1
|
Corneli A, McKenna K, Hanlen-Rosado E, Calvert SB, Mah E, Rosenfeld SJ. Stakeholder Reflections on Implementing the National Institutes of Health's Policy on Single Institutional Review Boards. Ethics Hum Res 2023; 45:15-26. [PMID: 37777977 DOI: 10.1002/eahr.500179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
The National Institutes of Health (NIH) requires use of a single institutional review board (sIRB) for multisite, nonexempt, NIH-funded research with human participants. The Clinical Trials Transformation Initiative (CTTI) conducted in-depth interviews with 34 stakeholders at two universities and in research administration leadership positions at multiple institutions about their experiences implementing the sIRB model, focusing on the NIH policy's goals soon after the policy was enacted. While some stakeholders suggested that using an sIRB has streamlined and reduced inefficiencies associated with the local IRB model, more stakeholders indicated that the sIRB model has not simplified the ethics review process and instead created new inefficiencies due to unclear roles and responsibilities for staff and institutions; a lack of systems and processes for implementing the sIRB model, including communication systems; and increased workloads. CTTI used these findings to propose a new framework for evaluating the NIH sIRB policy.
Collapse
Affiliation(s)
- Amy Corneli
- Associate professor in the Department of Population Health Sciences, a faculty member at the Duke Clinical Research Institute, and a lead social scientist of the Clinical Trials Transformation Initiative at Duke University School of Medicine
| | - Kevin McKenna
- Research program leader in the Department of Population Health Sciences and a senior research associate of the Clinical Trials Transformation Initiative at Duke University School of Medicine
| | - Emily Hanlen-Rosado
- Research program leader in the Department of Population Health Sciences and a research associate of the Clinical Trials Transformation Initiative at Duke University School of Medicine
| | - Sara B Calvert
- Director of projects in the Clinical Trials Transformation Initiative at Duke Clinical Research Institute at Duke University
| | - Eric Mah
- Associate dean of clinical and translational research in the Department of Health Sciences at the University of California, San Diego
| | | |
Collapse
|
2
|
Eisenstein EL, Walden A, Donovan K, Zozus MN, Yu FB, West VL, Hammond WE, Muhlbaier LH. Economic analysis of a single institutional review board data exchange standard in multisite clinical studies. Contemp Clin Trials 2022; 122:106953. [PMID: 36202199 PMCID: PMC10015373 DOI: 10.1016/j.cct.2022.106953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/17/2022] [Accepted: 09/29/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Single Institutional Review Boards (sIRB) are not achieving the benefits envisioned by the National Institutes of Health. The recently published Health Level Seven (HL7®) Fast Healthcare Interoperability Resources (FHIR®) data exchange standard seeks to improve sIRB operational efficiency. METHODS AND RESULTS We conducted a study to determine whether the use of this standard would be economically attractive for sIRB workflows collectively and for Reviewing and Relying institutions. We examined four sIRB-associated workflows at a single institution: (1) Initial Study Protocol Application, (2) Site Addition for an Approved sIRB study, (3) Continuing Review, and (4) Medical and Non-Medical Event Reporting. Task-level information identified personnel roles and their associated hour requirements for completion. Tasks that would be eliminated by the data exchange standard were identified. Personnel costs were estimated using annual salaries by role. No tasks would be eliminated in the Initial Study Protocol Application or Medical and Non-Medical Event Reporting workflows through use of the proposed data exchange standard. Site Addition workflow hours would be reduced by 2.50 h per site (from 15.50 to 13.00 h) and Continuing Review hours would be reduced by 9.00 h per site per study year (from 36.50 to 27.50 h). Associated costs savings were $251 for the Site Addition workflow (from $1609 to $1358) and $1033 for the Continuing Review workflow (from $4110 to $3076). CONCLUSION Use of the proposed HL7 FHIR® data exchange standard would be economically attractive for sIRB workflows collectively and for each entity participating in the new workflows.
Collapse
Affiliation(s)
| | - Anita Walden
- Oregon Health & Science University, Portland, OR, USA.
| | - Katrina Donovan
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Meredith N Zozus
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Feliciano B Yu
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | | | | | | |
Collapse
|
3
|
Cudkowicz M, Chase MK, Coffey CS, Ecklund DJ, Thornell BJ, Lungu C, Mahoney K, Gutmann L, Shefner JM, Staley KJ, Bosch M, Foster E, Long JD, Bayman EO, Torner J, Yankey J, Peters R, Huff T, Conwit RA, Shinnar S, Patch D, Darras BT, Ellis A, Packer RJ, Marder KS, Chiriboga CA, Henchcliffe C, Moran JA, Nikolov B, Factor SA, Seeley C, Greenberg SM, Amato AA, DeGregorio S, Simuni T, Ward T, Kissel JT, Kolb SJ, Bartlett A, Quinn JF, Keith K, Levine SR, Gilles N, Coyle PK, Lamb J, Wolfe GI, Crumlish A, Mejico L, Iqbal MM, Bowen JD, Tongco C, Nabors LB, Bashir K, Benge M, McDonald CM, Henricson EK, Oskarsson B, Dobkin BH, Canamar C, Glauser TA, Woo D, Molloy A, Clark P, Vollmer TL, Stein AJ, Barohn RJ, Dimachkie MM, Le Pichon JB, Benatar MG, Steele J, Wechsler L, Clemens PR, Amity C, Holloway RG, Annis C, Goldberg MP, Andersen M, Iannaccone ST, Smith AG, Singleton JR, Doudova M, Haley EC, Quigg MS, Lowenhaupt S, Malow BA, Adkins K, Clifford DB, Teshome MA, Connolly N. Seven-Year Experience From the National Institute of Neurological Disorders and Stroke-Supported Network for Excellence in Neuroscience Clinical Trials. JAMA Neurol 2021; 77:755-763. [PMID: 32202612 DOI: 10.1001/jamaneurol.2020.0367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance One major advantage of developing large, federally funded networks for clinical research in neurology is the ability to have a trial-ready network that can efficiently conduct scientifically rigorous projects to improve the health of people with neurologic disorders. Observations National Institute of Neurological Disorders and Stroke Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT) was established in 2011 and renewed in 2018 with the goal of being an efficient network to test between 5 and 7 promising new agents in phase II clinical trials. A clinical coordinating center, data coordinating center, and 25 sites were competitively chosen. Common infrastructure was developed to accelerate timelines for clinical trials, including central institutional review board (a first for the National Institute of Neurological Disorders and Stroke), master clinical trial agreements, the use of common data elements, and experienced research sites and coordination centers. During the first 7 years, the network exceeded the goal of conducting 5 to 7 studies, with 9 funded. High interest was evident by receipt of 148 initial applications for potential studies in various neurologic disorders. Across the first 8 studies (the ninth study was funded at end of initial funding period), the central institutional review board approved the initial protocol in a mean (SD) of 59 (21) days, and additional sites were added a mean (SD) of 22 (18) days after submission. The median time from central institutional review board approval to first site activation was 47.5 days (mean, 102.1; range, 1-282) and from first site activation to first participant consent was 27 days (mean, 37.5; range, 0-96). The median time for database readiness was 3.5 months (mean, 4.0; range, 0-8) from funding receipt. In the 4 completed studies, enrollment met or exceeded expectations with 96% overall data accuracy across all sites. Nine peer-reviewed manuscripts were published, and 22 oral presentations or posters and 9 invited presentations were given at regional, national, and international meetings. Conclusions and Relevance NeuroNEXT initiated 8 studies, successfully enrolled participants at or ahead of schedule, collected high-quality data, published primary results in high-impact journals, and provided mentorship, expert statistical, and trial management support to several new investigators. Partnerships were successfully created between government, academia, industry, foundations, and patient advocacy groups. Clinical trial consortia can efficiently and successfully address a range of important neurologic research and therapeutic questions.
