CFTCC
2015 Learning about the IND/IDE Process and Reimbursements for New Drugs and Devices
Erin O'Reilly, PhD, RAC
Assoc. Director, Regulatory Affairs
Translational Medicine Institute
Introduces the basics of filing an Investigational New Drug (IND) Application with the FDA
CFTCC
2015 Learning about the IND/IDE Process and Reimbursements for New Drugs and Devices
Erin O'Reilly, PhD, RAC
Assoc. Director, Regulatory Affairs
Translational Medicine Institute
Introduces the basics of filing an Investigational New Drug (IND) Application with the FDA
Investigational new drug application must be submitted after discovering a new drug and before beginning of clinical trials. Here given a brief note on the topic.The topics included are types of IND, criteria for application, Information in IND application, resources for IND application, laws.regulations, policies and procedures, IND forms and instructions, IND content requirements and review of IND
IND (Investigational New Drug) industrial perspectiveAYESHA NAZEER
Describing the Industry's/sponsor's/drug manufacturers' perspective of the Investigational New Drug Application (IND) program based on the survey conducted by the Office Of Inspector General (OIG).
The NDA application is the vehicle through which drug sponsors, such as biotech and pharmaceutical companies, formally propose that the FDA approve a new pharmaceutical for sale and marketing
INTRODUCTION
IND TYPES
IND CATEGORIES
THE IND APPLICATION MUST CONTAIN INFORMATION IN THREE BROAD AREA
THE REGULATORY ENVIRONMENT AND FDA ROLE
LIST OF IMPORTANT SECTIONS
GENERAL PRINCIPLES
INVESTIGATIONAL NEW DRUG GUIDANCE AND PLANNING
FDA FORM 1571
FDA FORM 1572
FDA FORM 3674
SUBMITTING AN IND
FOLLOWING RECEIPT OF IND BY THE FDA
RESPONDING TO A CLINICAL HOLD
REGULATORY REQUIREMENTS FOR AN IND DURING STUDY AND AT COMPLETION
PROTOCOL AMENDMENTS (21 CFR 312.30)
INFORMATION AMENDMENTS (21 CFR 312.31)
SAFETY REPORTS (21 CFR 312.32)
ANNUAL REPORTS (21 CFR 312.33)
WITHDRAWAL, TERMINATION, AND INACTIVATION
MONITORING RESPONSIBILITIES FOR SPONSOR-INVESTIGATORS
Investigational new drug application must be submitted after discovering a new drug and before beginning of clinical trials. Here given a brief note on the topic.The topics included are types of IND, criteria for application, Information in IND application, resources for IND application, laws.regulations, policies and procedures, IND forms and instructions, IND content requirements and review of IND
IND (Investigational New Drug) industrial perspectiveAYESHA NAZEER
Describing the Industry's/sponsor's/drug manufacturers' perspective of the Investigational New Drug Application (IND) program based on the survey conducted by the Office Of Inspector General (OIG).
The NDA application is the vehicle through which drug sponsors, such as biotech and pharmaceutical companies, formally propose that the FDA approve a new pharmaceutical for sale and marketing
INTRODUCTION
IND TYPES
IND CATEGORIES
THE IND APPLICATION MUST CONTAIN INFORMATION IN THREE BROAD AREA
THE REGULATORY ENVIRONMENT AND FDA ROLE
LIST OF IMPORTANT SECTIONS
GENERAL PRINCIPLES
INVESTIGATIONAL NEW DRUG GUIDANCE AND PLANNING
FDA FORM 1571
FDA FORM 1572
FDA FORM 3674
SUBMITTING AN IND
FOLLOWING RECEIPT OF IND BY THE FDA
RESPONDING TO A CLINICAL HOLD
REGULATORY REQUIREMENTS FOR AN IND DURING STUDY AND AT COMPLETION
PROTOCOL AMENDMENTS (21 CFR 312.30)
INFORMATION AMENDMENTS (21 CFR 312.31)
SAFETY REPORTS (21 CFR 312.32)
ANNUAL REPORTS (21 CFR 312.33)
WITHDRAWAL, TERMINATION, AND INACTIVATION
MONITORING RESPONSIBILITIES FOR SPONSOR-INVESTIGATORS
A regulatory strategy is critical to the commercialization of biomedical technologies. In particular, technologies such as new drugs and medical devices have more regulatory needs, and the strategy should be considered simultaneous to a commercialization pathway.
This Slide explains US-FDA requirements for IND. It will answer; What is an IND ?What are the IND Phases ?What is the IND Content?When FDA Terminates an IND ?Are cGMP Required for IND ?What Studies are exempt from IND?
