4. Why Does the FDA Conduct Inspections?
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Assess adherence to federal laws and regulations
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Confirm validity of data supporting INDs and NDAs
Determine that the safety, rights and welfare of
subjects were protected through consent and IRB/EC
procedures
Determine whether the trial was well controlled and
conducted according to the trial protocol/SOPs/
contracts/regulatory guidelines/CFRs
4
5. Major Federal Regulations Governing Clinical Research
Title 21, Code of Federal Regulations
ď¨Electronic Records; Electronic Signatures:
Part 11
ď¨Protection of Human Subjects:
Part 50
ď¨Financial Disclosure by Clinical Investigators:
Part 54
ď¨Institutional Review Boards:
Part 56
ď¨Investigational New Drug Applications:
Part 312
(Subpart D), Responsibilities of Clinical Investigators
and Sponsor
ď¨New Drug Applications:
Part 314
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6. Inspection of Clinical Investigators
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Does the principal investigator retain control of the trial and
has any authority been delegated?
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If authority has been delegated, has the principal
investigator retained control of the trial or has he/she given
full or partial control to someone else who FDA may not be
aware of until they initiate their inspection?
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FDA inspectors will conduct interviews and review
documentation in effort to identify all other physicians,
assistants, and any other personnel who are, or were,
associated with the trial; and to assess compliance to
protocol/SOPs/regulations
6
7. Three Types of Inspections of Clinical Investigators
Trial Oriented Inspection
⢠Primary focus is on verification of reported trial data related to an
NDA submission (pivotal trials)
Investigator Oriented Inspection
⢠Investigator Oriented: an inspection in which the focus is related
to suspicious behavior by the clinical investigator
Bioequivalence/Bioavailability Inspection
⢠Focus is mainly related to the conduct of the trial and collection
of data
7
9. Why is âMyâ Site Being Audited
ď¨ Investigator is conducting a significant # of clinical trials
ď¨ Investigator is conducting clinical trials outside his/her field of
specialization
ď¨ The investigator reports efficacy for a drug that appears to be too
good compared with the results of other investigators conducting
the same trial
ď¨ The investigator reports few adverse drug reactions as compared
with other investigators conducting the same trial
ď¨ Luck
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10. âFor Causeâ Inspections
No Advance Notice (1 day if lucky)ď
More Stressful Than Routine Inspections
Can Last for Weeks or Months with Intermittent Visits
May Involve FDA HQ Personnel
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11. What Could Prompt a âFor Causeâ Audit
ď¨ Complaint Related To Safety, Informed Consent, Coercion
ď¨ The Investigator Is Conducting Clinical Trials Outside His/Her Field
Of Specialization
ď¨ The FDA has received complaints from a patient or the sponsor
that the investigator is in alleged violation of the regulations,
protocol, or human rights
ď¨ The Investigator Reports Few Adverse Drug Reactions As
Compared With Other Investigators Conducting The Same Trial
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12. Four Major Segments of an FDA Inspection
Announcement of an
Inspection
Conduct of the Inspection
Exit Interview
Post Inspection
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14. Upon Arrival of the Auditor
ď¨ Contact Appropriate Personnel
ď¨ Confirm Credentials
ď¨ Receive FDA Form 482
ď¨ Determine Purpose
ď¨ Request Guidelines/expectations (Schedule, Debriefing,
Etc.)
ď¨ Assign an Appropriate Room
ď¨ FDA Inspection SOP
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15. Upon Announcement of an Inspection,
ď¨ Notify sponsor
cont.
ď¨ Retrieve CRFs for each
subject
ď¨ Establish roles
⢠primary/secondary
contacts
ď¨ Gather source
documents
⢠documentation
⢠making copies
ď¨ Retrieve & review trial
file & trial protocol
ď¨ Alert & prepare support
staff
ď¨ Visit/alert ancillary
facilities ( pharmacy,
clinical laboratory, etc.)
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16. Conduct of Inspection
ď¨
Tour/Facility Inspection
ď¨
Accompany At All Times
⢠Allow Inspector Quiet Time To Work
⢠Set Expectations
⢠Check Periodically To Answer Questions
ď¨
Staff Interviews
ď¨
Data Reviews
ď¨
Daily Debriefing
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17. Investigator Interview and Facility Inspection
People-Related Issues
ď¨ Who assisted in performing the trial?
ď¨ What were each personâs specific duties?
ď¨ How were the trial subjects recruited?
ď¨ Describe the monitoring (quality control)
procedures & your interaction with the monitor
⢠frequency of visits
⢠frequency of telephone calls
⢠information provided by monitor
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18. Investigator Interview and Facility Inspection, cont.
Facility-Related Issues
ď¨ Where was the trial conducted?
ď¨ What protocol specific equipment was used?
Where is it located?
ď¨ How and where were data recorded and stored?
ď¨ Where was investigational drug stored?
ď¨ What records provide documentation of drug
accountability to and from the sponsor?
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19. Review of Investigator Trial File
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â˘
â˘
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Protocol
Investigators Brochure
1572 with CV(s)
IRB/EC approval
letter(s) &
correspondence
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Sample IRB/IEC
approved informed
consent form
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Randomization
schedule
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â˘
â˘
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Monitoring documentation
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Signed consent form for each
subject
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Copies of completed CRFs
IND Safety Reports
Drug Accountability records
Lab Certification/CV(s)
Notification of trial end to
IRB/IEC & sponsor
19
20. Review of the Subjectsâ Consent Forms
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Review of the Signed Original And/or Revised Consent
Forms for Selected trial Subjects
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Verify Who Obtained or Witnessed Consent Process
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Verify Date of Consent to Ensure the Process Was
Before the Date of the First Trial Procedure
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Verify That Subjects Were Consented With the IRBApproved Form
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Verify That Each Subject Received a Copy of the
Original Signed Consent Form
20
21. Audit of Subjectsâ Records
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Review of Organization, Completeness, Condition, and
Location of Subjectsâ Records
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Review of Documentation to Assure That the Trial
Subjects Did Exist and Were Alive and Available for
Trial Participation
â˘
Review and Cross-comparison of Selected Case
Report Forms With Corresponding Source
Documentation
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22. Audit of Subjectsâ Records, cont.