Collapse
Affiliation(s)
| | | | | | | | | | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland
| | | | | | - Jeremy M Shefner
- Barrow Neurological Institute, University of Arizona College of Medicine, Tucson
| | | | | | | | | | | | | | | | | | | | - Robin A Conwit
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland
| | | | - Shlomo Shinnar
- Montefiore Medical Center: Einstein Campus, Bronx, New York
| | - Donna Patch
- Montefiore Medical Center: Einstein Campus, Bronx, New York
| | | | - Audrey Ellis
- Boston Children's Hospital, Boston, Massachusetts
| | | | - Karen S Marder
- Columbia University Irving Medical Center, New York, New York.,Weill Cornell Medical, New York, New York
| | - Claudia A Chiriboga
- Columbia University Irving Medical Center, New York, New York.,Weill Cornell Medical, New York, New York
| | - Claire Henchcliffe
- Columbia University Irving Medical Center, New York, New York.,Weill Cornell Medical, New York, New York
| | - Joyce Ann Moran
- Columbia University Irving Medical Center, New York, New York.,Weill Cornell Medical, New York, New York
| | - Blagovest Nikolov
- Columbia University Irving Medical Center, New York, New York.,Weill Cornell Medical, New York, New York
| | | | - Carole Seeley
- Emory University School of Medicine, Atlanta, Georgia
| | - Steven M Greenberg
- Massachusetts General Hospital, Boston.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Anthony A Amato
- Massachusetts General Hospital, Boston.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Sara DeGregorio
- Massachusetts General Hospital, Boston.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tina Ward
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John T Kissel
- Ohio State University Wexner Medical Center, Columbus
| | | | - Amy Bartlett
- Ohio State University Wexner Medical Center, Columbus
| | | | | | | | | | - Patricia K Coyle
- Stony Brook University, State University of New York, Stony Brook
| | - Jessica Lamb
- Stony Brook University, State University of New York, Stony Brook
| | - Gil I Wolfe
- University at Buffalo, State University of New York, Buffalo
| | | | - Luis Mejico
- SUNY Upstate Medical University, Syracuse, New York
| | | | | | | | | | | | | | | | | | | | | | | | - Tracy A Glauser
- Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Daniel Woo
- Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Angela Molloy
- Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Peggy Clark
- Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Richard J Barohn
- Children's Mercy Hospital, University of Kansas, Kansas City, Missouri
| | - Mazen M Dimachkie
- Children's Mercy Hospital, University of Kansas, Kansas City, Missouri
| | | | - Michael G Benatar
- University of Miami Miller School of Medicine, Coral Gables, Florida
| | - Julie Steele
- University of Miami Miller School of Medicine, Coral Gables, Florida
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Taylor HA, Ehrhardt S, Ervin AM. Public Comments on the Proposed Common Rule Mandate for Single-IRB Review of Multisite Research. Ethics Hum Res 2019; 41:15-21. [PMID: 30744312 DOI: 10.1002/eahr.500002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We reviewed the public comments submitted in response to the Department of Health and Human Services' (DHHS's) original and revised proposal for mandated single-IRB review of federally funded multisite research to see who responded to the proposed mandate and to determine what they said and how the agency addressed the public comments in its revised proposal. Our analysis indicates that support for the single-IRB mandate was limited. The most common argument against the proposed mandate came from those concerned with the loss of site-specific institutional review board (IRB) review of the protocol for a multisite study to address issues relevant to local context. Concerns were also raised that the single-IRB approach would replace one inefficient system (that entails, for example, multiple reviews of a single study) with another potentially inefficient system (involving the negotiation and management of multiple interinstitutional agreements). Empirical research about the implementation of DHHS's final rule-and the separate rule of the National Institutes of Health-mandating single-IRB review is needed to determine whether the single-IRB model achieves the stated goals.
Collapse
Affiliation(s)
- Holly A Taylor
- Associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and a member of the core faculty at Johns Hopkins Berman Institute of Bioethics
| | - Stephan Ehrhardt
- Associate professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health
| | - Ann-Margret Ervin
- Assistant scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health
| |
Collapse
|
5
|
Behera SK, Das S, Xavier AS, Selvarajan S, Anandabaskar N. Indian Council of Medical Research's National Ethical Guidelines for biomedical and health research involving human participants: The way forward from 2006 to 2017. Perspect Clin Res 2019; 10:108-114. [PMID: 31404208 PMCID: PMC6647898 DOI: 10.4103/picr.picr_10_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The Indian Council of Medical Research (ICMR) recently published the third revised guidelines "National Ethical Guidelines for Biomedical and Health-Related Research Involving Human Participants" in 2017. The changes to the guidelines were needed to acculturate the rapid advances in the research environment and advances in science and technology. The revised guidelines propose substantial changes/ modifications compared to the previous version. These include the introduction of broad consent, ethical issues related to deception, review of multi-centric research by a single ethics committee and ethical issues involved in implementation research and other issues related to public health research. The revised guidelines also incorporate modifications and minor changes to the previous version. Although most of the changes in the revised guidelines are in parallel to most of the international guidelines, we have also highlighted the minor differences compared to other international guidelines.
Collapse
Affiliation(s)
- Sapan Kumar Behera
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Saibal Das
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Alphienes Stanley Xavier
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sandhiya Selvarajan
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
- IEC (Human Studies), Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nishanthi Anandabaskar
- Department of Pharmacology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| |
Collapse
|
6
|
Adams HR, Defendorf S, Vierhile A, Mink JW, Marshall FJ, Augustine EF. A novel, hybrid, single- and multi-site clinical trial design for CLN3 disease, an ultra-rare lysosomal storage disorder. Clin Trials 2019; 16:555-560. [PMID: 31184505 DOI: 10.1177/1740774519855715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Travel burden often substantially limits the ability of individuals to participate in clinical trials. Wide geographic dispersion of individuals with rare diseases poses an additional key challenge in the conduct of clinical trials for rare diseases. Novel technologies and methods can improve access to research by connecting participants in their homes and local communities to a distant research site. For clinical trials, however, understanding of factors important for transition from traditional multi-center trial models to local participation models is limited. We sought to test a novel, hybrid, single- and multi-site clinical trial design in the context of a trial for Juvenile Neuronal Ceroid Lipofuscinosis (CLN3 disease), a very rare pediatric neurodegenerative disorder. METHODS We created a "hub and spoke" model for implementing a 22-week crossover clinical trial of mycophenolate compared with placebo, with two 8-week study arms. A single central site, the "hub," conducted screening, consent, drug dispensing, and tolerability and efficacy assessments. Each participant identified a clinician to serve as a collaborating "spoke" site to perform local safety monitoring. Study participants traveled to the hub at the beginning and end of each study arm, and to their individual spoke site in the intervening weeks. RESULTS A total of 18 spoke sites were established for 19 enrolled study participants. One potential participant was unable to identify a collaborating local site and was thus unable to participate. Study start-up required a median 6.7 months (interquartile range = 4.6-9.2 months). Only 33.3% (n = 6 of 18) of spoke site investigators had prior clinical trial experience, thus close collaboration with respect to study startup, training, and oversight was an important requirement. All but one participant completed all study visits; no study visits were missed due to travel requirements. CONCLUSIONS This study represents a step toward local trial participation for patients with rare diseases. Even in the context of close oversight, local participation models may be best suited for studies of compounds with well-understood side-effect profiles, for those with straightforward modes of administration, or for studies requiring extended follow-up periods.