Nutritional Labeling And Clinical Investigation And Evaluation Of Medical Dev...gauravpatil327512
Regulatory Aspects of Food and Nutraceuticals : "Nutritional Labeling And Clinical Investigation And Evaluation Of Medical Devices And IVDs Recommended Dietary Allowances in Europe "
Regulatory Compliance in Clinical Research: Navigating the FDA and Other Agen...ClinosolIndia
Regulatory compliance is a crucial aspect of conducting clinical research, ensuring that studies meet the requirements and standards set by regulatory agencies such as the U.S. Food and Drug Administration (FDA) and other relevant bodies. Here are some key points to navigate regulatory compliance in clinical research:
Familiarize Yourself with Applicable Regulations: Stay updated on the relevant regulations and guidelines that govern clinical research, including FDA regulations, International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines, and local regulatory requirements. Understand the specific regulations that apply to your study, such as those related to investigational new drugs (IND) or investigational device exemptions (IDE).
Obtain Institutional Review Board (IRB) Approval: IRBs play a crucial role in ensuring the protection of human subjects in research. Before initiating a clinical trial, obtain IRB approval by submitting a detailed study protocol, informed consent documents, and other required materials. IRBs review the study's scientific merit, ethical considerations, and compliance with regulations.
Investigational New Drug (IND) or Investigational Device Exemption (IDE) Application: If your clinical research involves the use of investigational drugs or devices, you may need to submit an IND or IDE application to the FDA. These applications provide detailed information on the investigational product, its safety, efficacy, manufacturing processes, and proposed study design.
Good Clinical Practice (GCP) Guidelines: GCP guidelines provide a framework for the conduct of clinical research to ensure data integrity and participant protection. Adhere to GCP principles, including informed consent, protocol adherence, accurate documentation, and appropriate monitoring and reporting of adverse events.
Adverse Event Reporting: Monitor and report adverse events occurring during the study promptly. Follow the FDA's requirements for safety reporting, including expedited reporting of serious and unexpected adverse events. Maintain accurate and complete records of adverse events and their follow-up actions.
Data Integrity and Documentation: Ensure the integrity, accuracy, and traceability of study data. Implement robust data management practices, including proper documentation, source data verification, and secure storage of study documents. Follow regulatory requirements for data retention, including archiving study records for the required period.
Audits and Inspections: Be prepared for audits and inspections by regulatory agencies. Maintain organized and easily accessible study documentation, including study protocols, informed consent forms, case report forms, and correspondence with IRBs and regulatory agencies. Cooperate with auditors or inspectors and address any identified deficiencies or findings promptly.
CDSCO Biologicals - Rules, Regulations, Guidelines and Standards for Regulato...Mohamed Fazil M
M. Pharmacy - Pharmaceutical Regulatory Affairs (MRA)
1st Semester - Regulations and Legislation for Biologics (MRA 104T)
Unit 2 - Rules, Regulations, Guidelines and Standards for Regulatory Filing of Biologicals
CDSCO Biologicals
Discovery of Drug and Introduction to Clinical Trial_Katalyst HLSKatalyst HLS
Introduction to Discovery of Drug and Introduction to Clinical Trials in Pharmaceuticals, Bio-Pharmaceuticals, Medical Devices, Cosmeceuticals and Foods.
Similar to CFTCC Workshop: IND Exemption, Preparation, and Maintenance (20)
CFTCC
2015 Learning about the IND/IDE Process and Reimbursements for New Drugs and Devices
Erika Segear Johnson, PhD, RAC
Regulatory Affairs Scientist
Duke Translational Medicine Institute
Introduces the basics of filing an Investigational Device Exeption (IDE) Application with the FDA
Taste Defense: Mouthwash and Taste Modification Device for Patients on Chemot...CFTCC
2014 CFTCC Annual Symposium Poster Session
Taste Defense, 2013 Create to Innovate for Cancer Care Hackathon First Place Winners
Nicholas Woolf MS-II/PHDI
Andrew Brown MD MBA
Ian Butterworth MSc
Osasere Evbuomwan PhD
http://www.bu.edu/cftcc/multi-media/2014cftccsymposiummedia/
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. Templates and Guidance
Best Practices Templates/Instructions
http://tiny.cc/d7bpt
Recorded Webcasts
http://tinyurl.com/8n34gr4
2
3. Part 1: IND Exemptions
Definitions
Studies Using FDA Approved Drugs
FDA Regulations & Guidance on IND
Exemptions
FDA Review Process
Special Cases
Case Scenarios
3
4. What is a Drug?
A drug is anything that meets the definition of a
drug per the FD&C Act (201(g)(1)). . .
