Pharmacists' involvement in clinical trials and ethical committees
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1 19th Congress of the European Associat Barcelona, Spain, March 2014 Barcelona, Spain, th CONGRESS OF THE EUROPEAN ASSOCIATION OF HOSPITAL PHARMACISTS Pharmacists' involvement in clinical trials and ethical committees Seminar H3 26 March 2014 Marisa Dell Aera - Rachele Giuliani AOU CONSORZIALE Policlinico Bari - Italy D. McRobbie; S. Eichinger; M. Klemp Peer review workshop Conflict of interest: Nothing to disclose 1
2 .a longstanding issue 1994 vol.8, n 3-4 EC s members Responsibility within Scientific Secretaries Trial Management Develop specific 1992 competences to critically assess scientific information (Evidence Based Medicine Vs Real Clincal Practice) ETHICAL AND HIGH-QUALITY TRIALS PHARMACISTS INVOLVEMENT At a local level TRASPARENCY OF DATA EUDRACT Contact person Single site Handling IMP EC s Component 2
3 ETHICAL AND HIGH-QUALITY TRIALS At a local level PHARMACISTS INVOLVEMENT TRASPARENCY OF DATA AND DATA DISCUSSION EUDRACT Contact person Single site Handling IMP EC s Component Adequacy of the Study Team Structural Adequacy/Quality Insurance Clarity of information in booklets and leaflets used for patient enrollment Informed Consent Protocol EC s Component What has the EC to consider evaluating clinical trials? PHARMACIST Investigator s Brochure/IMPD PHARMACIST EU Durective2001/20/CE 3
4 Adequacy of both the PI and the co-investigators Structural Adequacy/Quality Insurance Clarity of information in booklets and leaflets used for patient enrollment Informed Consent Protocol EC s Component What has the EC to consider evaluating clinical trials? PHARMACIST Investigator s Brochure/IMPD PHARMACIST EU Durective2001/20/CE Investigator s Brochure/IMPD PHARMACIST Physical, chemical, and pharmaceutical properties and formulation Non-clinical studies Effects in humans Summary of data and guidance for the investigator Contraindications Special Warnings and Special Precautions for use Interactions 4
5 Adequacy of both the PI and the co-investigators Structural Adequacy/Quality Insurance EC s Component What has the EC to consider evaluating clinical trials? Clarity of information in booklets and leaflets used for patient enrollment Informed Consent Protocol PHARMACIST Investigator s Brochure/IMPD PHARMACIST EU Durective2001/20/CE Protocol PHARMACIST Pharmacist with a particular expertise in methodology of health research and GCP RESEARCH HYPOTHESIS PLAUSIBILITY TARGET and ENDPOINT ICH E6 JULY COMPARATOR ADEQUACY FOLLOWUP TIMELINE ADEQUACY STUDY DESIGN BIAS MINIMIZATION EXCLUSION CRITERIA AND SAFETY ASSESSMENT COHERENCE WITH IB INFORMATION SUPERIORITY AND NON INFERIORITY ASSESSMENT MARGIN STATISTICAL ANALYSIS EU Durective2001/20/CE 5
6 Independent information Evaluation of clinical trials GCP knowledge Two parallel paths for the hospital pharmacist Critical appraisal selection of drugs in formularies drug reviewing therapeutic protocols/hta report Off-label use Compassionate use ETHICAL AND HIGH-QUALITY TRIALS At a local level PHARMACISTS INVOLVEMENT TRASPARENCY OF DATA EUDRACT Contact person Single site Handling of IMP EC s Component 6
7 HANDLING IMP IMP RECEPTION 2005/28/CE LABELLING Handling IMP PHARMACIST Pharmacist with a particular expertise in galenic procedures and GMP (ICH Q7 and Annex 13) PACKAGING GALENIC PREPARATION 2001/20/CE Contribution on randomization and blinding procedures ETHICAL AND HIGH-QUALITY TRIALS PHARMACISTS INVOLVEMENT At a local level TRASPARENCY OF DATA Handling IMP EUDRACT Contact person Single site EC s Component 7
8 Handling IMP TRASPARENCY OF DATA: EUDRACT REGISTRY Pharmacist with a particular expertise in health research methodology and GCP May 2004 September 2004 October 2004 EU DATABASE REGISTRATION Improve Transparency Promote Cooperation Avoid Redondancy ETHICAL AND HIGH-QUALITY TRIALS At a local level PHARMACISTS INVOLVEMENT TRASPARENCY OF DATA AND DATA DISCUSSION EUDRACT Contact person Single site Handling IMP EC s Component 8
9 single Experimental Centre Networks of Monitors Clinical trial Quality Teams Research cores Non-profit Research Networks of Monitors