Collapse
Affiliation(s)
- Heather R Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Sara Defendorf
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Amy Vierhile
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Jonathan W Mink
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
| | - Frederick J Marshall
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Erika F Augustine
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.,Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
7
|
Henrikson NB, Blasi PR, Corsmo JJ, Sheffer Serdoz E, Scrol A, Greene SM, Matthews TL, Ralston JD. "You Really Do Have to Know the Local Context": IRB Administrators and Researchers on the Implications of the NIH Single IRB Mandate for Multisite Genomic Studies. J Empir Res Hum Res Ethics 2019; 14:286-295. [PMID: 31113270 DOI: 10.1177/1556264619850440] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 2016, the U.S. National Institutes of Health (NIH) announced a new policy requiring single institutional review board (sIRB) review for multisite studies. However, adherence to the new policy requires the separation of regulatory institutional review board (IRB) work per Federal guidance from site-specific local compliance concerns. In particular, genomic research is subject to a wide range of state laws, institutional requirements, and local population preferences. In this qualitative study, we explored the anticipated needs of genomics researchers and IRB administrators around implementing the policy. We observed multiple uncertainties, particularly about intersite communication processes, sIRB selection processes, and roles of the reviewing IRB and local sites regarding local context information relevant to genomics. Optimal implementation of the NIH policy may require additional guidance for researchers and IRB administrators.
Collapse
Affiliation(s)
- Nora B Henrikson
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Paula R Blasi
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Jeremy J Corsmo
- 2 Cincinnati Children's Hospital Medical Center, OH, USA.,3 University of Cincinnati, OH, USA
| | | | - Aaron Scrol
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Sarah M Greene
- 5 Health Care Systems Research Network, Seattle, WA, USA
| | - Tanya L Matthews
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - James D Ralston
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, USA
| |
Collapse
|
8
|
Kaufmann P, Pariser AR, Austin C. From scientific discovery to treatments for rare diseases - the view from the National Center for Advancing Translational Sciences - Office of Rare Diseases Research. Orphanet J Rare Dis 2018; 13:196. [PMID: 30400963 PMCID: PMC6219030 DOI: 10.1186/s13023-018-0936-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022] Open
Abstract
We now live in a time of unprecedented opportunities to turn scientific discoveries into better treatments for the estimated 30 million people in the US living with rare diseases. Despite these scientific advances, more than 90% of rare diseases still lack an effective treatment. New data and genetics technologies have resulted in the first transformational new treatments for a handful of rare diseases. This challenges us as a society to accelerate progress so that no disease and no patient is, ultimately, left behind in getting access to safe and effective therapeutics. This article reviews initiatives of the National Center for Advancing Translational Sciences (NCATS) Office of Rare Diseases Research (ORDR) that are aimed at catalyzing rare diseases research. These initiatives fall into two groups: Promoting information sharing; and building multi-disciplinary multi-stakeholder collaborations. Among ORDR’s information sharing initiatives are GARD (The Genetics and Rare Diseases Information Center), RaDaR (The Rare Diseases Registries Program) and the NCATS Toolkit for Patient-Focused Therapy Development (Toolkit). Among the collaboration initiatives are the RDCRN (Rare Diseases Clinical Research Network), and the NCATS ORDR support for conferences and workshops. Despite the success of these programs, there remains substantial work to be done to build enhanced collaborations, clinical harmonization and interoperability, and stakeholder engagement so that the recent scientific advances can benefit all patients on the long list of rare diseases waiting for help.
Collapse
Affiliation(s)
- Petra Kaufmann
- Avexis Inc. Formerly of Office of Rare Diseases Research (ORDR), National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | | |
Collapse
|
9
|
Diamond MP, Eisenberg E, Huang H, Coutifaris C, Legro RS, Hansen KR, Steiner AZ, Cedars M, Barnhart K, Ziolek T, Thomas TR, Maurer K, Krawetz SA, Wild RA, Trussell JC, Santoro N, Zhang H. The efficiency of single institutional review board review in National Institute of Child Health and Human Development Cooperative Reproductive Medicine Network-initiated clinical trials. Clin Trials 2018; 16:3-10. [PMID: 30354458 DOI: 10.1177/1740774518807888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Timely review of research protocols by institutional review boards leads to more rapid initiation of clinical trials, which is critical to expeditious translation from bench to bedside. This observational study examined the impact of a single institutional review board on time and efforts required to initiate clinical trials by the National Institute of Child Health and Human Development Cooperative Reproductive Medicine Network. METHODS Collection of data from the same six main clinical sites for three current clinical trials and two past clinical trials, including time from institutional review board submission to approval, pages submitted, consent form length, number of required attachments, other regulatory requirements, order of review at central or local sites, and language in documents at individual participating sites. Results from two past clinical trials were also included. RESULTS While time required for actual institutional review board submission's review and initial approval was reduced with use of a single institutional review board for multicenter trials (from a mean of 66.7-24.0 days), total time was increased (to a mean of 111.2 or 123.3 days). In addition to single institutional review board approval, all institutions required local approval of some components (commonly consent language and use of local language), which varied considerably. The single institutional review board relied on local institutions for adding or removing personnel, conflict of interest review, and auditing of activities. CONCLUSION A single institutional review board reduced time for initial review and approval of protocols and informed consents, although time for the entire process was increased, as individual institutions retained oversight of components of required regulatory review. In order to best achieve the National Institute of Health's goals for improved efficiency in initiation and conduct of multisite clinical research, greater coordination with local institutional review boards is key to streamlining and accelerating initiation of multisite clinical research.
Collapse
Affiliation(s)
- Michael P Diamond
- 1 Department of Obstetrics & Gynecology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Esther Eisenberg
- 2 Fertility and Infertility Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - Hao Huang
- 3 Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Christos Coutifaris
- 4 Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard S Legro
- 5 Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, PA, USA
| | - Karl R Hansen
- 6 Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | - Anne Z Steiner
- 7 Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Marcelle Cedars
- 8 Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Kurt Barnhart
- 4 Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tracy Ziolek
- 4 Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tracey R Thomas
- 3 Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Kate Maurer
- 4 Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen A Krawetz
- 9 Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Robert A Wild
- 6 Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | - J C Trussell
- 10 Upstate University Hospital, Syracuse, NY, USA
| | - Nanette Santoro
- 11 Department of Obstetrics and Gynecology, University of Colorado Denver, Denver, CO, USA
| | - Heping Zhang
- 3 Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | | |
Collapse
|
10
|
Implications of the Revised Common Rule for Human Participant Research. Chest 2018; 155:272-278. [PMID: 30312589 DOI: 10.1016/j.chest.2018.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 11/20/2022] Open
Abstract
This paper looks at the implications of changes to the regulatory governance of human participant research that can be expected with implementation of the Revised Common Rule (RCR). The RCR refers to revisions of the existing federal regulations that govern the performance of research involving human subjects (ie, clinical research) in the United States and, under certain circumstances, when such research is also performed outside the United States. The term "common" is included because it refers to the fact that these regulations, often referred to as Code of Federal Regulations 46, is the common denominator regulations agreed to across a wide swath of federal agencies.