“. . .articles intended for use in the diagnosis, cure,
mitigation, treatment, or prevention of disease in man or
other animals. . .”
“…a substance (other than food*) intended to affect the
structure or any function of the body”**
* Note: “… food used as such (only to provide taste, aroma or
nutritive value), or to affect the structure or function of the body,
other than by providing nutrition, is not a drug”
** Note: “…compounds administered to blunt or provoke a
physiological response or to study the mechanism of action or
metabolism of a drug.”
4
5. What is an Investigational Drug?
A drug that is not approved to be marketed in
the US
An approved drug that is not used according to
its approved label
Note: Practice of medicine allows a physician to
use any approved drug without prior regulatory
approval
5
6. IND Exemption Assessment
Is the drug investigational?
It is not approved in the US
It is not used according to the label (off-label)
If the drug is investigational and is used in a
clinical study, it is subject to 21 CFR 312
Note: Off-label use is common and allowed in the
practice of medicine and often may be the standard of
care
6
7. Test Article
Approved in US for
marketing as a drug
Not approved in US for
marketing as a drug
Investigational Drug Commercially Available Drug
Requires an IND Might Require an IND
On-label Off-label
IND not
required*
It depends!
* Assuming no marketing application planned
8. IND Exemption Assessment
21 CFR Part 312.2(b) – IND Exemptions
FDA guidance document: “IND Exemptions for
Studies of Lawfully Marketed Drug or Biologic
Products for the Treatment of Cancer”
http://tinyurl.com/nqkbkd
FDA guidance document: “Investigational New
Drug Applications (INDs) - Determining Whether
Human Research Studies Can Be Conducted
Without an IND”
http://tinyurl.com/2g7z7kv
8
9. IND Exemption Assessment
21 CFR 312.2(b)(1): The clinical investigation of
a drug product that is lawfully marketed in the
United States is exempt from the requirements
of this part if all of the following apply:
(i) The investigation is not intended to be reported to
the FDA in support of a new indication for use nor
intended to be used to support a significant change in
the labeling for the product
9
10. IND Exemption Assessment
(ii) . . .the investigation is not intended to support a
significant change in the advertising for the product
(iii) the investigation does not involve a route of
administration or dosage level or use in a patient
population that significantly increases the risks (or
decreases the acceptability of the risks) associated
with the use of the drug product
(iv) the investigation is conducted in compliance with
IRB and informed consent regulations
(v) the study is conducted in compliance with
regulations regarding promotion or distribution of
investigational drugs
10
11. IND Exemption Assessment
Evaluate risks associated with the changes in:
Patient Population
Route of Administration
Dose and dosing regimen
Drug Combinations
11
12. IND Exemption Assessment
12
Studies that generally are exempt:
Single-arm, phase 2 trials using marketing drugs to
treat a cancer different from that indicated in the
approved labeling and using doses and schedules
similar to those in the labeling
Combinations of drugs, or new routes or schedules
that have been described in the professional medical
literature
13. IND Exemption Assessment
13
Studies that are generally not exempt:
Studies involving substitution of a new agent of
unproven activity are generally not exempt in settings
where standard therapy provides a cure or increase in
survival
Initial studies in humans of changes in the schedule of
drug administration, new routes of administration or
novel combinations of drugs
14. IND Exemption Assessments
Modifications to the marketed drug
Low-risk modifications to the lawfully marketed drug
(e.g. over-encapsulation, changes to color, scoring or
size for blinding purposes) are generally acceptable
For modifications beyond what is listed above, FDA
should be consulted
Mechanisms to consult FDA will be discussed later
14
15. Question
Do you have to go to the FDA to get an IND
exemption?
YES
NO
15
16. Answer
No – the IRB can (and the investigator)
“because the assessment of risks involved in a
therapeutic procedure is an everyday part of the
practice of medicine, the individual investigator should
usually be able to determine the applicability of the
exemption (due to risk) . . .”
However, at any time the FDA can be asked if
the study meets the criteria for IND exemption.
