 10 Ethics Committee § EC approval of protocol / informed consent form (ICF) and notification to DCGI prior to initiation § Approval for sites without EC by institutional / independent EC § EC approval of protocol amendments and notification to DCGI 11 Appendices § I Data to be submitted along with the application to conduct clinical trials / import / manufacture of new drugs for marketing in the country § I-a Data required to be submitted by an applicant for grant of permission to import and / or manufacture a new drug already approved in the country § II Structure, Contents And Format For Clinical Study Reports § III Animal Toxicology (Non-clinical Toxicity Studies) § IV Animal Pharmacology 12 Appendices § I Data for submission for application to conduct clinical trials / import / manufacture of new drugs for marketing in the country § I-a Data for submission for application for grant of permission to import and / or manufacture a new drug already approved in the country. § II Structure, Contents And Format For Clinical Study Reports § III Animal Toxicology (Non-clinical Toxicity Studies) § IV Animal Pharmacology 13 Appendices § § § § § § V Informed Consent VI Fixed Dose Combinations (FDCs) VII Undertaking by Investigator VIII Ethics Committee IX Stability Testing Of New Drugs X Contents Of The Proposed Protocol For Clinical Trial § XI Data Elements For Reporting Serious Adverse Events Occurring In A Clinical Trial 14 Appendix II Format For Clinical Study Reports 1. 2. 3. 4. 5. 6. 7. Title page Synopsis Statement of Compliance to GCP Abbreviations Table of contents Ethics committee Study team 15 Appendix II Format For Clinical Study Reports 8. Introduction 9. Objective 10. Plan 11. Subjects 12. Efficacy 13. Safety 14. Discussion 15. List of References 16 Appendices for Clinical Study Reports a. b. c. d. e. f. g. h. i. j. k. l. Protocol and amendments Specimen of Case Record Form Investigators’ name(s) with contact addresses, phone, email etc. Patient data listings List of trial participants treated with investigational product Discontinued participants Protocol deviations CRFs of cases involving death and life threatening adverse event cases Publications from the trial Important publications referenced in the study Audit certificate, if available Investigator’s certificate that he/she has read the report and that the report accurately describes the conduct and the results of the study. 17 Appendix V Essential Elements of Informed Consent § § § § § § § § § § § Trial involves research Purpose Trial treatments and randomization Trial procedures Risk Benefit Alternative treatments Compensation / treatment for injury Subject’s responsibilities Experimental aspects Any payment 18 Appendix V Essential Elements of Informed Consent §Confidentiality §New information §Voluntary participation §Person/s to contact Ø for study information Ø rights of subject Ø if study related injury §Reasons for termination §Duration of study §Number of subjects §Any other pertinent information 19 Appendix V Format Of Informed Consent Form §Study Title: Study Number: §Subject’s Initials: Subject’s Name: Date of Birth / Age: § Consent Statements with initials in [ ] §Signature (or Thumb impression) of the Subject / Legally Acceptable Representative: Date: § Signatory’s Name: §Signature of the Investigator: Date: §Study Investigator’s Name: § Signature of the Witness: Date: § Name of the Witness: 20 Appendix VII Undertaking By The Investigator 1. Full name, address and title of the Principal Investigator (or Investigator(s) when there is no Principal Investigator) 2. Name and address of the medical college, hospital or other facility where the clinical trial will be conducted: Education, training & experience that qualify the Investigator for the clinical trial (Attach details including Medical Council registration number, and / or any other statement(s) of qualification(s)) 3. Name and address of all clinical laboratory facilities to be used in the study. 4. Name and address of the Ethics Committee that is responsible for approval and continuing review of the study. 5. Names of the other members of the research team (Co- or subInvestigators) who will be assisting the Investigator in the conduct of the investigation (s). 6. Protocol Title and Study number (if any) of the clinical trial to be conducted by the Investigator 8. Signature with Date 21 Appendix VII.7 Commitments by The Investigator i. ii. iii. iv. v. vi. vii. Study not to begin until EC / DCGI approval Adherence to protocol Personal supervision Ensure requirements of IC and EC review Report of AE to sponsor Understanding of investigator’s brochure Ensure that all associates, colleagues and employees suitably qualified and experienced and aware of their obligations 22 Commitments by Investigator viii.Maintenance of records and availability for audits / sponsor inspection / EC and DCGI ; Cooperation in audits ix. Report to EC promptly about changes and unanticipated problems x. Report all unexpected serious adverse events to the Sponsor in 24 hrs and EC within 7 days xi. Confidentiality of data and patients xii. Compliance with all other obligations of clinical investigators 23 Appendix VIII Ethics Committee § No of members at least 7 members § Chairperson from outside the institution) § Other members a mix of medical/non-medical, scientific and non-scientific persons, including lay public 24 Quorum for EC At least 5 members with the following representations: a) basic medical scientists (preferably one b) pharmacologist). c) clinicians d) legal expert e) social scientist / representative of nongovernmental voluntary agency / philosopher / ethicist / theologian or a similar person f) lay person from the community. 25 Documents for Review by Ethics Committee a. Trial Protocol( including protocol amendments), date version b. Patient Information Sheet and Informed Consent Form (including updates if any) in English and/or vernacular language. c. Investigator’s Brochure, date, version d. Proposed methods for patient accrual including advertisement (s) etc. proposed to be used for the purpose. e. Principal Investigator’s current CV. f. Insurance Policy / Compensation for participation and for serious adverse events occurring during the study participation. g. Investigator’s Agreement with the Sponsor. h. Investigator’s Undertaking (Appendix VII). 26 GCP - A Shared Responsibility Sponsor Investigator Regulatory Authority Ethics Committee 27