Mitigating Risks in Clinical Studies
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In the course of any clinical trial, there are risks associated with specific activities and tasks. This webinar will highlight some of these key risk areas and provide guidance on combining technology with best practices to help mitigate risks.
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Mitigating Risks in Clinical Studies
- 1. Mitigating Risk in Clinical Studies William Gluck, PhD VP, DATATRAK Clinical and Consulting Services April 11, 2013
- 2. Introduction William βBillβ Gluck, Ph.D, DATATRAK International, Inc. @DATATRAKinc Bill Gluck joined DATATRAK International in October 2010 as VP of DATATRAKβs Clinical and Consulting Services (DCCS). Dr. Gluck has more than 28 years of experience in the pharmaceutical and biotechnology industries and has diversified experience in clinical trial management systems and electronic data capture. Confidential β 2
- 3. Agenda β’β― Risk in Clinical Studies ββ― Definitions ββ― Identifying Risk in Clinical Trials β’β― Study Set-Up and Initiation β’β― Study Conduct and Optimization β’β― Leveraging Technology to Mitigate Risk β’β― Thoughts on the Future ββ― Virtual Trials ββ― Technology Driven Drug Development (TD3β’) β’β― Wrap-Up Confidential β 3
- 4. Risk in Clinical Studies Risk1 A probability or threat of damage, injury, liability, loss, or any other negative occurrence that is caused by external or internal vulnerabilities, and that may be avoided through preemptive action Risk Mitigation2 A systematic reduction in the extent of exposure to a risk and/or the likelihood of its occurrence 1http://en.wikipedia.org/wiki/Risk 2http://www.businessdictionary.com/definition/risk-mitigation.html Confidential β 4
- 5. Identifying Risk In Clinical Studies βΊβ― Study Set-Up and Initiation β’β― Study Protocol β’β― Qualification, Training, Experience of all Study Personnel β’β― Recruitment β’β― Informed Consent βΊβ― Study Conduct and Optimization β’β― Protocol Deviations (inclusive of eligibility criteria) β’β― Drug Accountability β’β― Data Collection and Data Quality Confidential β 5
- 6. Leveraging Technology Study Set-Up and Initiation Confidential β 6
- 7. Study Protocol Risk β’β― Study protocol is not well defined β’β― Complex β’β― Risk assessments and plans are not adequate β’β― Amendments and Mid-Study Changes Mitigation β’β― Use of CDISC standards ββ― Protocol and Study/Trial Design Model β’β― Adaptive study design planning β’β― Risk-based Approach planning β’β― Electronic Data Collection (EDC) Confidential β 7
- 8. Adaptive Study Design Study design that allows: β’β― Modification of pre-defined aspects of a study β’β― Interim reviews of accumulating study data β’β― No affect on the validity and integrity of the trial Adaptive design requires: β’β― Multiple stages β’β― Access to accumulated study data β’β― Apply the following rules (one or more) at interim reviews: ββ― Allocation Rule ββ― Sampling Rule ββ― Stopping Rule ββ― Decision Rule At any interim data review subsequent stages of the study can be redesigned taking into account all available data Confidential β 8
- 9. Risk-Based Approach to Monitoring Draft guidance β released August 2011 βΊβ― FDA is clear that onsite visits are not always necessary and that βcentralized monitoringβ may be preferred βΊβ― Factors to consider when developing any type of monitoring plan β’β― Complexity of study design β’β― Types of study endpoints β’β― Clinical complexity of study population β’β― Geography β’β― Relative experience of the clinical investigator and of the sponsor with the investigator β’β― Electronic data capture ββ― Metrics generation ββ― Site quality assessments β’β― Relative safety of the investigational product β’β― Stage of the study β’β― Quantity of data βΊβ― Potential time and money savings as well as increased data quality Confidential β 9
- 10. Qualification,Training, Experience Risk β’β― Lack of experience β’β― Lack of essential documentation/records β’β― Medical records inadequately maintained Mitigation β’β― Clinical Trial Management System (CTMS) β’β― Electronic Trial Master File (eTMF) β’β― EDC and/or e-Training Records Confidential β 10
- 11. Recruitment Risk β’β― Identification of sites/patients β’β― Delays in recruitment/enrollment ββ― Due to recruitment of qualified participants ββ― Due to site issues/quality Mitigation β’β― Electronic Health Records β’β― Social Media β’β― EDC ββ― Patient data reviews ββ― Metrics reporting Confidential β 11
- 12. Informed Consent Risk β’β― Patient confidentiality and protection β’β― Adequately informed of study risks Mitigation β’β― Standardization β’β― Use of multi-media β’β― Electronic Informed Consent (virtual studies) Confidential β 12
- 13. Leveraging Technology Study Conduct and Optimization Confidential β 13
- 14. Protocol Deviations Risk β’β― Inclusion/Exclusion criteria β’β― Procedural deviations from the study protocol β’β― Enforcement of stopping rules/dose modification rules Mitigation β’β― Electronic health records β’β― EDC ββ― Risk-based Approach to monitoring ββ― Edit check specifications ββ― Metrics reporting Confidential β 14
- 15. Drug Accountability Risk β’β― Proper drug assignments β’β― Site accountability β’β― Dose management Mitigation β’β― EDC ββ― Randomization ββ― Drug inventory management ββ― Metrics reporting β’β― Electronic Reported Patient Outcomes (ePRO) Confidential β 15
- 16. Data Collection and Quality Risk β’β― Site issues ββ― Data quality β high query rates ββ― Staff turn-over β’β― Patient diary data collection β incomplete data Mitigation β’β― EDC ββ― Risk-based Approach to monitoring ββ― Metrics reporting ββ― eTraining β’β― ePRO Confidential β 16
- 17. Thoughts on the Future Confidential β 17
- 18. Virtual Studies Combines process and technology to streamline the conduct of a study leveraging: Protocol definitions and process SOPβs Electronic informed consent eTraining eSource EDC - Metrics reporting - Data import/export Confidential β 18
- 19. Technology Driven Drug Development (TD3β’) Patient-focused to improve patient adherence and safety as well as clinical outcomes More than a virtual trial, TD3β’ is a holistic approach that leverages technology-based processes: Address study needs Evaluate viability of drug pipeline Reallocate focus and resources Confidential β 19
- 20. WRAP-UP Mitigating risk depends upon the identification of risks and the proactive planning to address points of risk during the clinical study Technology provides multiple tools to assist in assessing and mitigating risk The future is now β virtual trials and TD3β’ Confidential β 20
- 21. William Gluck, Ph.D. VP, D ATATRAK Clinical and Consulting Services D ATATRAK International, Inc. Phone: 919-651-0222 Cell: 919-522-9681 E-Mail: Bill.Gluck@datatrak.net Confidential β