16
17. Reasons to Go to FDA . . .
IRBs as part of multi-site studies may have
different conclusions as to whether a study is IND
exempt
Some funding sources (commercial and Federal)
may want FDA confirmation of IND exemption
status
You and your IRB disagree on the IND exemption
assessment
17
18. IND Exemption Assessment by FDA
Formal process
The protocol is submitted as part of a complete IND
The cover letter explains rational for IND exemption
The review is on a 30-day clock
Informal process
Less work up front
Not all divisions will provide IND exemption
assessments outside of the IND review process
Not on a clock, but generally faster
18
19. IND Exemption Assessment by FDA
IND cover letter
State in the first paragraph that you believe the study
may be exempt
Restate the five exemption criteria and how/why you
meet them
Focus on safety (number 3 of exemption criteria)
Make sure that your IND application is complete in
case you are not exempt
IND applications covered later
19
20. IND Exemption Assessment by FDA
Informal Process
Start with Pre-IND consultation contacts listed on FDA
CDER website
http://tinyurl.com/kskl6e
For CBER, go to the Organizational Charts website
http://www.fda.gov/AboutFDA/CentersOffices/OrganizationCharts/ucm135943.htm
Click on the appropriate office that your IND would be
reviewed by, e.g.:
Office of Vaccines Research and Review
Office of Cellular Tissue and Gene Therapies
Contact appropriate Division Director or Project Officer
20
22. IND Exemption Assessment by FDA
Informal process
Call or email contact and explain situation
Ask if they will review the study and determine
whether the study meets the IND exemption criteria
Email protocol for review
FDA typically responds within 2 weeks whether the
study meets the IND exemption criteria
Use the email response to support IND exemption
requests with IRB or other interested parties
22
24. Endogenous Compounds
Endogenous compounds (those naturally found
in the body)
Often used in challenge studies to evoke
physiological response, characterize a disease
or establish mechanism of action
These studies require an IND!
Note: Although there is no intent to treat or mitigate
disease, there is intent to affect the structure or
function of the body
24
25. Definition of a Drug
A drug is anything that meets the definition of a
drug per the FD&C Act. . .
“. . .articles intended for use in the diagnosis, cure,
mitigation, treatment, or prevention of disease. . .”
“. . . a substance (other than food) intended to affect
the structure or any function of the body. . .”
Note: this definition not limited to compounds intended
for therapeutic purpose
25
26. Live Organisms
Challenge studies with live organisms (viruses,
bacteria and fungi) administered to study
pathogenesis or host response require INDs
Note: Although there is no therapeutic purpose, there
is intent to affect the structure/function of the body
26
27. Dietary Supplements
Under the Dietary Supplement Health and
Education Act of 1994, a dietary supplement is
defined as a product taken by mouth that are
intended to supplement the diet and contain a
dietary ingredient
Examples include vitamins, minerals,
herbs/botanicals, amino acids, concentrates,
metabolites, extracts or combinations of these
ingredients
27
28. Dietary Supplements
Under DSHEA, a dietary supplement is not
considered a drug if the intended use for which it
is marketed is only to affect the structure or any
function of the body
(i.e., not intended to be used for a therapeutic purpose)
28
29. Dietary Supplements
Thus, the need for an IND in a study involving
dietary supplements is determined by intent
Structure/function study with no therapeutic intent,
then no IND is required
Examples of studies not requiring an IND:
Studying the effect of calcium on bone mass
Studying the effect of fiber on bowel regularity
29
30. Dietary Supplements
If the clinical investigation is intended to
evaluate the dietary supplement’s ability to
diagnose, cure, mitigate, treat, or prevent a
disease, then an IND is required
Examples of studies requiring an IND:
Effect of a dietary supplement on osteoporosis
Effect of a dietary supplement to treat chronic diarrhea
or constipation
Effect of a dietary supplement on depression or
cognitive decline
30
31. Food
Section 201(f) of the FD&C Act (21 U.S.C.
321(f)) defines a food as:
(1) articles used for food or drink for man or other
animals,
(2) chewing gum, and
(3) articles used for components of any such articles
Whether an IND is needed for a clinical study is
again determined by intent
31
32. Food
Food is considered to be a drug if it is intended
for use in the diagnosis, cure, mitigation,
treatment, or prevention of disease. . .
An IND would be required if used as part of a clinical
study
Food that is intended to effect the structure or
function of the body are not drugs, as long as
the intended structure or function effect derives
from the product’s character as a food; its taste,
aroma, or nutritive value
No IND needed for such a study
32
33. Food
A study of an edible product to support growth of
children
No IND is required
A study of the same edible product used to
assess the blocking the absorption of
carbohydrates in the gut
The product becomes a drug because the primary
purpose of consuming it has changed (no longer for
its taste, aroma, or nutritive value)
An IND would be required
33
34. Case Scenario #1
Investigator plans to do a trial to assess the
effectiveness of Vitamin D in the treatment of
depression
Vitamin D manufactured by company X is legally
marketed as a drug to treat osteoporosis
Vitamin D manufactured by company (Y) is
legally marketed as a supplement
34
35. Case Scenario #1
Is this a drug study subject to 21 CFR 312?