Collapse
|
11
|
Bartlett A, Kolb SJ, Kingsley A, Swoboda KJ, Reyna SP, Sakonju A, Darras BT, Shell R, Kuntz N, Castro D, Iannaccone ST, Parsons J, Connolly AM, Chiriboga CA, McDonald C, Burnette WB, Werner K, Thangarajh M, Shieh PB, Finanger E, Coffey CS, Yankey JW, Cudkowicz ME, McGovern MM, McNeil DE, Arnold WD, Kissel JT. Recruitment & retention program for the NeuroNEXT SMA Biomarker Study: Super Babies for SMA! Contemp Clin Trials Commun 2018; 11:113-119. [PMID: 30094386 PMCID: PMC6072892 DOI: 10.1016/j.conctc.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/26/2018] [Accepted: 07/12/2018] [Indexed: 01/09/2023] Open
Abstract
Background/Aims Recruitment and retention of research participants are challenging and critical components of successful clinical trials and natural history studies. Infants with spinal muscular atrophy (SMA) have been a particularly challenging population to study due to their fragile and complex medical issues, poor prognosis and, until 2016, a lack of effective therapies. Recruitment of healthy infants into clinical trials and natural history studies is also challenging and sometimes assumed to not be feasible. Methods In 2011, our group initiated a two-year, longitudinal natural history study of infants with SMA and healthy infant controls to provide data to assist in the analysis and interpretation of planned clinical trials in infants with SMA. The recruitment goal was to enroll 27 infants less than 6 months of age with SMA and 27 age-matched healthy infants within the two-year enrollment period. A detailed recruitment and retention plan was developed for this purpose. In addition, a survey was administered to participant families to understand the determinants of participation in the study. Results All healthy infants were recruited within the study's first year and 26 SMA infants were recruited within the two-year recruitment period. Thirty-eight participant families responded to the recruitment determinants survey. Nearly half of respondents (18/38, 48%) reported that they first heard of the study from their physician or neurologist. The most common reason to decide to enroll their infant (22/38, 58%) and to remain in the study (28/38, 74%) was their understanding of the importance of the study. Thematic recruitment tools such as a study brochure, video on social media, and presentations at advocacy meetings were reported to positively influence the decision to enroll. Conclusions A proactive, thematic and inclusive recruitment and retention plan that effectively communicates the rationale of a clinical study and partners with patients, advocacy groups and the local communities can effectively recruit participants in vulnerable populations. Recommendations for the proactive integration of recruitment and retention plans into clinical trial protocol development are provided.
Collapse
Affiliation(s)
- Amy Bartlett
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Stephen J. Kolb
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Corresponding author. Department of Neurology, Wexner Medical Center at The Ohio State University, Rightmire Hall, Rm 226A, 1060 Carmack Road, Columbus, OH, 43210, United States.
| | - Allison Kingsley
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Kathryn J. Swoboda
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
- Department of Neurology, Boston Children's Hospital, Boston, MA, United States
| | - Sandra P. Reyna
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
- Biogen, Boston, MA, United States
| | - Ai Sakonju
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
- SUNY Upstate Medical Center, Syracuse, NY, United States
| | - Basil T. Darras
- Department of Neurology, Boston Children's Hospital, Boston, MA, United States
| | - Richard Shell
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Nancy Kuntz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Diana Castro
- UT Southwestern Medical Center, Dallas, TX, United States
| | | | - Julie Parsons
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
| | - Anne M. Connolly
- Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Claudia A. Chiriboga
- Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY, United States
| | - Craig McDonald
- University of California - Davis, Davis, CA, United States
| | | | - Klaus Werner
- Duke University Medical Center, Durham, NC, United States
| | | | - Perry B. Shieh
- University of California - Los Angeles, Los Angeles, CA, United States
| | - Erika Finanger
- Dorenbecher Children's Hospital, Portland, OR, United States
| | - Christopher S. Coffey
- Department of Biostatistics, NeuroNEXT Data Coordinating Center, University of Iowa, Iowa City, IA, United States
| | - Jon W. Yankey
- Department of Biostatistics, NeuroNEXT Data Coordinating Center, University of Iowa, Iowa City, IA, United States
| | - Merit E. Cudkowicz
- Department of Neurology, NeuroNEXT Clinical Coordinating Center, Massachusetts General Hospital, Boston, MA, United States
| | - Michelle M. McGovern
- Department of Neurology, NeuroNEXT Clinical Coordinating Center, Massachusetts General Hospital, Boston, MA, United States
| | - D. Elizabeth McNeil
- Biogen, Boston, MA, United States
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - W. David Arnold
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Physical Medical and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - John T. Kissel
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | |
Collapse
|
12
|
Johnson AM, Jones SB, Duncan PW, Bushnell CD, Coleman SW, Mettam LH, Kucharska-Newton AM, Sissine ME, Rosamond WD. Hospital recruitment for a pragmatic cluster-randomized clinical trial: Lessons learned from the COMPASS study. Trials 2018; 19:74. [PMID: 29373987 PMCID: PMC5787294 DOI: 10.1186/s13063-017-2434-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/29/2017] [Indexed: 11/10/2022] Open
Abstract
Background Pragmatic randomized clinical trials are essential to determine the effectiveness of interventions in “real-world” clinical practice. These trials frequently use a cluster-randomized methodology, with randomization at the site level. Despite policymakers’ increased interest in supporting pragmatic randomized clinical trials, no studies to date have reported on the unique recruitment challenges faced by cluster-randomized pragmatic trials. We investigated key challenges and successful strategies for hospital recruitment in the Comprehensive Post-Acute Stroke Services (COMPASS) study. Methods The COMPASS study is designed to compare the effectiveness of the COMPASS model versus usual care in improving functional outcomes, reducing the numbers of hospital readmissions, and reducing caregiver strain for patients discharged home after stroke or transient ischemic attack. This model integrates early supported discharge planning with transitional care management, including nurse-led follow-up phone calls after 2, 30, and 60 days and an in-person clinic visit at 7–14 days involving a functional assessment and neurological examination. We present descriptive statistics of the characteristics of successfully recruited hospitals compared with all eligible hospitals, reasons for non-participation, and effective recruitment strategies. Results We successfully recruited 41 (43%) of 95 eligible North Carolina hospitals. Leading, non-exclusive reasons for non-participation included: insufficient staff or financial resources (n = 33, 61%), lack of health system support (n = 16, 30%), and lack of support of individual decision-makers (n = 11, 20%). Successful recruitment strategies included: building and nurturing relationships, engaging team members and community partners with a diverse skill mix, identifying gatekeepers, finding mutually beneficial solutions, having a central institutional review board, sharing published pilot data, and integrating contracts and review board administrators. Conclusions Although we incorporated strategies based on the best available evidence at the outset of the study, hospital recruitment required three times as much time and considerably more staff than anticipated. To reach our goal, we tailored strategies to individuals, hospitals, and health systems. Successful recruitment of a sufficient number and representative mix of hospitals requires considerable preparation, planning, and flexibility. Strategies presented here may assist future trial organizers in implementing cluster-randomized pragmatic trials. Trial registration Clinicaltrials.gov, NCT02588664. Registered on 23 October 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2434-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anna M Johnson
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA.