10 Clinical Trial Quality Teams AIFA Notification 23 April 2008 AIFA Project aim at improving the Quality within non-profit clinical trials Partecipants Network Clinical Trial Quality Team (CTQT) Hospital Pharmacists, Scientific Director, Quality Control Clinical Trial Quality Teams 10
11 Research Cores ETHICAL AND HIGH-QUALITY TRIALS PHARMACISTS INVOLVEMENT At a local level TRASPARENCY OF DATA Handling IMP EUDRACT Contact person Single site EC s Component 11
12 The experience at the Policlinico of Bari Pharmacists involvement in clinical trials at a MULTICENTER and INTERNATIONAL level Integrated research network not for profit investigator-driven Consortium AOU Policlinico of Bari is involved as one of the Beneficiaries of a Project funded by the EU Commission (FP7 Programme) A research network including: 16 partners 6 European countries 4 non- European countries 18 recruiting sites 2 clinical trials 1 observational study 12
13 Research Network international scientific institutions for a multi-cultural network COUNTRY COUNTRY Albania Albania Cyprus Cyprus Egypt Egypt Germany Greece Greece Italy Italy The Netherlands Tunisia The Netherlands Tunisia UK INSTITUTION INSTITUTION QENDER SPITALORE UNIVERSITARE NENEA TIRANE QENDER SPITALORE UNIVERSITARE NENEA TIRANE MINISTRY OF HEALTH OF THE REPUBLIC OF CYPRUS MINISTRY OF HEALTH OF THE REPUBLIC OF CYPRUS CAIRO UNIVERSITY, FACULTY OF MEDICINE, PEDIATRIC HOSPITAL, HEMATOLOGY DEPARTMENT CAIRO UNIVERSITY, FACULTY OF MEDICINE, PEDIATRIC HOSPITAL, HEMATOLOGY DEPARTMENT UNIVERSITAETSKLINIKUM ERLANGEN NATIONAL AND KAPODISTRIAN UNIVERSITY OF ATHENS NATIONAL AND KAPODISTRIAN UNIVERSITY OF ATHENS AZIENDA OSPEDALIERA ANTONIO CARDARELLI - AZIENDA OSPEDALIERA OSPEDALI RIUNITI VILLA SOFIA-CERVELLO AZIENDA OSPEDALIERO - AZIENDA OSPEDALIERA UNIVERSITARIA DI PADOVA - AZIENDA CONSORZIALE OSPEDALIERO UNIVERSITARIA CONSORZIALE POLICLINICO DI BARI - FONDAZIONE PER LA RICERCA FARMACOLOGICA GIANNI BENZI POLICLINICO ONLUS - FONDAZIONE DI BARI ITALIANA - AZIENDA L. GIAMBRONE OSPEDALIERA PER ANTONIO LA GUARIGIONE CARDARELLI DELLA - AZIENDA THALASSEMIA CONSORTIUM OSPEDALIERA OSPEDALI FOR BIOLOGICAL RIUNITI AND VILLA PHARMACOLOGICAL SOFIA-CERVELLO - AZIENDA S OSPEDALIERA (COORDINATOR) PADOVA - FONDAZIONE PER LA RICERCA FARMACOLOGICA GIANNI BENZI ONLUS - FONDAZIONE ITALIANA L. UNIVERSITEIT GIAMBRONE PER LEIDEN LA GUARIGIONE DELLA THALASSEMIA CONSORTIUM FOR BIOLOGICAL AND PHARMACOLOGICAL S (COORDINATOR) CENTRE NATIONAL DE GREFFE DE MOELLE OSSEUSE UNIVERSITEIT LEIDEN CENTRE NATIONAL DE GREFFE DE MOELLE OSSEUSE THE ROYAL LONDON HOSPITAL (EC s submission in progress) Hospital Pharmacy of AOU Policlinico of Bari Coordinating Role for: PK STUDY DRUG PHARMACOVIGILANCE SAFETY & EFFICACY STUDY 13
14 ETHICAL AND HIGH-QUALITY TRIALS At a local level PHARMACISTS INVOLVEMENT TRASPARENCY OF DATA Handling IMP EUDRACT Contact person Single site EC s Component Coordinating role At a local At an level internationl level PROJECT DESIGN ETHICAL AND HIGH-QUALITY TRIALS PHARMACISTS INVOLVEMENT TRASPARENCY OF DATA SOP on IMP handling & PV, Official Templates ecrf design, User Manual and etraining Protocol, Study Procedure Manual EC s Component Handling IMP EUDRACT Contact person SAE Collecting and Processing SUSAR & Eudravigilance Single site Multi sites 14
15 Coordinating role At a local At an level internationl level PROJECT DESIGN ETHICAL AND HIGH-QUALITY TRIALS PHARMACISTS INVOLVEMENT TRASPARENCY OF DATA SOP on IMP handling & PV, Official Templates ecrf design, User Manual and etraining Protocol, Study Procedure Manual EC s Component Handling IMP EUDRACT Contact person SAE Collecting and Processing SUSAR & Eudravigilance Single site Multi sites Coordinating role At an internationl level PROJECT DESIGN ETHICAL AND HIGH-QUALITY TRIALS PHARMACISTS INVOLVEMENT SOP on IMP handling & PV, Official Tempales ecrf design, User Manual and etraining Protocol, Study Procedure Manual EC s Component TRASPARENCY OF DATA EUDRACT Contact person Single site Handling IMP Multi sites SAE Collecting Processing SUSAR & Eudravigilance 15
