GCP Audits in Southeast Asia and Turkey
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Current Updates from recent GCP Audits in Southeast Asia and Turkey
Shehnaz VakhariaPrincipal ConsultantTheraverity
Disclaimer
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2
2010 Statistics
Reference: ClinicalTrials.gov; Phase I, II, III Interventional StudiesPeriod: 1-Jan-2010 to 1-May-2011
Asia – 10%
East Asia
Reference: ClinicalTrials.gov; Phase I, II, III Interventional StudiesPeriod: 1-Jan-2010 to 1-May-2011
South Asia
Reference: ClinicalTrials.gov; Phase I, II, III Interventional StudiesPeriod: 1-Jan-2010 to 1-May-2011
Southeast Asia
Reference: ClinicalTrials.gov; Phase I, II, III Interventional StudiesPeriod: 1-Jan-2010 to 1-May-2011
Middle East
Reference: ClinicalTrials.gov; Phase I, II, III Interventional StudiesPeriod: 1-Jan-2010 to 1-May-2011
Clinical Trials - 2010
# of Studies
0
10
20
30
40
50
60
70
80
Countries
India
Korea
Isreal
China
Taiwan
Singapore
Turkey
Thailand
Phillipines
79 77
51
46
2216
1310
Reference: ClinicalTrials.gov; Phase I, II, III Interventional StudiesPeriod: 1-Jan-2010 to 1-May-2011
US FDA Inspection History
22
6
9
13
4
1
6 7 7
0
5
10
15
20
25
Countries
India
Korea
Isreal
China
Taiwan
Singapore
Turkey
Thailand
Phillipines
5 yrs
2 yrs
18 yrs
10yrs
8 yrs
2 yrs
09yrs
12yrs
# of Inspections
Deficiencies
0%
20%
40%
60%
80%
100%
Deficiency Code 18
Deficiency Code 16
Deficiency Code 15
Deficiency Code 14
Deficiency Code 6
Deficiency Code 5
Deficiency Code 4
Deficiency Code 3
03 = Inadequate Informed Consent Form
04 = Inadequate Drug Accountability
05 = Failure to follow investigational plan
06 = Inadequate and Inaccurate records
14 = Failure to obtain or document IRB Approval
15 = Failure to notify IRB of changes, failure to submit progress reports
16 = Failure to report adverse drug reactions
18 = Other
Deficiencies
Audits 2010Recent Audits (2010)
India85%
China6%
S Korea6%
Turkey3%
India
China
S Korea
Turkey
India
patients / day / OPD
South Korea
patients / day/ OPD
China
patients / day / OPD
Turkey
patients / day / OPD
50-100 70-140 80-150 200-400
Comparison
High patient load
India
South Korea
China
Turkey
Principal Investigator Medically Qualified
Medically Qualified
Medically Qualified
Medically Qualified
Sub-Investigators Medically Qualified
Medically Qualified
Medically Qualified
Medically Qualified
Study Co-ordinators Science Degree
Medically Qualified
Medically Qualified
Nursing / Science Degree
Qualified Site Personnel
Comparison
India South Korea China Turkey
Paper Yes Yes
However Prescription Records - Electronic, linked to Hospital Pharmacy
Yes Yes
Comparison
Paper Source records
India South Korea China Turkey
English Local
Prescription Records - English
Local Local
Comparison
Source Records Language
India South Korea China Turkey
90% * 100%Prescriptions - Hospital Electronic System
100% 100%
Comparison
OPD records retained by the patients rather than physicians
Issues Availability of past medical records to verify the inclusion / exclusion criteria is a challenge
Comparison
OPD Registration System
OPD Files / Document Storage with the Hospital MRD Improvements
Issue
Lack of Awareness
India South Korea
China Turkey
Hospital Medical Records Division (MRD)
Yes Yes Yes Yes *
Comparison Hospitalization records retained by Hospital Medical Records Division (MRD)
Hospital MRD records for over 70% subjects were not available for review during the audit in Turkey and had never been monitored with the data recorded in the eCRF
Issue
India South Korea China Turkey
Yes * Yes Yes Yes
Comparison
Use of Protocol Specific Source Templates
Issue In about 20% of the audits in India and 100% audits in China and Turkey the monitoring had been performed only with the Protocol Specific Source Templates !!!
India South Korea China Turkey
50% 90% No No
Comparison
Identification of clinical trial participation on source files
Improvement
Issue Subject Safety Jeopardized
India South Korea
China Turkey
ICH GCP Awareness Yes Yes Yes Yes
Understanding of ICH GCP
Yes Yes Yes Questionable
Comparison
Good Clinical Practice (GCP)
Example
Impartial witness not present during informed consent discussion, but had signed the ICF later.
Reason: Hospital Employee, not involved in the study. Had a busy schedule, so it was not possible for the witness to be present through the informed consent process
Signed informed consent document was destroyed by the site Reason: Subject had withdrawn consent
Subject Diary Cards had not been dispensed to the subjects enrolled in the study, per protocol requirement.
Reason: According to the sub-investigator, the subject’s relatives were not comfortable in completion of the diaries.
Treating investigators were present in the room where un-blinded
pharmacists prepared study medicationReason: To help pharmacists
Examples Turkey
India South Korea
China Turkey
Training on ICH GCP Yes Yes Yes Yes
Training on Local Regulations
NO NO NO NO
Comparison Training
Comparison
Protocol Deviations
India South Korea China Turkey
Yes Yes Yes Yes
Major Protocol Deviations
India South Korea China Turkey
20 % No No Yes
India South Korea
China Turkey
Secure with limited access
Yes Yes Yes Were not allowed
Fire Protection 50 %
Fire Extinguishers
Water Sprinklers
Central System (Powder)
Central System (Powder)
Temperature and Humidity Monitoring
NO * NA NA NA
Comparison Document Storage Facilities
Difference however is in Medical Records Room storage facilities vs that maintained by the investigator sites (Clinical Research Facility)
Medical Records Room, Hospital Facility Clinical Research Document Storage
Temperature and Humidity Monitoring ??
India South Korea
China Turkey
Secure with limited access
Yes Yes Yes Yes
Fire Protection 50 %
Fire Extinguishers
Water Sprinklers
Yes Yes
Comparison Study IP Storage Facilities
Improvements observed in newer investigator site facilities in India for IP Storage
Examples
10% of investigator sites audited in India had installed Biometric Access for the IP storage facility
100% investigator sites had air-conditioning units installed in the IP storage facility 20% investigator sites had B.O.D (Biochemical Oxygen Demand) Incubators with
temperature control and secure access for storage of IP between 15 to 30 °C 50% investigator sites had UPS back-up for the IP storage facility 50 % investigator sites had generator back-ups lasting 8 hours
Most Common Issues
Documentation
Changes
File Notes
Inadvertently!!!!!!
InsertionsCancellations
Back-dating
Whether Source Notes, EC Approvals, IP Dispensing
Missing
Recent Updates- CDSCO, INDIA
Recent News- INDIA
Recent News- INDIA
Questions?
Shehnaz Kairas Vakharia, MSPrincipal Consultant, Theraverity
Indiashehnaz@theraverity.com
+(91) 9821543016
THANK YOU
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