Clinical trial principles

Table of ContentsPreamble ...1 Commitment to Protecting Research Participants...5 Conduct of Clinical Trials ...7 Ensuring Objectivity in Research ...13 Providing Information About Clini

Table of Contents

Preamble 1

Commitment to Protecting Research Participants 5

Conduct of Clinical Trials .7

Ensuring Objectivity in Research 13

Providing Information About Clinical Trials 19

Expanded Access to Investigational Drugs 27

Q & A 33

P reaMble

The Pharmaceutical research and Manufacturers of america

(PhrMa) represents research-based pharmaceutical andbiotechnology companies our members discover, develop,manufacture and market new medicines and vaccines to enablepatients to live longer and healthier lives

The development of new therapies to treat disease and improve quality

of life is a long and complex process a critical part of that process isclinical research, the study of a pharmaceutical product in humans(research participants) clinical research involves both potential benefitsand risks to the participants and to society at large investigationalclinical research is conducted to answer specific questions, and someaspects of the therapeutic profile (benefits and risks) of the product(s)tested cannot be fully known without study in humans in sponsoringand conducting clinical research, PhrMa members place greatimportance on respecting and protecting the safety of researchparticipants

Principles for the conduct of clinical research are set forth ininternationally recognized documents, such as the Declaration ofHelsinki and the Guideline for Good clinical Practice of theinternational conference on Harmonization (icH) The principles ofthese and similar reference standards are translated into legalrequirements through laws and regulations enforced by nationalauthorities such as the u.s Food and Drug administration (FDa).PhrMa members have always been committed, and remaincommitted, to sponsoring clinical research that fully complies with alllegal and regulatory requirements

companies but also regulatory agencies; investigative site staff andmedical professionals who serve as clinical investigators; hospitals andother institutions where research is conducted; and institutional reviewboards and ethics committees (irbs/ecs)

PhrMa adopts these voluntary Principles to clarify our members’relationships with other individuals and entities involved in theclinical research process and to set forth the principles we follow.The key issues addressed here are:

•Protecting research Participants

•conduct of clinical Trials

•ensuring objectivity in research

•Providing information about clinical Trials

•expanded access to investigational Drugs

These Principles reinforce our commitment to the safety of researchparticipants, and they provide guidance to address issues that bear

on this commitment in the context of clinical trials that enrollresearch participants and are designed, conducted and sponsored

by member companies

For purposes of these Principles, a “clinical trial” means aninterventional trial involving human subjects from Phase 1 and beyond.For example, the term does not include the use of a drug in the normalcourse of medical practice or non-clinical laboratory studies

These revised Principles take effect on June 1, 2015

c oMMiTMenT To P roTecTinG

r esearcH P arTiciPanTs

We conduct clinical research in a manner that recognizes

the importance of protecting the safety of andrespecting research participants our interactions withresearch participants, as well as with clinical investigators and the otherpersons and entities involved in clinical research, recognize thisfundamental principle and reinforce the precautions established toprotect research participants

c onDucT oF c linical T rials

We conduct high quality clinical research, including trials

and observational studies, to test scientific hypothesesrigorously and gather bona fide scientific data inaccordance with applicable laws and regulations, as well as locallyrecognized good clinical practice, wherever in the world clinical trialsare undertaken When conducting multinational, multi-site trials, inboth the industrialized and developing world, we follow standardsbased on the Guideline for Good clinical Practice of the icH inaddition, clinical trial protocols are reviewed by independent irbs/ecs

as well as national health authorities

a Clinical Trial Design. sponsors conduct clinical trials based onscientifically designed protocols, which balance potential risk tothe research participant with the possible benefit to theparticipant and to society scientific, ethical and clinicaljudgments must guide and support the design of the clinical trial,particularly those aspects directly affecting the researchparticipants such as inclusion/exclusion criteria, endpoints, andchoice of control, including active and/or placebo comparator.

b Selection of Investigators. investigators are selected based onqualifications, training, research or clinical expertise in relevantfields, the potential to recruit research participants and the ability toconduct clinical trials in accordance with good clinical practices andapplicable legal requirements

c Training of Investigators.investigators and their staff are trained onthe clinical trial protocol, pharmaceutical product, and proceduralissues associated with the conduct of the particular clinical trial

d IRB/EC Review. Prior to commencement, each clinical trialprotocol is reviewed by an irb/ec that has independentdecision-making authority, and has the responsibility andauthority to protect research participants

•The irb/ec has the right to disapprove, require changes, orapprove the clinical trial before any participants are enrolled

at the institution or investigative site for which it hasresponsibility

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•The irb/ec is provided relevant information from priorstudies, the clinical trial protocol, and any materialsdeveloped to inform potential participants about theproposed research.

e Informed Consent.We require that clinical investigators obtain anddocument informed consent, freely given without coercion, from allpotential research participants

•Potential research participants are to be adequatelyinformed about potential benefits and risks, alternativeprocedures or treatments, nature and duration of the clinicaltrial, and provided the opportunity to ask questions aboutthe study and receive answers from a qualified healthcareprofessional associated with the trial

