November 16, 2004. Taming the New Clinical System Compliance Requirements. 1.02 Regulatory Issues in Pharmaceutical Product Development. Michael Breggar Global Director Life Sciences Life Science and Health Care Regulatory Practice Deloitte & Touche LLP. - PowerPoint PPT Presentation
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• Defines specific technical and procedural requirements for the design, use, and implementation of computer systems, devices and instruments that create, modify, maintain, archive and retrieve electronic records in support of our client’s current and drugs and developmental pipeline products– Technical - achieved by the computer hardware or software– Procedural - achieved by people and policies
• Scope is any system used for the research, manufacture, packaging, holding or monitoring of any FDA regulated product
• Is the “oversight” regulation to already established rules that govern our business (Good Clinical Practices, Good Manufacturing Practices, Good Laboratory Practices)
represented in digital form that is created, modified, maintained, archived, retrieved or distributed electronically
• The regulation defines the criteria for making electronic records equivalent in FDA’s eyes to traditional paper records
– Electronic Signatures• The act of signing/approving
using electronic means instead of traditional handwriting - replaces human signatures
• Use is voluntary, if used, the regulation defines the criteria for accepting electronic signatures in place of handwritten signatures
• The system must be able to associate the username/ password with a person and identify the meaning of the signature (approval of a clinical study report for example)
Two Components to the Regulation:
Electronic collection of clinical trial data
Data collection from laboratory instruments
Electronic batch record processing
Electronic tracking and disbursement of raw materials
Using a unique username and password to approve case report form data, to approve promotional or advertising pieces, or to release raw materials or samples for use.
and Compliance CongressA challenge of interpretation (Early)…
•What are “open vs. closed” systems?
– CLOSED SYSTEMS: ... “an environment in which system access is controlled by persons who are responsible for the content of electronic records that are on the system.”
– OPEN SYSTEMS: … “an environment in which system access is not controlled by persons who are responsible for the content of electronic records that are on the system.”
and Compliance CongressCompliance and Technology Issues
• Validation of the system • Demonstrate ability to generate accurate and complete copies of
record in both human readable and electronic form• Demonstrate that records can be accurately and readily retrieved
during the records retention period• Limiting of system access to authorized individuals• Use of secure, computer-generated, time-stamped audit trails to
independently record the date and time of operator entries and actions that create, modify, or delete electronic records. (NOTE: the audit trail itself becomes an “electronic record” subject to requirements of Part 11)
• Use of operational system checks to enforce permitted sequencing of steps and events, as appropriate
• Use of authority checks to ensure that only authorized individuals can use the system, electronically sign a record, access the operation or computer system input or output device, alter a record, or perform the operation at hand
and Compliance CongressCompliance and Technology Issues
• Use of device (e.g., terminal) checks to determine, as appropriate, the validity of the source of data input or operational instruction
• Determination that persons who develop, maintain, or use electronic record/electronic signature systems have the education, training, and experience to perform their assigned tasks
• Written policies that hold individuals accountable and responsible for actions initiated under their electronic signatures, in order to deter record and signature falsification
• Use of appropriate controls over systems documentation including:– Adequate controls over the distribution of, access to, and use of
documentation for system operation and maintenance– Revision and change control procedures to maintain an audit trail that
documents time-sequenced development and modification of systems documentation
• Approved standard operating procedures around system operation, usage and maintenance -- employees and supervisors trained in the procedures
and Compliance CongressClinical System “Principles”
• Identify the steps which involve computerized systems• Identify hw/sw being used• System must support requirements in the protocol itself• System must have error “filters” (“…preclude errors in data
• SOPs – Detail about the system (setup)– Data collection and handling– System maintenance– Backup, archive, disaster recovery (including alternative recording
methods)– Security – Change control
• System Access and Security• Audit Trails• Date and Time Stamps• Record retention/retrieval• Reliability/validation• Change control• Training
and Compliance CongressWhat FDA Investigators may look for:
• Record Keeping. Company’s SOPs on providing electronic and paper records upon FDA request
• Audit Trails. System’s capability to automatically capture “who, what, when and where”
• Security. Record or trace of changes introduced to records• Access and Passwords. Level of sophistication and difficulty to
decipher and impost passwords. Screen savers, reentries and other common practices in-site
• Training. Proof that IT professionals and all employees have been trained on Part 11, computer system validation in general and other procedural documentation
• Administrative Controls. SOPs on system operation and maintenance • Documentation. Functional requirements and specifications, modules
interaction and system validation• Internal reviews. Evidence of internal audits from QA/QC staff• Corrective action plans and Validation. Evidence of assessment of
existing systems, time frame for corrections, and validation and progress to date
and Compliance CongressPDUFA III & Risk Management
• On June 12, 2002, Congress reauthorized, for the second time, the Prescription Drug User Fee Act (PDUFA III) under which FDA agreed to meet certain performance goals
– One of those goals was to produce guidance for industry on risk management activities for drug and biological products.