If yes, could the study be IND exempt?
Using Vitamin D from Company X?
Using Vitamin D from Company Y?
35
36. Case Scenario #1
In case of clinical studies using supplements the
need for an IND is determined by intent
Structure/function study – no IND required
Therapeutic study – IND required
36
37. Case Scenario #1
For IND exemption criterion
21 CFR 312.2(b)(1) – “the investigation of a drug
product that is lawfully marketed in the United States”
21 CFR 312.2(b)(1)
37
38. Case Scenario #2
Drug A and Drug B are both FDA approved to be
given in a combination for the treatment of colon
cancer
An investigator wants to add Drug C to Drugs A
and B in colon cancer
Drug C is approved for treatment of breast
cancer
Trial design is Drugs A, B and C versus Drugs A
and B in colon cancer
38
39. Case Scenario #2
Is this study eligible for IND exemption?
What drug(s) is/are used off-label in this study?
39
40. Case Scenario #2
Yes, all drugs are approved and thus eligible for
an IND exemption
Drugs A and B are approved to be give in the
combination for this indication, but not approved
to be given in combination with Drug C
Drug C is neither approved to be given in the
combo with A and B nor approved for this
indication
40
41. Case Scenario #3
Investigator plans to study the structural and
functional changes that occur in the eye after the
exposure to ragweed
Ragweed extract is an FDA approved drug for
use in the skin prick test to diagnose allergy
Investigator plans to administer drops of the
extract in the eye
41
42. Case Scenario #3
Is this a drug study subject to 21 CFR 312?
If yes, could the study be IND exempt?
42
43. Case Scenario #3
Yes, this is a drug study (structure – function
study)
Yes, the study is eligible for IND exemption
43
45. IND Preparation and Maintenance
Definitions and Types of INDs
IND Format and Content
Forms
Filing and FDA Review Process
Other Types of INDs
IND Maintenance
45
46. Definitions
Sponsor is an individual, company, academic
institution, or other organization that takes
responsibility for and initiates a clinical
investigation
Investigator is an individual who conducts a
clinical trial - under whose immediate direction a
drug is administered or dispensed
46
47. Definitions
Sponsor-Investigator is an individual who both
initiates and conducts an investigation, and
under whose immediate direction a drug is
administered or dispensed
Commercial IND
Ultimate goal is to obtain marketing approval
Sponsor-Investigator IND (Investigator-Initiated
IND)
Primarily research-driven (goal is publication)
47
48. IND Format and Content
1. Form 1571 (cover sheet)
2. Table of Contents
3. Introductory Statement
4. General Investigation Plan
5. Investigators Brochure
6. Protocols
7. Chemistry, Manufacturing and Control Data (CMC)
8. Pharmacology and Toxicology Data
9. Previous Human Experience
10. Other Information
11. Biosimilar User Fee Cover Sheet
12. Clinical Trials Certification of Compliance
48
49. IND Content and Format
Usual IND types
FDA approved drug
Use drug label to support IND
Non-FDA approved drug from company
Letter of Authorization to support IND
Non-FDA approved drug; sponsor is manufacturer
Sponsor is responsible for all information
49
50. IND Content and Format
FDA Guidance on Content and Format of INDs
http://www.fda.gov/downloads/Drugs/.../Guidances/ucm074980.pdf
Introductory Statement and General Investigational
Plan
21 CFR 312.23(3)
Sections usually separated into Sections 3 and 4 in IND
as listed on Form 1571
This information usually derived from Protocol
Investigational Plan lists broad objectives and planned
duration of the proposed clinical investigation(s)
This section is updated in each year’s Annual Report
50
51. IND Content and Format
Investigator’s Brochure
21 CFR 312.23(5) (Content of IB)
21 CFR 312.55 (Requirements for IB)
IB not required if it is a Sponsor-Investigator IND and a single
site study
ICH E6 (Proposed content and format of IB)
51
52. IND Content and Format
Protocol
21 CFR 312.23(6) (Content of Protocol)
ICH E6 (Proposed content and format of protocol)
6.1 Protocol
More than one protocol can be submitted to IND
INDs are drug and indication specific, so multiple protocols
must all pertain to the same drug and indication
6.2 Informed Consent
6.3 Form 1572 & CV
52
53. IND Content and Format
CMC
21 CFR 312.23 (7)
Approved drug labeling, Letter of Authorization or
Sponsor provides information
Content of CMC section discussed later
Pharmacology and Toxicology Information
21 CFR 312.23 (8)
Approved drug labeling, Letter of Authorization or
Sponsor provides information
53
54. Letter of Authorization
This is a letter (amendment) from a sponsor or
company to their IND, IDE or DMF stating that
confidential information in their submission can
be used in support of your IND
Thus, the FDA has “permission” to reference the
named submission to access information as part
of the review of your IND