| | - Sara B Jones
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA
| | - Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sylvia W Coleman
- Department of Neurology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Laurie H Mettam
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA
| | - Anna M Kucharska-Newton
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA
| | - Mysha E Sissine
- Department of Neurology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Wayne D Rosamond
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA
| |
Collapse
|
13
|
Krosschell KJ, Bosch M, Nelson L, Duong T, Lowes LP, Alfano LN, Benjamin D, Carry TB, Devine G, Kelley C, Gadekan R, Malkus EC, Pasternak A, Provance-Orr S, Roemeiser-Logan L, Nicorici A, Trussell D, Young SD, Fetterman JR, Montes J, Powers PJ, Quinones R, Quigley J, Coffey CS, Yankey JW, Bartlett A, Kissel JT, Kolb SJ. Motor Function Test Reliability During the NeuroNEXT Spinal Muscular Atrophy Infant Biomarker Study. J Neuromuscul Dis 2018; 5:509-521. [PMID: 30223401 PMCID: PMC8112280 DOI: 10.3233/jnd-180327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The NeuroNEXT SMA Infant Biomarker Study, a two year, longitudinal, multi-center study of infants with SMA type 1 and healthy infants, presented a unique opportunity to assess multi-site rater reliability on three infant motor function tests (MFTs) commonly used to assess infants with SMA type 1. OBJECTIVE To determine the effect of prospective MFT rater training and the effect of rater experience on inter-rater and intra-rater reliability for the Test of Infant Motor Performance Screening Items (TIMPSI), the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) and the Alberta Infant Motor Scale (AIMS). METHODS Training was conducted utilizing a novel set of motor function test (MFT) videos to optimize accurate MFT administration and reliability for the study duration. Inter- and intra-rater reliability of scoring for the TIMPSI and inter-rater reliability of scoring for the CHOP INTEND and the AIMS was assessed using intraclass correlation coefficients (ICC). Effect of rater experience on reliability was examined using ICC. Agreement with 'expert' consensus scores was examined using Pearson's correlation coefficients. RESULTS Inter-rater reliability on all MFTs was good to excellent. Intra-rater reliability for the primary MFT, the TIMPSI, was excellent for the study duration. Agreement with 'expert' consensus was within predetermined limits (≥85%) after training. Evaluator experience with SMA and MFTs did not affect reliability. CONCLUSIONS Reliability of scores across evaluators was demonstrated for all three study MFTs and scores were reproducible on repeated administration. Evaluator experience had no effect on reliability.
Collapse
Affiliation(s)
- Kristin J. Krosschell
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Bosch
- Department of Biostatistics, NeuroNEXT Data Coordinating Center, University of Iowa, Iowa City, IA, USA
| | - Leslie Nelson
- Physical Therapy, UT Southwestern Medical Center, Dallas, TX, USA
| | - Tina Duong
- Department of Neurology, Stanford University, Palo Alto, CA, USA
| | - Linda P. Lowes
- Neurology, Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Danielle Benjamin
- Physical Therapy, Oregon Health and Science University, Portland, OR, USA
| | - Terri B. Carry
- Physical Therapy, Children’s Hospital Colorado, Aurora, CO, USA
| | - Ginger Devine
- Pi Beta Phi Rehabilitation Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carolyn Kelley
- Physical Therapy, Children’s Hospital Colorado, Aurora, CO, USA
| | - Rebecca Gadekan
- Neuromuscular Division, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Amy Pasternak
- The Department of Physical Therapy and Occupational Therapy Services, Boston Children’s Hospital, Boston, MA, USA
- The Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
| | | | | | - Alina Nicorici
- Physical Medicine and Rehabilitation, University of California – Davis, Davis, CA, USA
| | | | - Sally Dunaway Young
- Departments of Neurology and Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Jacqueline Montes
- Departments of Neurology and Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
| | - Penny J. Powers
- Pi Beta Phi Rehabilitation Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Janet Quigley
- The Department of Physical Therapy and Occupational Therapy Services, Boston Children’s Hospital, Boston, MA, USA
- The Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
| | - Christopher S. Coffey
- Department of Biostatistics, NeuroNEXT Data Coordinating Center, University of Iowa, Iowa City, IA, USA
| | - Jon W. Yankey
- Department of Biostatistics, NeuroNEXT Data Coordinating Center, University of Iowa, Iowa City, IA, USA
| | - Amy Bartlett
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John T. Kissel
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephen J. Kolb
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
14
|
Largent EA, Weissman JS, Gupta A, Abraham M, Rozenblum R, Lynch HF, Cohen IG. Patient-Centered Outcomes Research: Stakeholder Perspectives and Ethical and Regulatory Oversight Issues. ACTA ACUST UNITED AC 2018. [DOI: 10.1002/eahr.401002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Emily A. Largent
- University of Pennsylvania; Leonard Davis Institute of Health Economics; Perelman School of Medicine
| | | | - Avni Gupta
- Women’s Hospital; Center for Surgery and Public Health; Brigham
| | - Melissa Abraham
- Harvard Medical School; Massachusetts General Hospital; Harvard Medical School; Department of Psychiatry; Center for Bioethics
| | - Ronen Rozenblum
- Women’s Hospital; Harvard Medical School; Unit for Innovative Healthcare Practice and Technology; Brigham
| | - Holly Fernandez Lynch
- University of Pennsylvania; Leonard Davis Institute of Health Economics; Perelman School of Medicine
| | - I. Glenn Cohen
- Harvard Law School; Harvard Law School; Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics
| |
Collapse
|
15
|
Largent EA, Weissman JS, Gupta A, Abraham M, Rozenblum R, Lynch HF, Cohen IG. Patient-Centered Outcomes Research: Stakeholder Perspectives and Ethical and Regulatory Oversight Issues. IRB 2018; 40:7-17. [PMID: 30631218 PMCID: PMC6324926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- Emily A Largent
- Research Associate, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital
| | - Avni Gupta
- Center for Surgery and Public Health, Brigham and Women's Hospital
| | - Melissa Abraham
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital and Faculty Associate Center for Bioethics, Harvard Medical School
| | - Ronen Rozenblum
- Unit for Innovative Healthcare Practice and Technology, Brigham and Women's Hospital Harvard Medical School
| | - Holly Fernandez Lynch
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School Faculty, Center for Bioethics, Harvard Medical School
| | - I Glenn Cohen
- Harvard Law School, Faculty Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School
| |
Collapse
|
16
|