– As an initial step towards satisfying that goal, FDA issued three concept papers focused on various aspects of risk management, including • (1) conducting premarketing risk assessment, • (2) developing and implementing risk minimization tools, • (3) performing postmarketing pharmacovigilance and
pharmacoepidemiologic assessments. – After Public Comment, FDA issued three draft guidance documents on
risk management activities: • Premarketing Risk Assessment (Premarketing Guidance) • Development and Use of Risk Minimization Action Plans (RiskMAP Guidance) • Good Pharmacovigilance Practices and Pharmacoepidemiologic Assessment
II. BACKGROUND PDUFA III Guidance Performance Goal Overview of the Risk Management Guidances
III. THE ROLE OF RISK ASSESSMENT IN RISK MANAGEMENT
IV. GENERATING RISK IINFORMATION DURING CLINICAL TRIALS
Size of premarketing safety database Considerations for development of premarketing safety databaseDetecting unanticipated interactions as part of safety assessmentDeveloping comparative safety data
V. SPECIAL CONSIDERATIONS FOR RISK ASSESSMENT
Risk Assessment During Product DevelopmentSafety Aspects That Should Be Addressed During Product DevelopmentRisk Assessment and Minimizing the Potential for Medication Errors
VI. DATA ANALYSIS AND PRESENTATION
Describing Adverse Events to Identify Safety SignalsAnalyzing Temporal or Other AssociationsAnalyzing Dose Effect as a Contribution to Risk AssessmentRole of Data Pooling in Risk AssessmentUsing Pooled Data During Risk AssessmentRigorous Ascertainment of Reasons for Withdrawals from StudiesLong Term Follow-up Important Aspects of Data Presentation
• Risk assessment occurs throughout a product's lifecycle, – Beginning with the early identification of a product as a candidate,
through the premarketing development process, all the way thru to post-marketing studies
– To develop a risk management plan and perform post-approval pharmacovigilance, it is important to have as good an idea as possible of the product's underlying risks and benefits prior to approval
– This process entails ensuring that the body of evidence generated by the clinical trials not only defines the product's effectiveness, but also comprehensively describes its safety (as required by the FD&C Act, which calls for the conduct of all tests reasonably applicable to evaluate a drug's safety)
Deloitte POV: A critical component of FDA approval process will now include an
evaluation how well the pre-marketing/phase 3 studies define that product’s safety profile within a risk/benefit framework
Generating Risk Information During Clinical Trials
• Providing detailed guidance on what constitutes an adequate safety database for all products is impossible
• The nature and extent of safety data that would provide sufficient information about risk for purposes of approving a product are individualized decisions based on a number of factors
• Decisions on approvability will be based upon both existing risk information and safety questions as part of a product’s risk assessment. If the product offers no new benefits, the risk levels must be low
• FDA recommends that sponsors pay careful attention to safety issues from the outset of the product development cycle – Investigate potential problems that may be suspected from preclinical
data – As experience accrues, refine or modify a products safety evaluations
Deloitte POV: FDA’s focus on risk/benefit data requires continual review, evaluation
Considerations for Developing a Premarketing Safety Database
• Although the characteristics of an appropriate safety database are product-specific, some general principles can be applied– Efforts to ensure the quality and completeness of a safety
database should be comparable to those made to support efficacy
– If data from multiple trials is used when assessing safety, it is critical to examine terminology, assessment methods, and use of standard terms to be sure that information is not obscured or distorted
– Evaluation of the reasons for leaving a study (deaths, dropouts, etc) are particularly important to understanding a product’s safety profile
Deloitte POV: FDA views safety as the critical component leading to product approval – If your product isn’t a blockbuster – you must have data to support it’s
safety (good safety data doesn’t hurt with blockbusters either)
Development of a Premarketing Safety Database – Specific Issues
• Size of the Premarketing Safety Database • Even large clinical development programs cannot reasonably be
expected to identify all risks associated with a product. Some risks become apparent only when a product is used in tens of thousands or even millions of patients in the general population. However, the larger and more comprehensive a preapproval database, the more likely it is that serious adverse events will be detected.