A copy of the amendment is included in your
submission in the appropriate section of the IND
(CMC, Pharm/Tox)
54
55. Letter of Authorization
Required for all non-approved drugs unless
sponsor is providing necessary information
It is not required for FDA-approved drugs, even
if drug manufacturer has an open IND
It is not necessary to obtain permission of drug
manufacturer to use drugs in research studies
Research is also exempt of license/patent status
of drug
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56. CMC Section
FDA Guidance on cGMP for Phase 1 Drugs
http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInfo
rmation/Guidances/ucm070273.pdf
Drug Substance
Manufacturer
Raw Materials
Manufacturing Process
Analytical Testing (in-process and release)
Release specifications
Certificate of Analysis
Stability data and protocol
56
57. CMC Section
Drug Product
Manufacturer
Manufacturing Process
Analytical Testing
Specifications
Certificate of Analysis
Stability data and protocol
Container Closure
Labeling
57
59. CMC, Biologics
In-process and release specifications,
Certificate of Analysis
Stability data, protocol
Container/Closure
Labeling
Guidance for Cell Therapy CMC
http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegula
toryInformation/Guidances/Xenotransplantation/ucm074131.htm
59
60. Pharmacology/Toxicology
Animal safety studies are required for IND
application (IND enabling toxicity studies)
Nonclinical safety studies must be done according to
Good Laboratory Practice (21 CFR Part 58)
ICH Guidance M3 lists nonclinical studies that must be
performed by phase of drug development
http://www.fda.gov/downloads/Drugs/GuidanceComplianceRe
gulatoryInformation/Guidances/UCM292340.pdf
LOA or drug label may be sufficient for this
section
60
61. Previous Human Experience
May not be any previous human experience if
drug is completely new
May be able to refer to published literature
Same indication
Different indication
61
62. Required Forms
1571
Goes in Section 1
1572
Goes in Section 6.3 along with CV
3674
Formerly placed in Section 10, now goes in Section 12
of new 1571
Obtain updated forms at FDA website
http://www.fda.gov/AboutFDA/ReportsManualsForms/Forms/defa
ult.htm
62
63. FDA Form 1571
Key Components
This is a legal commitment to comply with regulations
covering clinical trials conducted under IND
“WARNING: A willfully false statement is a criminal offense”
Instructions to fill out form found on FDA website:
http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Forms/
UCM182850.pdf
Must be submitted with each submission to your IND
Name of the Sponsor (person) who takes responsibility
for and initiates clinical investigation (Field 1)
For Sponsor-Investigator IND, the person should be
named and sign the form (Field 25)
63
64. FDA Form 1571
Key Components
If a pharmaceutical company will be supplying the
drug, but will not itself be submitting the IND (with that
protocol), the company is not the sponsor
The date of submission on the form (Field 2) should
match the date on the cover letter
The date of the Sponsor’s signature (Field 22) can be
different from the date of the submission (Field 2)
The order of the items listed in Field 13, Contents of
Application, should be followed in your IND
The form can be on separate pages
64
66. FDA Form 1572
Key Components
Investigator is named in Field 1 and signs in Field 11
Contractual agreement between an Investigator, the
Sponsor and the FDA
“I agree to comply with all other requirements regarding the
obligations of clinical investigators and all other pertinent
requirements in 21 CFR Part 312”
“WARNING: A willfully false statement is a criminal offense”
Subinvestigators are listed in Field 6
These are individuals who will assist the investigator and
make a direct and significant contribution to the data
This section must be updated as needed and the amended
1572 submitted to the IND
66
67. FDA Form 3674
Certification of Compliance that all requirements
for registration of applicable clinical trials on
clinicaltrials.gov have been met
Field 9: Certification
Box A is checked if the clinical trial is not subject to
the registration requirements
Box B is checked if the registration requirements do
not apply at the time of the submission of the IND
Checked if it is an applicable clinical trial but the CT.gov
registration is not complete
67
68. FDA Form 3674
Field 9, Certification
Box C is checked if the study has been registered
Provide the National Clinical Trial (NCT) number
So if you have an applicable trial at the time of
submission, but have not registered, you can either:
Check B with the initial submission and the resubmit 3674
when you have an NCT number (checking C this time)
Or Check C with the initial submission and write ‘Pending’ in
the space for the NCT number
You will need to write “Pending” physically as the field will only
accept 8 digits
68
70. FDA Form 3674
What clinical trials must be registered?