•clinical investigators should disclose to potential researchparticipants during the informed consent process that theinvestigator and/or the institution is receiving payment forthe conduct of the clinical trial

•in those cases where research participants — for reasonssuch as age, illness, or injury — are incapable of giving theirconsent, the informed consent of a legally acceptablerepresentative is required

•because participation in a clinical trial is voluntary, allresearch participants have the right to withdraw fromcontinued participation in the clinical trial, at any time,without penalty or loss of benefits to which they areotherwise entitled.

f Clinical Trial Monitoring. Trials are monitored using appropriatelytrained and qualified individuals The sponsor will have proceduresfor these individuals to report on the progress of the trial, includingpossible scientific misconduct

•These individuals verify compliance with good clinicalpractices, including (but not limited to) adherence to theclinical trial protocol, enrollment of appropriate researchparticipants, and the accuracy and complete reporting ofclinical trial data

•if a sponsor learns that a clinical investigator issignificantly deficient in any area, it will either work withthe investigator to obtain compliance or discontinue theinvestigator’s participation in the study, and notify therelevant authorities as required

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g Ongoing Safety Monitoring. all safety issues are tracked andmonitored in order to understand the safety profile of the productunder study significant new safety information will be sharedpromptly with the clinical investigators and any Data and safetyMonitoring board or committee (DsMb), and reported toregulatory authorities in accordance with applicable law.

h Privacy and Confidentiality of Medical Information sponsors respectthe privacy rights of research participants and safeguard theconfidentiality of their medical information in accordance with allapplicable laws and regulations

i Quality Assurance.Procedures are followed to ensure that trials areconducted in accordance with good clinical practices and that dataare generated, documented and reported accurately and incompliance with all applicable requirements

j Clinical Trials Conducted in the Developing World When conductingclinical trials in the developing world, sponsors collaborate withinvestigators and seek to collaborate with other relevant parties, such

as local health authorities and host governments, to address issuesassociated with the conduct of the proposed study and its follow-up

e nsurinG o bJecTiviTy

in r esearcH

We respect the independence of the individuals and

entities involved in the clinical research process, so thatthey can exercise their judgment for the purpose ofprotecting research participants and to ensure an objective andbalanced interpretation of trial results our contracts and interactionswith them will not interfere with this independence

a Independent Review and Safety Monitoring. in certain studies,generally large, randomized, multi-site studies that evaluateinterventions intended to prolong life or reduce risk of a majoradverse health outcome, the patients, investigators and the sponsormay each be blinded to the treatment each participant receives toavoid the introduction of bias into the study in such cases,monitoring of interim study results and of new information fromexternal sources by a DsMb may be appropriate to protect thewelfare of the research participants if a DsMb is established, itsmembers should have varied expertise, including relevant fields ofmedicine, statistics, and bioethics sponsors help establish, and alsorespect, the independence of DsMbs

•clinical investigators participating in a clinical trial of apharmaceutical product should not serve on a DsMb that ismonitoring that trial it is also not appropriate for such aninvestigator to serve on DsMbs monitoring other trials withthe same product if knowledge accessed through the DsMbmembership may influence his or her objectivity

•a voting member of a DsMb should not have significantfinancial interests or other conflicts of interest that wouldpreclude objective determinations employees of thesponsor may not serve as members of the DsMb, but mayotherwise assist the DsMb in its evaluation of clinical trialdata.

b Payment to Research Participants. research participants provide avaluable service to society They take time out of their daily lives andsometimes incur expenses associated with their participation inclinical trials When payments are made to research participants:

•any proposed payment should be reviewed and approved

by an independent irb/ec

•Payments should be based on research participants’ timeand/or reimbursement for reasonable expenses incurredduring their participation in a clinical trial, such as parking,travel, and lodging expenses Payment may be monetaryand/or consist of items of modest value based on thefactors noted above

•The nature and amount of compensation or any otherbenefit should be consistent with the principle of voluntaryinformed consent

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c Payment to Clinical Investigators.Payment to clinical investigators ortheir institutions should be reasonable and based on workperformed by the investigator and the investigator’s staff, not onany other considerations.

•a written contract or budgetary agreement should be inplace, specifying the nature of the research services to beprovided and the basis for payment for those services

•Payments or compensation of any sort should not be tied

to the outcome of clinical trials

•clinical investigators or their immediate family should nothave a direct ownership interest in the specificpharmaceutical product being studied

•clinical investigators and institutions should not becompensated in company stock or stock options for workperformed on individual clinical trials

•When enrollment is particularly challenging, reasonableadditional payments may be made to compensate the clinicalinvestigator or institution for time and effort spent on extrarecruiting efforts to enroll appropriate research participants

•When clinical investigators and their staff are required totravel to meetings in conjunction with a clinical trial, theymay be compensated for their time and offeredreimbursement for reasonable travel, lodging, and mealexpenses The venue and circumstances should beappropriate for the purpose of the meeting; specifically,resorts are not appropriate venues While modest meals orreceptions may be appropriate during company-sponsoredmeetings with investigators, companies should not providerecreational or entertainment events in conjunction withthese meetings it is not appropriate to pay honoraria ortravel or lodging expenses for those who are not involved inthe clinical trial.