Kolb SJ, Coffey CS, Yankey JW, Krosschell K, Arnold WD, Rutkove SB, Swoboda KJ, Reyna SP, Sakonju A, Darras BT, Shell R, Kuntz N, Castro D, Parsons J, Connolly AM, Chiriboga CA, McDonald C, Burnette WB, Werner K, Thangarajh M, Shieh PB, Finanger E, Cudkowicz ME, McGovern MM, McNeil DE, Finkel R, Iannaccone ST, Kaye E, Kingsley A, Renusch SR, McGovern VL, Wang X, Zaworski PG, Prior TW, Burghes AHM, Bartlett A, Kissel JT. Natural history of infantile-onset spinal muscular atrophy. Ann Neurol 2017; 82:883-891. [PMID: 29149772 DOI: 10.1002/ana.25101] [Citation(s) in RCA: 251] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Infantile-onset spinal muscular atrophy (SMA) is the most common genetic cause of infant mortality, typically resulting in death preceding age 2. Clinical trials in this population require an understanding of disease progression and identification of meaningful biomarkers to hasten therapeutic development and predict outcomes. METHODS A longitudinal, multicenter, prospective natural history study enrolled 26 SMA infants and 27 control infants aged <6 months. Recruitment occurred at 14 centers over 21 months within the NINDS-sponsored NeuroNEXT (National Network for Excellence in Neuroscience Clinical Trials) Network. Infant motor function scales (Test of Infant Motor Performance Screening Items [TIMPSI], The Children's Hospital of Philadelphia Infant Test for Neuromuscular Disorders, and Alberta Infant Motor Score) and putative physiological and molecular biomarkers were assessed preceding age 6 months and at 6, 9, 12, 18, and 24 months with progression, correlations between motor function and biomarkers, and hazard ratios analyzed. RESULTS Motor function scores (MFS) and compound muscle action potential (CMAP) decreased rapidly in SMA infants, whereas MFS in all healthy infants rapidly increased. Correlations were identified between TIMPSI and CMAP in SMA infants. TIMPSI at first study visit was associated with risk of combined endpoint of death or permanent invasive ventilation in SMA infants. Post-hoc analysis of survival to combined endpoint in SMA infants with 2 copies of SMN2 indicated a median age of 8 months at death (95% confidence interval, 6, 17). INTERPRETATION These data of SMA and control outcome measures delineates meaningful change in clinical trials in infantile-onset SMA. The power and utility of NeuroNEXT to provide "real-world," prospective natural history data sets to accelerate public and private drug development programs for rare disease is demonstrated. Ann Neurol 2017;82:883-891.
Collapse
Affiliation(s)
- Stephen J Kolb
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH.,Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Christopher S Coffey
- Department of Biostatistics, NeuroNEXT Data Coordinating Center, University of Iowa, Iowa City, IA
| | - Jon W Yankey
- Department of Biostatistics, NeuroNEXT Data Coordinating Center, University of Iowa, Iowa City, IA
| | - Kristin Krosschell
- Departments of Physical Therapy and Human Movement Sciences and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - W David Arnold
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH.,Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kathryn J Swoboda
- Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, UT.,Department of Neurology, Boston Children's Hospital, Boston, MA
| | - Sandra P Reyna
- Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, UT.,Biogen, Boston, MA
| | - Ai Sakonju
- Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, UT.,SUNY Upstate Medical Center, Syracuse, NY
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital, Boston, MA
| | | | - Nancy Kuntz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | - Julie Parsons
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Anne M Connolly
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Claudia A Chiriboga
- Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY
| | | | | | | | | | - Perry B Shieh
- University of California-Los Angeles, Los Angeles, CA
| | | | - Merit E Cudkowicz
- Department of Neurology, NeuroNEXT Clinical Coordinating Center, Massachusetts General Hospital, Boston, MA
| | - Michelle M McGovern
- Department of Neurology, NeuroNEXT Clinical Coordinating Center, Massachusetts General Hospital, Boston, MA
| | - D Elizabeth McNeil
- Biogen, Boston, MA.,National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | | | | | | | - Allison Kingsley
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Samantha R Renusch
- Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Vicki L McGovern
- Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Xueqian Wang
- Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Thomas W Prior
- Department of Molecular Pathology, Ohio State Wexner Medical Center, Columbus, OH
| | - Arthur H M Burghes
- Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Amy Bartlett
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - John T Kissel
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
| | -
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
17
|
Rishu AH, Marinoff N, Julien L, Dumitrascu M, Marten N, Eggertson S, Willems S, Ruddell S, Lane D, Light B, Stelfox HT, Jouvet P, Hall R, Reynolds S, Daneman N, Fowler RA. Time required to initiate outbreak and pandemic observational research. J Crit Care 2017; 40:7-10. [PMID: 28288355 PMCID: PMC7126421 DOI: 10.1016/j.jcrc.2017.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/15/2016] [Accepted: 02/01/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Observational research focused upon emerging infectious diseases such as Ebola virus, Middle East respiratory syndrome, and Zika virus has been challenging to quickly initiate. We aimed to determine the duration of start-up procedures and barriers encountered for an observational study focused upon such infectious outbreaks. MATERIALS AND METHODS At 1 pediatric and 5 adult intensive care units, we measured durations from protocol receipt to a variety of outbreak research milestones, including research ethics board (REB) approval, data sharing agreement (DSA) execution, and patient study screening initiation. RESULTS The median (interquartile range) time from site receipt of the protocol to REB submission was 73 (30-126) days; to REB approval, 158 (42-188) days; to DSA completion, 276 (186-312) days; and to study screening initiation, 293 (269-391) days. The median time from REB submission to REB approval was 43 (13-85) days. The median time for all start-up procedures was 335 (188-335) days. CONCLUSIONS There is a lengthy start-up period required for outbreak-focused research. Completing DSAs was the most time-consuming step. A reactive approach to newly emerging threats such as Ebola virus, Middle East respiratory syndrome, and Zika virus will likely not allow sufficient time to initiate research before most outbreaks are advanced.
Collapse
Affiliation(s)
- Asgar H Rishu
- Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, M4N 3M5, Canada
| | - Nicole Marinoff
- Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, M4N 3M5, Canada
| | - Lisa Julien
- Division of Critical Care Medicine, Dalhousie University and the Capital District Health Authority, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Mariana Dumitrascu
- Département de Pédiatrics et Soins Intensifs, Hôpital Ste-Justine, l'Université de Montréal, Montréal, Québec, H3T 1C5, Canada
| | - Nicole Marten
- Section of Critical Care Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, R2H 2A6, Canada
| | - Shauna Eggertson
- Section of Critical Care Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, R2H 2A6, Canada
| | - Su Willems
- Department of Critical Care Medicine, Royal Columbian Hospital, University of British Columbia, Vancouver, British Columbia, V3L 3W7, Canada
| | - Stacy Ruddell
- Department of Critical Care Medicine, Foothills Hospital, University of Calgary, Alberta, Canada T2N 2T9
| | - Dan Lane
- Department of Critical Care Medicine, Foothills Hospital, University of Calgary, Alberta, Canada T2N 2T9
| | - Bruce Light
- Section of Critical Care Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, R2H 2A6, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Foothills Hospital, University of Calgary, Alberta, Canada T2N 2T9
| | - Philippe Jouvet
- Département de Pédiatrics et Soins Intensifs, Hôpital Ste-Justine, l'Université de Montréal, Montréal, Québec, H3T 1C5, Canada
| | - Richard Hall
- Division of Critical Care Medicine, Dalhousie University and the Capital District Health Authority, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Steven Reynolds
- Department of Critical Care Medicine, Royal Columbian Hospital, University of British Columbia, Vancouver, British Columbia, V3L 3W7, Canada
| | - Nick Daneman
- Division of Infectious Diseases, Department of Medicine and Clinical Epidemiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada M4N 3M5
| | - Robert A Fowler
- Departments of Medicine and Critical Care Medicine, Sunnybrook Health Sciences Center, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada M4N 3M5.