Applicable clinical trials are:
Interventional studies (drugs, biologics, devices)
Phase 2 – 4, Phase 1 drug safety studies are not required
US FDA jurisdiction (e.g., IND/IDE or US site)
Studies initiated after September 27, 2007, or initiated on or
before that date and were still ongoing as of December 26,
2007
70
71. FDA Form 3674
ICMJE requires public trial registration at time of first
patient enrollment if clinical data will be accepted for
publication
The Public Health Service Act requires registration
no later than 21 days after enrollment of the first
subject
Penalties up to a $10,000 fine for failing to submit or for
submitting fraudulent information to ClinicalTrials.gov
After notification of noncompliance, the fine may go up to
$10,000 per day until resolved
For federally funded grants, penalties may include the
withholding or recovery of grant funds
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72. Filing the IND
Cover Letter
Dated the date of submission
Should summarize the content of your submission
May ask questions or ask for FDA comment on items
Important to list an alternate contact person
Submit original and two copies of IND
Less than 3 copies may result in delay of review
Typically original is in a grey ACCO-like report cover
2 copies are in different colors (other than grey)
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73. Filing the IND
Where to send the initial IND application?
CDER (for drugs or protein therapeutics)
Food and Drug Administration
Center for Drug Evaluation and Research
Central Document Room
5901 Ammendale Road
Beltsville, MD 20705-1266
73
74. Filing the IND
Where to send the initial IND application?
CBER
Food and Drug Administration
Center for Biologics Evaluation and Research
Food and Drug Administration
1401 Rockville Pike, Suite 200N
Rockville, MD 20852-1448
Address to the Attention of the Division Director
74
75. IND Review by FDA
Sponsor receives acknowledgement letter with
IND number 10-14 days after submission
The letter contains the name of the project manager –
this will be your contact person for the IND
Save this letter
Approximately 7-10 days before decision, FDA
may contact sponsor if there are issues that
need to be resolved
Be available and respond quickly
You can email responses to FDA, but you need to
formally submit responses to IND
75
76. IND Review by FDA
By regulation, FDA must complete its review
within 30 days of receipt of the submission
If no issues are identified by day 30, the IND is
considered to be in effect (“approved”)
FDA does not routinely send a letter stating that
IND is in effect
This 30th day after receipt of the IND is your
‘effective date’
This date is important as the Annual Report is due
each year within 60 days (+/-) of this date
76
77. IND Review by FDA
The FDA’s primary objective in all reviews is to
ensure the safety and rights of subjects
All components of the IND maybe responsible for
safety concerns; the clinical protocol, the
manufacturing process/ drug product, or the
pharmacology toxicology data
To address FDA concerns, commitments in
writing may sometimes preclude a clinical hold
E.g., revise protocol, submit CoA for drug product, etc
This would be submitted as an amendment to the IND
77
78. IND Review by FDA
If issues cannot be resolved within this 30 day
period, the FDA places the study (or IND) on
“clinical hold”
This will be communicated by phone or email by the
30th
day
The official letter will listing the clinical hold issues will
arrive in approximately 30 days
78
79. IND Review by FDA
FDA is not bound by a defined period of time to
review responses to clinical hold issues
When the clinical hold is lifted – the ‘effective
date’ is now the date on the letter from FDA
stating that you may now proceed
79
80. Other Types of INDs
Single patient IND
Often referred to as ‘compassionate use’
This IND is used when patient cannot be enrolled in a
clinical trial for a variety of reasons:
Patient does not fit inclusion/exclusion criteria
Current protocols are no longer enrolling
Pharmaceutical industry has concerns as data from these
patients must be submitted as part of NDA/BLA review
80
81. Other Types of INDs
Emergency Use IND
There is not sufficient time to submit IND prior to
giving drug to patient
Must contact FDA and get approval
IND is submitted as soon as possible
Treatment IND
Non-drug manufacturer opens IND to allow patient
access to drug during NDA/BLA preparation or FDA
review
Treatment protocol is opened under manufacturer’s
IND
81
82. Maintenance of the IND
IND Amendments
Protocol, Information, Requests, Safety, Annual
Reports
Ending an IND
Inactivation
Withdrawal
Termination
82
84. Maintenance of the IND
Protocol amendments
New protocol
Change in protocol
New investigator
Post Marketing Requirement/Post Marketing