d Potential Conflicts of Interest.a potential conflict of interest exists,

in the research setting, whenever an investigator’s professionaljudgment could be influenced by a secondary interest, such as apotential financial gain, career advancement, outside employment,personal considerations or relationships, investments, gifts, paymentfor services, and board memberships in the strict sense, someconflict of interest may exist in all research settings For example,physicians who are specialists and/or leaders in their field are oftenextensively engaged by both the private and public sectors toprovide their expertise Further, by the nature of their practices,there are often a limited number of physicians who are bestqualified to ensure that a specific trial will be able to reach and enrollthe required number of patients

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Physicians are subject to an array of professional standards and ethicalobligations, including institutional disclosure policies and governmentregulations regarding disclosure of potential financial conflicts ofinterest in clinical research during the drug approval process.companies should recognize and support physicians and researchers inmeeting these standards and ethical obligations, including thefollowing requirements for authorship:

•When authors submit a manuscript to a medical journal,whether an article or a letter, they are responsible fordisclosing all financial and personal relationships that mightbias their work To prevent ambiguity, authors should stateexplicitly whether potential conflicts do or do not exist

•authors should identify individuals who provide writing orother assistance and disclose the funding source for thisassistance authors should describe the role of the studysponsor(s), if any, in study design; in the collection,analysis, and interpretation of data; in the writing of thereport; and in the decision to submit the report forpublication if the sponsor had no such involvement, theauthors should so state

P roviDinG i nForMaTion a bouT

c linical T rials

america’s pharmaceutical research companies are committed

to the transparency of clinical trials that are sponsored byour member companies We recognize that there areimportant public health benefits associated with making appropriateclinical trial information widely available to healthcare practitioners,patients, and others such disclosure must maintain protections forindividual privacy, intellectual property, and contract rights, as well asconform to legislation and current national practices in patent law.availability of information about clinical trials and their results in atimely manner is often critical to communicate important newinformation to the medical profession, patients and the public Wedesign and conduct clinical trials in an ethical and scientificallyrigorous manner to determine the benefits, risks, and value ofpharmaceutical products as sponsors, we are responsible forreceipt and verification of data from all research sites for the studies

we conduct; we ensure the accuracy and integrity of the entirestudy database, which is owned by the sponsor

a Clinical Trial Registration and Communication of Study Results.clinicaltrials may involve already marketed products and/or investigationalproducts We commit to the timely submission and registration on apublic database of summary information about all clinical trials that

we conduct involving the use of our marketed or investigationalproducts in patients We also commit to the timely submission andposting of summary results of all clinical trials conducted in patientsinvolving the use of our products that are approved for marketing,

or that are investigational products whose development programsare discontinued, regardless of outcome in addition, if informationfrom any clinical trial is felt to be of significant medical importance,then we will work with investigators to publish the data

b Authorship and Research Contributors

1 Authors consistent with standards of the internationalcommittee of Medical Journal editors and major journalguidelines for authorship, anyone who: (1) provides substantialcontributions into the conception or design of a study, or dataacquisition, or data analysis and interpretation; and (2) writes orrevises the manuscript involving important intellectual content;and (3) has final approval of the version to be published, shouldreceive appropriate recognition as an author when the manuscript

is published conversely, individuals who do not contribute in thismanner do not warrant authorship authors should meetconditions 1, 2, and 3

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•all persons designated as authors should qualify forauthorship, and all those who qualify with respect to each

of the three criteria should be listed by companies; althoughjournals may restrict the number of authors who may belisted each author should have participated sufficiently inthe work to take public responsibility for appropriateportions of the content

•When a large, multi-center group has conducted the work,the group should identify the individuals who accept directresponsibility for the manuscript acquisition of funding,collection of data, or general supervision of the researchgroup, alone, does not justify authorship

•all authors, whether from within a sponsoring company orexternal, will be given the relevant statistical tables, figures,and reports needed to support the planned publication

2 Contributors like other research sponsors, companiessometimes employ staff to help analyze and interpret data, and toproduce manuscripts and presentations such personnel must act

in conjunction with the investigator-author Their contributionsshould be recognized appropriately in resulting publications —either as a named author or in acknowledgments, depending ontheir level of contribution

•contributors who do not meet the criteria for authorshipshould be listed in an acknowledgments section examples

of those who might be acknowledged include a person whoprovided purely technical help, writing assistance, or adepartment chair who provided only general support

•Groups of persons who have contributed materially to thepaper but whose contributions do not justify authorshipmay be listed under a heading such as “clinical investigators”

or “participating investigators,” and their function orcontribution should be described — for example, “served asscientific advisors,” “critically reviewed the study proposal,”

“collected data,” or “provided and cared for study patients.”

•authors should declare whether or not they had assistancewith study design, data collection, data analysis, ormanuscript preparation if such authorship assistance wasavailable, the authors should disclose the identity of thepeople that provided the assistance and any entity thatsupported it in the published article Financial and materialsupport should also be acknowledged

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