• The appropriate size of a safety database supporting a new product will depend on a number of factors specific to that product, including: – Its novelty (i.e., whether it represents a new treatment or is similar to
available treatment) – The potential advantages of the product over existing therapy – The intended population – The intended duration of use
Development of a Premarketing Safety Database – Specific Issues
• Long-Term Controlled Safety Studies – It is common clinical practice for much of the long-term patient
exposure data to come from single-arm or uncontrolled studies– It may be preferable to develop controlled, long-term safety data
• A Diverse Safety Database – Phase 3 safety databases should include a diverse population– FDA recommends that, to the extent feasible, only patients with
obvious contraindications be excluded from study entry in phase 3 trials. • Inclusion of a diverse population allows for the development of safety data in
a broader population that includes patients previously excluded from clinical trials, such as the elderly, patients with concomitant diseases, and patients taking multiple medications.
• Broadening inclusion criteria in phase 3 studies enhances the generalizability of study findings and may, therefore, allow the product to be labeled for broader use.
Development of a Premarketing Safety Database – Specific Issues
• Exploring Dose Effects Throughout the Clinical Program – Currently, it is common for only one or two doses to be studied
beyond phase 2. – FDA believes that a number of characteristics common to many phase
2 studies limit the ability of these trials to provide definitive data on exposure-response, or adequate data for definitive phase 3 dose selection including; • Shorter durations of exposure • Common use of pharmacodynamic (PD) endpoints, rather than clinical
Development of a Premarketing Safety Database – Specific Issues
• Detecting Unanticipated Interactions as Part of a Safety Assessment – No clinical pharmacology program can guarantee a full
understanding of all possible risks related to product interactions. – Risk assessment programs should address a number of potential
interactions during controlled safety and effectiveness trials, including: • Drug-drug interactions • Product-demographic relationships — increased study population
diversity (gender, age, and race, etc) • Product-disease interactions — by ensuring sufficient variability in
disease state and concomitant diseases • Product-dietary supplement interactions — for commonly used
supplements that are likely to be co-administered
Deloitte POV: Expanded studies to define previously unknown and unstudied
and Compliance CongressData Analysis and Presentation
• Premarketing Clinical studies must now endeavor to:– Accurately & consistently describe Adverse Events to identify
safety signals– Analyze and report temporal associations as related to Adverse
Events– Analyzing dose effect and it’s contribution to risk assessment – Use of pooled data during risk assessments– All placebo-controlled studies in a clinical studies should be
considered and evaluated for appropriateness for inclusion– Rigorous ascertainment of reasons for withdrawals from studies– Long-term follow-up
Deloitte POV: The safety & efficacy data requirements for pre-marketing trials, from pre-clinical development through phase 3 and post-marketing, continue
to expand and become more complex – HOW DOES THE INDUSTRY RESPOND???
Dr. Michael M. Breggar Global Director Life SciencesLife Science and Health Care Regulatory PracticeDeloitte & Touche [email protected](610) 479-3848Dr. Breggar leads the Life Sciences Regulatory segment for Deloitte. He has over twenty-five years of professional experience in health care consulting. He is a recognized industry leader and speaker in the fields of, technology optimization in R&D, computer-related system compliance, pharmaceutical e-Business, quality systems and product development issues. His strong background in drug development, regulatory and industry affairs complements years of hands-on experience of analyzing pharmaceutical operations and processes for compliance with pragmatic business drivers and relevant regulatory bodies.
Gregory V. Page, PhDFDA Life Sciences Practice LeaderLife Science and Health Care Regulatory PracticeDeloitte & Touche [email protected](516) 918-7092Dr. Page is the FDA Life Sciences Practice leader. He has over 20 years experience in both the Pharmaceutical and Biotech life sciences industries focusing on Quality Systems, Validation and FDA Regulatory Compliance. He has extensive experience in new business/product development, project management and QC/QA/RA issues. Greg has extensive FDA audit experience (annual audits, licensing inspections & product meetings) and 483/warning letter/consent decree response & remediation program development. He has led compliance risk assessment and remediation projects for a number of pharmaceutical and medical device companies.