Commitment (PMR/PMC)
84
85. Maintenance of the IND
Protocol amendments – changes to an existing
protocol
A brief summary of the changes between the revised
protocol and previous version is a nice reviewer aid
It is not necessary to provide clean and tracked-change versions
The amended protocol is official as soon as it is received
at FDA
There is no defined review time for of amendments to the IND
However, if there are changes that could be construed as having
a safety impact, it is recommended that the sponsor hear from
FDA that the changes in the protocol are acceptable
IRB approval of the amended protocol is also required
85
86. Maintenance of the IND
Protocol amendments – changes to existing
protocol
Exception
When a change is necessary to eliminate an apparent
immediate safety hazard to subjects, this can be implemented
without prior IRB or FDA review
Both IRB and FDA must be notified as soon as possible
86
87. Maintenance of the IND
New investigator
The signed 1572 and CV of a new principal
investigator at a new site must be submitted to the
IND within 30 days of the site enrolling their first
subject
It is good regulatory practice for the sponsor to collect
the 1572, CV and IRB approval letter from the site
prior to shipping drug
87
88. Maintenance of the IND
Information Amendments
Chemistry/Microbiology
Pharmacology/Toxicology
Clinical
Statistics
Clinical Pharmacology
88
89. Maintenance of the IND
Information Amendments
Generally comprised of new technical information
Statement identifying the nature and purpose of the
amendment in the cover letter is recommended
Submit information amendments as needed but, if
possible, not more than once every 30 days
Amended 1572 forms can be submitted as clinical
amendments
You can bundle different types of amendments
in the same submission
89
90. Maintenance of the IND – IND
Safety Reports
Types
Initial Written Report
Follow-up to a Written Report
Reporting requirements
Serious and Unexpected Adverse Events associated
with the use of the drug must be reported within a
defined period of time
The sponsor must notify the FDA and all participating
investigators
FDA Guidance:
“Safety Requirements for INDs….” Dec. 2012
http://www.fda.gov/downloads/Drugs/.../Guidances/UCM227351.pdf
90
91. Maintenance of the IND
- IND Safety Reports
An SAE is any adverse drug experience occurring
at any dose that results in any of the following
outcomes
death
a life-threatening adverse drug experience,
inpatient hospitalization or prolongation of existing
hospitalization,
a persistent or significant disability/incapacity
a congenital anomaly/birth defect
91
92. Maintenance of the IND
- IND Safety Reports
Unexpected SAE
Any event in which the specificity or severity of the
event is not consistent with the current investigator
brochure (IB), package insert or protocol
The assessment of relatedness/possible
relatedness to the use of the drug is made by
both the sponsor and the investigator
The investigator is responsible for reporting
unexpected SAEs to the IRB
92
93. Maintenance of the IND
- IND Safety Reports
Reporting to FDA
Unexpected fatal or life-threatening AE must reported
within 7 calendar days
Serious and unexpected adverse drug experience
must be reported in 15 calendar days
New animal findings that suggest significant risk to
human subjects must be reported in 15 calendar days
Follow-up IND safety reports are submitted as
relevant safety information is available
93
94. Maintenance of the IND
- IND Safety Reports
Reporting to FDA
IND safety reports are usually reported using the
MedWatch FDA Form 3500A
The sponsor (or FDA )may propose a different
reporting format and frequency for safety reporting
Must be approved in advance by FDA to be acceptable
94
95. Maintenance of the IND
- Annual Reports
Annual reports are due with 60 days of the
anniversary of the effective date of the IND
Content (21 CFR 312.33)
Individual Study Information
Summary Information (Safety)
Updated General Investigational Plan
Investigator Brochure (if changed)
Protocol Modifications (if not already submitted)
Foreign Marketing Developments
Outstanding Business
95
96. Ending the IND
Withdrawal - Initiated by the sponsor
If withdrawn for safety reason, IRB must be notified
Inactive Status – Initiated by FDA or sponsor
Sponsor - at any time
FDA – if no subjects enrolled in 2 years, investigation
remains on clinical hold for >1 year or IND is inactive
for >5 years
INDs can be reactivated by submission of a new
protocol
As long as an IND is active, an Annual Report is
due
96
97. Ending the IND
Termination – Initiated by the FDA
Based on safety issues, deficiencies in the IND or in
the conduct of an investigation
Rare occurrence, but FDA will do this if they feel
subjects in the study are at unacceptable risk
97