16 SOP on IMP handling & PV, Official Tempales PROJECT DESIGN DRUG SOP on IMP handling & PV, Official Tempales PROJECT DESIGN DRUG 16
17 SOP on IMP handling & PV, Official Tempales PROJECT DESIGN DRUG PHARMACOVIGILANCE SOP on IMP handling & PV, Official Tempales PROJECT DESIGN DRUG PHARMACOVIGILANCE OFFICIAL DOCUMENT TEMPLATES Product Receipt Form, Label Log, Accountability Log, Disposal Authorization Request Etc.. IMPs LABELS DRAFT English, Arabic, Italian, Greek, Albanian, French Directive 2003/94/EC Art.15 17
18 ecrf: Drug Management Section Design, User Manual, etraining ecrf: Drug Management Section Design, User Manual, etraining E-training Software User Manual 18
19 Protocol, Study Procedure Manual PROJECT DESIGN Amendements PROTOCOL STUDY PROCEDURE MANUAL 2. INVESTIGATIONAL MEDICINAL PRODUCTS (IMPs) IMPs DETAILS IMPs dose adjustments 2.2. IMPs SUPPLY AND RECEIPT 2.3. IMPs STORAGE CONDITIONS 2.4. ADMINISTRATION When should the IMP be administered? How the IMPs dispensed to patients should be identified? How the IMP should be administered? How do I assess subjects treatment compliance? Which treatment the patient should receive at the end of the study? 2.5. IMPs DISPOSAL. 9. SERIOUS ADVERSE EVENTS REPORTING Coordinating role At an internationl level PROJECT DESIGN SOP on IMP handling & PV, Official Tempales ETHICAL AND HIGH-QUALITY TRIALS PHARMACISTS INVOLVEMENT TRASPARENCY OF DATA ecrf design, User Manual and etraining Protocol, Study Procedure Manual EC s Component EUDRACT Representative Single site Handling IMP Multi sites SAE Collecting Processing SUSAR & Eudravigilance 19
20 Handling IMP: coordinating role among sites D.M /11/2007 Art. 15 Intermediate warehouse for the direct supply of all the 12 Italian Sites involved (IMP importation) Correct and Timely supply Handling IMP: coordinating role among sites D.M /11/2007 Art. 15 Intermediate warehouse for the direct supply of all the 12 Italian Sites involved (IMP importation) Coordination of the drug management activities and Documentation for all the Sites (Italian and Non-Italian) Mediator among Sites and IMP Producer Disposal Procedures Support SAE Collecting and Processing - SUSAR & Eudravigilance 20
21 SAE Collecting and Processing - SUSAR & Eudravigilance Receiving and reviewing all the SAE form Preparing a draft case narrative based on the provided information; identifying, organizing and sending queries for the site; forwarding by /fax to the QPPV and MM, to the IMP Producer AIFA notification September and to the DSMC 2012 to adopt and implement CT-3 EU guidelines of 2011 Requesting and processing follow-up information and ICH E2F. AIFA training course September 2013: Assessment of Expectedness Hospital SAR Pharmacist SUSAR QPPV EUDRAVIGILANCE SAE Collecting and Processing - SUSAR & Eudravigilance ICH E2F JULY SAFETY AGREEMENT DEVELOPMENT SAFETY REPORT (DSUR) Every 12 month starting from DIBD PERIODIC SAFETY REPORT Every 6 month starting from DIBD 21
22 Coordinating role At an internationl level PROJECT DESIGN SOP on IMP handling & PV, Official Tempales ETHICAL AND HIGH-QUALITY TRIALS PHARMACISTS INVOLVEMENT TRASPARENCY OF DATA ecrf design, User Manual and etraining Protocol, Study Procedure Manual EC s Component EUDRACT Representative Single site Handling IMP Multi sites SAE Collecting Processing SUSAR & Eudravigilance Monitoring Activities at a Multeicenter Level Site Assessment Check List PSQV: Pre Study Qualification Visit Prequalification Check list 22
23 Monitoring Activities at a Multeicenter Level Visit at Sites as Sponsor representative together with the delegated CRA SIV: Site Initiation Visit MOV: On Trial Monitoring Visit COV: Close Out Visit.a longstanding issue 1994 vol.8, n 3-4 EC s members Responsibility within Scientific Secretaries Trial Management Develop specific competence to critically assess scientific information (Evidence Based Medicine Vs Real Clincal Practice) Strengthen of our contribution in the field of clinical research and of independent research mainly 23
24 Thank you 24
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