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Review and evaluation of Serious Adverse Events,
and how and when they were reported to the IRB/IEC
and Sponsor
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Review for subject Drop-Outs
⢠Are they being reported to the sponsor?
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What are the reported reasons for Drop-Outs?
⢠Did patient move, experience some type of adverse
event, or decide to voluntarily withdraw?
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23. Examples of Areas Reviewed
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Compare adherence to
practices & procedures
to Contract/SOPs/
protocol/guidelines
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Identify
departments/functions/
key personnel
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Authority delegated
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Authority to review & approve
reports & data tables,
evaluations , AEâs
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Review contractual
agreement
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Organization charts
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Names/titles of
responsible persons
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Job descriptions, CVâs,
training records
â˘
Facility
â˘
Subject records
â˘
Drug accountability
23
24. Be Prepared to Discuss
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Responsibilities
â˘
SOPs
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Organization Chart
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Roles/Functions
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Training
⢠general
⢠trial specific
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Transfer of obligations
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Tracking of activities
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Central Files
Source Documents
Trial Documentation
Problem Resolution
Subject Screening/Decisions
AE Reporting
Validation
Equipment
Quality Assurance
24
25. Be Prepared to Discuss
Essentially,
anything related to your job,
internal processes
and the project
25
26. During the InterviewâŚ...
ď¨ be able to clearly & succinctly
explain your job responsibilities,
processes (know your job
description, SOPs, contracts,
protocol, etc.)
ď¨ think before you speak
ď¨ make sure you understand the
question
⢠DONâT ASSUME
⢠clarify if necessary
26
27. During the InterviewâŚâŚ cont.
ď¨ answer ONLY questions asked
⢠donât volunteer
⢠get comfortable with âpregnant
pauseâ
ď¨ answer ONLY questions related to
your position
ď¨ answer ONLY questions you
know, otherwise
⢠I donât know
⢠I will/someone else will follow up
ď¨ answer truthfully
27
28. During the InterviewâŚâŚ cont.
ď¨ Correct Erroneous Information
Provided
ď¨ Know & Refer Back to Processes
ď¨ Refer Back to Protocol, Reports, and
Other Documents
ď¨ Know Contract & Protocol
Expectations
ď¨ Be Positive
ď¨ Be Polite
ď¨ Be Prepared
ď¨ Be Alert to Hallway Talk
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29. During the InterviewâŚâŚ cont.
ď¨ Do Not Argue
ď¨ Do Not Deny the Obvious
ď¨ Do Not Get Hooked on âFishing
Expeditionsâ
ď¨ Do Not Comment on Quality
ď¨ Do Not Respond to Casual
Comments
29
30. During the InterviewâŚâŚ cont.
ď¨ Do Not Express Frustrations
or Editorialize
ď¨ Do Not Respond to Questions
Unless QA/Management Is
Present
ď¨ Do Not Read or Sign
Affidavits or Statements
ď¨ Do Not Provide Copies of Any
Documents (QA/Management)
30
31. FDA is trained in
interviewing &
interrogation
techniques
31
32. Conclusion
ď¨ Know & Follow SOPs, Protocol, Contract, Plans,
etc.
ď¨ Ensure Your CV, Training Records Are Current
ď¨ Document & Follow up With Problems
ď¨ Be Aware of Quality Trends
ď¨ Ensure Documentation Is Adequate & Accurately
Reflects Activities
32
33. Most Common Reasons for FDA to Reject a Trial
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Source Documentation Not Available
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Failed to Follow the Protocol
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Unreported Concomitant Medications That Might
Interfere With Evaluation of the Drug
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Unreported Adverse Experiences That Could Be
Associated With the Investigational Drug
33
34. Investigator-Oriented Inspections Results (FDA)
Inadequate and
inaccurate records
52%
failure to adhere
to protocol
52%
Inadequate subject
consent form
44%
inadequate record of
drug accountability
28%
Failure to inform IRB/IEC
of changes / progress
14%
34
35. Investigator-Oriented Inspections Results (FDA),
Deficiency
cont.
451 Inspections
Unapproved Concomitant Therapy
11%
Submission of False Data
11%
Problems With Records Availability
9%
Inappropriate Follow-up of Adverse Reactions
7%
Inappropriate Delegation of Authority
5%
Failure to Obtain IRB Approval
3%
Sub-investigators Not Listed
4%
June, 2008 to October, 2009
35
36. Trial Oriented Inspections Results (FDA)
Deficiency
483 Inspections
Inadequate Consent Form
49%
Failure to Adhere to Protocol
31%
Inadequate and Inaccurate Records
26%
Inadequate Drug Accountability
20%
Failure to Inform IRB of Changes / Progress
7%
Inappropriate Follow-up of Adverse Reactions
3%
Unapproved Concomitant Therapy
3%
Failure to Obtain IRB Approval
3%
Problems With Record Availability
3%
Sub-investigators Not Listed
2%
Failure to Obtain Informed Consent
1%
June, 2008 to October, 2009
36
37. Possible Adverse Consequences of FDAâs
Observation of Deficient Clinical Research
Investigator
Sponsor
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Restrictive Sanctions
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Rejection of Invalid Data
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Disqualification
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Delay of NDA Review
and Approval
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Criminal Prosecution
â˘
Unapproved NDA
37