| |
Collapse
|
18
|
Affiliation(s)
- Ann-Margret Ervin
- From the Department of Epidemiology (A.-M.E., S.E.) and the Department of Health Policy and Management (H.A.T.), Johns Hopkins Bloomberg School of Public Health, and the Johns Hopkins Berman Institute of Bioethics (H.A.T.) - both in Baltimore
| | - Holly A Taylor
- From the Department of Epidemiology (A.-M.E., S.E.) and the Department of Health Policy and Management (H.A.T.), Johns Hopkins Bloomberg School of Public Health, and the Johns Hopkins Berman Institute of Bioethics (H.A.T.) - both in Baltimore
| | - Stephan Ehrhardt
- From the Department of Epidemiology (A.-M.E., S.E.) and the Department of Health Policy and Management (H.A.T.), Johns Hopkins Bloomberg School of Public Health, and the Johns Hopkins Berman Institute of Bioethics (H.A.T.) - both in Baltimore
| |
Collapse
|
19
|
Magruder KM, Goretzka S, Sade R. Reviewing Human Subjects Research: Efficiency and Quality for the Military and Beyond. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:48-50. [PMID: 27366851 DOI: 10.1080/15265161.2016.1187218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
20
|
Cummings J, Aisen P, Barton R, Bork J, Doody R, Dwyer J, Egan JC, Feldman H, Lappin D, Truyen L, Salloway S, Sperling R, Vradenburg G. Re-Engineering Alzheimer Clinical Trials: Global Alzheimer's Platform Network. J Prev Alzheimers Dis 2016; 3:114-120. [PMID: 28459045 PMCID: PMC5408881 DOI: 10.14283/jpad.2016.93] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Alzheimer's disease (AD) drug development is costly, time-consuming, and inefficient. Trial site functions, trial design, and patient recruitment for trials all require improvement. The Global Alzheimer Platform (GAP) was initiated in response to these challenges. Four GAP work streams evolved in the US to address different trial challenges: 1) registry-to-cohort web-based recruitment; 2) clinical trial site activation and site network construction (GAP-NET); 3) adaptive proof-of-concept clinical trial design; and 4) finance and fund raising. GAP-NET proposes to establish a standardized network of continuously funded trial sites that are highly qualified to perform trials (with established clinical, biomarker, imaging capability; certified raters; sophisticated management system. GAP-NET will conduct trials for academic and biopharma industry partners using standardized instrument versions and administration. Collaboration with the Innovative Medicines Initiative (IMI) European Prevention of Alzheimer's Disease (EPAD) program, the Canadian Consortium on Neurodegeneration in Aging (CCNA) and other similar international initiatives will allow conduct of global trials. GAP-NET aims to increase trial efficiency and quality, decrease trial redundancy, accelerate cohort development and trial recruitment, and decrease trial costs. The value proposition for sites includes stable funding and uniform training and trial execution; the value to trial sponsors is decreased trial costs, reduced time to execute trials, and enhanced data quality. The value for patients and society is the more rapid availability of new treatments for AD.
Collapse
Affiliation(s)
- J Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - P Aisen
- University of Southern California, Los Angeles, CA, USA
| | - R Barton
- Eli Lilly, Indianapolis, IN, USA
| | - J Bork
- Pintail Solutions, Indianapolis, IN, USA
| | - R Doody
- Baylor College of Medicine, Alzheimer's Disease and Memory Disorder Center, Baylor, TX, USA
| | - J Dwyer
- Global Alzheimer's Platform Foundation, USA
| | - J C Egan
- Eli Lilly, Indianapolis, IN, USA
| | - H Feldman
- University of British Columbia, Vancouver, BC, USA
| | - D Lappin
- FaegreBD Consulting, Washington, DC, USA
| | - L Truyen
- Johnson & Johnson, New Brunswick, NJ, USA
| | | | | | | |
Collapse
|
21
|
Kolb SJ, Coffey CS, Yankey JW, Krosschell K, Arnold WD, Rutkove SB, Swoboda KJ, Reyna SP, Sakonju A, Darras BT, Shell R, Kuntz N, Castro D, Iannaccone ST, Parsons J, Connolly AM, Chiriboga CA, McDonald C, Burnette WB, Werner K, Thangarajh M, Shieh PB, Finanger E, Cudkowicz ME, McGovern MM, McNeil DE, Finkel R, Kaye E, Kingsley A, Renusch SR, McGovern VL, Wang X, Zaworski PG, Prior TW, Burghes AHM, Bartlett A, Kissel JT. Baseline results of the NeuroNEXT spinal muscular atrophy infant biomarker study. Ann Clin Transl Neurol 2016; 3:132-45. [PMID: 26900585 PMCID: PMC4748311 DOI: 10.1002/acn3.283] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 10/30/2015] [Accepted: 12/10/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study prospectively assessed putative promising biomarkers for use in assessing infants with spinal muscular atrophy (SMA). METHODS This prospective, multi-center natural history study targeted the enrollment of SMA infants and healthy control infants less than 6 months of age. Recruitment occurred at 14 centers within the NINDS National Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT) Network. Infant motor function scales and putative electrophysiological, protein and molecular biomarkers were assessed at baseline and subsequent visits. RESULTS Enrollment began November, 2012 and ended September, 2014 with 26 SMA infants and 27 healthy infants enrolled. Baseline demographic characteristics of the SMA and control infant cohorts aligned well. Motor function as assessed by the Test for Infant Motor Performance Items (TIMPSI) and the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) revealed significant differences between the SMA and control infants at baseline. Ulnar compound muscle action potential amplitude (CMAP) in SMA infants (1.4 ± 2.2 mV) was significantly reduced compared to controls (5.5 ± 2.0 mV). Electrical impedance myography (EIM) high-frequency reactance slope (Ohms/MHz) was significantly higher in SMA infants than controls SMA infants had lower survival motor neuron (SMN) mRNA levels in blood than controls, and several serum protein analytes were altered between cohorts. INTERPRETATION By the time infants were recruited and presented for the baseline visit, SMA infants had reduced motor function compared to controls. Ulnar CMAP, EIM, blood SMN mRNA levels, and serum protein analytes were able to distinguish between cohorts at the enrollment visit.
