An FDA Audit: What the Investigator and Sponsor Need to Know Joseph P. Salewski, Chief Bioresearch Monitoring Branch Center for Biologics Evaluation and Research 301-827-6220 FAX 301-827-6748 At the Beginning Read and understand your obligations under: Form FDA 1571 Form FDA 1572 Protocol Form FDA 1571 Not begin study until 30 days after FDA’s receipt of IND Not to begin or continue studies that are placed on hold An IRB that complies with 21 CFR Part 56 is responsible for the initial and continuing review of the study Form FDA 1571 An agreement to follow all other applicable requirements Name of individuals who are responsible for monitoring the conduct and progress of the study Name of individuals who are responsible for the review and evaluation of safety information Form FDA 1572 Will assure that the study will not start prior to review and approval by the IRB Will conduct and personally supervise the study according to the relevant protocol Will only change the protocol after notifying the sponsor and obtaining IRB approval prior to implementing the change Form FDA 1572 Will seek a properly constituted IRB and obtain initial and on-going review Will obtain informed consent of subjects and submit progress reports to the IRB at intervals not to exceed 1 year Will prepare and maintain adequate and accurate case histories designed to record all pertinent observations for each subject Form FDA 1572 Will prepare and maintain adequate and accurate drug accountability records Will collect and report the data in a way to accurately and completely reflect the observations noted during the study Will report immediately and promptly if adverse events are alarming Form FDA 1572 Will assure that the study will not start prior to review and approval by the IRB Will conduct and personally supervise the study according to the relevant protocol Will only change the protocol after notifying the sponsor and obtaining IRB approval prior to implementing the change Form FDA 1572 Will communicate to sub-investigators information on scientific matters of importance related to the investigation Will ensure that the drug is administered according to the stated dosing regime, including dose, route, rate, and duration, and maintains records documenting such facts Form FDA 1572 Will certify that the drugs are being tested for investigational purposes and will obtain informed consent of subjects or their representative prior to enrollment FDA Preparation Review Compliance Program Review Applicable Regulations Review Prior Inspection Record Review Assignment Package FDA Preparation: Assignment Package Background on: Product development Clinical trial Subject population Protocol Signed 1572 FDA Preparation: Assignment Package Line listings Adverse event(s) Informed Consent Form Number of subjects enrolled Site specific outcome(s) What Is Reviewed Administrative Protocol/Informed consent forms Amendments to protocol/consents Drug accountability records Sponsor/IRB correspondence IRB Approvals/Progress reports/AE reports FD-1572s/Investigator Agreements What Is Reviewed Case Report Forms How data is recorded/corrected Compared to source documents Supporting Files(Source Documentation) Hospital Chart Clinic Chart Research Chart What Is Reviewed Informed Consent Forms Are all required elements included Are additional elements relevant Was it approve by the IRB Were they signed and dated by subjects Does FDA have current version What Is Inspected Interview study staff Test article storage area Data Audit Examine case report forms and compare with source documents Compare sponsor tabulations with source documents and case report forms Critical Issues Is study entry recorded? Is there a subject/diagnosis? Is drug administration documented? Is there study raw data? Did an IRB approve all significant stages? Did each subject provide proper informed consent prior to study entry? Critical Issues Were all screened subjects entered Does amount of test article used coincide with number of subjects treated Was test article properly disposed Was blind maintained Was randomization scheme followed Exit Interview Discuss inspection findings May issue an FD-483 Represents deviations from federal regulations for clinical investigators Verbal response to FD-483 Common Deficiencies at Clinical Sites Protocol non-adherence Failure to report concomitant therapy Inadequate and inaccurate records Failure to report adverse events Inadequate drug accountability IRB problems Informed consent What Goes Wrong Most Often at the Clinical Site Most commonly observed deficiencies in these areas include Failure to follow the protocol Violation of inclusion/exclusion criteria Failure to perform required tests Failure to maintain adequate and accurate records absence of supporting source documents inaccurate or incomplete source documents Tips for a Successful Study: Enhancing Protocol Adherence Protocol design should be as simple as possible, promoting collection of quality data without compromising study objectives Focus on essential data points Explain significance in terms of study objectives (efficacy/safety) or subject protection Avoid ambiguity and vagueness Inclusion/exclusion criteria Adverse experiences Tips for a Successful Study: Enhancing Protocol Adherence Fully understand protocol limits and the importance of strict compliance How much latitude is available for clinical treatment (e.G. Concomitant therapy)? Is it ok to use the hospital or clinic protocol for performing routine procedures (e.G. Chemotherapy)? Is it ok to skip procedures that are not medically necessary (lab tests, PEs, biopsies)? Which protocol procedures can be performed by nonphysician study support staff? Tips for a Successful Study: Enhancing Record Quality Clearly understand what records are to be maintained and how they should be completed Original source data for critical study endpoints Use your site’s indigenous record-keeping system to the maximum extent possible, discuss this with the sponsor up front All records should meet the ALCOA test Tips for a Successful Study: Understand the Elements of Data Quality Attributable Legible Contemporaneous Original Accurate Tips for a Successful Study: Enhancing Record Quality Minimize the need for transcription Don’t throw anything away especially originals Expect the worst FDA will be inspecting the records Tips for A Successful Study: Understand Regulatory Responsibilities Read the following before you sign-on ICH GCP Consolidated Guideline FDA GCP Regulations FDA Information Sheets for IRB’s and Clinical Investigators: http://www.fda.gov/oc/oha/irb/toc.html 21 CFR Part 312 http://www.access.gpo.gov/nara/cfr/index.html Tips for A Successful Study: Communicate With the IRB Protocol changes Continuing review With sponsor and monitors Openly address problems With regulatory authorities Understand expectations Honor reporting obligations Preparing for Site Visit FDA investigator follows compliance program CP 7348.811 (clinical investigator inspections) and 21 CFR 312.60 Have available: All study documents Person knowledgeable about the study A place to review records Access to a photocopier