Collapse
Affiliation(s)
- Stephen J Kolb
- Department of Neurology The Ohio State University Wexner Medical Center Columbus Ohio; Department of Biological Chemistry & Pharmacology The Ohio State University Wexner Medical Center Columbus Ohio
| | - Christopher S Coffey
- Department of Biostatistics Neuro NEXT Data Coordinating Center University of Iowa Iowa City Iowa
| | - Jon W Yankey
- Department of Biostatistics Neuro NEXT Data Coordinating Center University of Iowa Iowa City Iowa
| | - Kristin Krosschell
- Departments of Physical Therapy and Human Movement Sciences and Pediatrics Northwestern University Feinberg School of Medicine Chicago Illinois
| | - W David Arnold
- Department of Neurology The Ohio State University Wexner Medical Center Columbus Ohio; Department of Physical Medicine and Rehabilitation The Ohio State University Wexner Medical Center Columbus Ohio
| | - Seward B Rutkove
- Department of Neurology Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Kathryn J Swoboda
- Departments of Neurology and Pediatrics University of Utah Salt Lake City Utah; Department of Neurology Neuro NEXT Clinical Coordinating Center Massachusetts General Hospital Boston Massachusetts
| | - Sandra P Reyna
- Departments of Neurology and Pediatrics University of Utah Salt Lake City Utah; Department of Neurology Neuro NEXT Clinical Coordinating Center Massachusetts General Hospital Boston Massachusetts
| | - Ai Sakonju
- Departments of Neurology and Pediatrics University of Utah Salt Lake City Utah
| | - Basil T Darras
- Department of Neurology Boston Children's Hospital Boston Massachusetts
| | | | - Nancy Kuntz
- Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois
| | | | | | - Julie Parsons
- Children's Hospital Colorado, University of Colorado School of Medicine Aurora Colorado
| | - Anne M Connolly
- Washington University School of Medicine in St. Louis St. Louis Missouri
| | - Claudia A Chiriboga
- Department of Neurology Columbia College of Physicians and Surgeons New York New York
| | | | | | | | | | - Perry B Shieh
- University of California - Los Angeles Los Angeles California
| | | | - Merit E Cudkowicz
- Department of Neurology Neuro NEXT Clinical Coordinating Center Massachusetts General Hospital Boston Massachusetts
| | - Michelle M McGovern
- Department of Neurology Neuro NEXT Clinical Coordinating Center Massachusetts General Hospital Boston Massachusetts
| | - D Elizabeth McNeil
- National Institute of Neurological Disorders and Stroke Bethesda Maryland
| | | | - Edward Kaye
- Sarepta Therapeutics Cambridge Massachusetts
| | - Allison Kingsley
- Department of Neurology The Ohio State University Wexner Medical Center Columbus Ohio
| | - Samantha R Renusch
- Department of Biological Chemistry & Pharmacology The Ohio State University Wexner Medical Center Columbus Ohio
| | - Vicki L McGovern
- Department of Biological Chemistry & Pharmacology The Ohio State University Wexner Medical Center Columbus Ohio
| | - Xueqian Wang
- Department of Biological Chemistry & Pharmacology The Ohio State University Wexner Medical Center Columbus Ohio
| | | | - Thomas W Prior
- Department of Molecular Pathology Ohio State Wexner Medical Center Columbus Ohio
| | - Arthur H M Burghes
- Department of Biological Chemistry & Pharmacology The Ohio State University Wexner Medical Center Columbus Ohio
| | - Amy Bartlett
- Department of Neurology The Ohio State University Wexner Medical Center Columbus Ohio
| | - John T Kissel
- Department of Neurology The Ohio State University Wexner Medical Center Columbus Ohio
| | | |
Collapse
|
22
|
Ervin AM, Taylor HA, Meinert CL, Ehrhardt S. RESEARCH ETHICS. Evidence gaps and ethical review of multicenter studies. Science 2015; 350:632-3. [PMID: 26542556 DOI: 10.1126/science.aac4872] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Ann-Margret Ervin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Holly A Taylor
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Curtis L Meinert
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephan Ehrhardt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
23
|
Grady C. Institutional Review Boards: Purpose and Challenges. Chest 2015; 148:1148-1155. [PMID: 26042632 PMCID: PMC4631034 DOI: 10.1378/chest.15-0706] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/30/2015] [Indexed: 11/01/2022] Open
Abstract
Institutional review boards (IRBs) or research ethics committees provide a core protection for human research participants through advance and periodic independent review of the ethical acceptability of proposals for human research. IRBs were codified in US regulation just over three decades ago and are widely required by law or regulation in jurisdictions globally. Since the inception of IRBs, the research landscape has grown and evolved, as has the system of IRB review and oversight. Evidence of inconsistencies in IRB review and in application of federal regulations has fueled dissatisfaction with the IRB system. Some complain that IRB review is time-consuming and burdensome without clear evidence of effectiveness at protecting human subjects. Multiple proposals have been offered to reform or update the current IRB system, and many alternative models are currently being tried. Current focus on centralizing and sharing reviews requires more attention and evidence. Proposed changes to the US federal regulations may bring more changes. Data and resourcefulness are needed to further develop and test review and oversight models that provide adequate and respectful protections of participant rights and welfare and that are appropriate, efficient, and adaptable for current and future research.
Collapse
Affiliation(s)
- Christine Grady
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD.
| |
Collapse
|
24
|
O'Rourke PP, Carrithers J, Patrick-Lake B, Rice TW, Corsmo J, Hart R, Drezner MK, Lantos JD. Harmonization and streamlining of research oversight for pragmatic clinical trials. Clin Trials 2015; 12:449-56. [PMID: 26374678 DOI: 10.1177/1740774515597685] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The oversight of research involving human participants is a complex process that requires institutional review board review as well as multiple non-institutional review board institutional reviews. This multifaceted process is particularly challenging for multisite research when each site independently completes all required local reviews. The lack of inter-institutional standardization can result in different review outcomes for the same protocol, which can delay study operations from start-up to study completion. Hence, there have been strong calls to harmonize and thus streamline the research oversight process. Although the institutional review board is only one of the required reviews, it is often identified as the target for harmonization and streamlining. Data regarding variability in decision-making and interpretation of the regulations across institutional review boards have led to a perception that variability among institutional review boards is a primary contributor to the problems with review of multisite research. In response, many researchers and policymakers have proposed the use of a single institutional review board of record, also called a central institutional review board, as an important remedy. While this proposal has merit, the use of a central institutional review board for multisite research does not address the larger problem of completing non-institutional review board institutional review in addition to institutional review board review—and coordinating the interdependence of these reviews. In this article, we describe the overall research oversight process, distinguish between institutional review board and institutional responsibilities, and identify challenges and opportunities for harmonization and streamlining. We focus on procedural and organizational issues and presume that the protection of human subjects remains the paramount concern. Suggested modifications of institutional review board processes that focus on time, efficiency, and consistency of review must also address what effect such changes have on the quality of review. We acknowledge that assessment of quality is difficult in that quality metrics for institutional review board review remain elusive. At best, we may be able to assess the time it takes to review protocols and the consistency across institutions.
Collapse
Affiliation(s)
| | | | - Bray Patrick-Lake
- Clinical Trials Transformation Initiative, Duke University, Durham, NC, USA
| | - Todd W Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Jeremy Corsmo
- Office of Research Compliance and Regulatory Affairs, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Raffaella Hart
- Biomedical Research Alliance of New York, Lake Success, NY, USA
| | - Marc K Drezner
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - John D Lantos
- Children's Mercy Bioethics Center, Children's Mercy Hospital, Kansas City, MO, USA
| |
Collapse
|