1
|
Nichols C, Kunkel LE, Baker R, Jelstrom E, Addis M, Hoffman KA, McCarty D, Korthuis PT. Use of single IRBs for multi-site studies: A case report and commentary from a National Drug Abuse Treatment Clinical Trials Network study. Contemp Clin Trials Commun 2019; 14:100319. [PMID: 30656242 PMCID: PMC6329321 DOI: 10.1016/j.conctc.2019.100319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/13/2018] [Accepted: 01/05/2019] [Indexed: 11/30/2022] Open
Abstract
Recent NIH policy stipulates that multi-site studies must use a single or IRB (Institutional Review Board) in order to streamline the review process while maintaining standards for human subjects protection. The Western States Node of the Clinical Trials Network (CTN) used a single IRB for protocol CTN-0067, a clinical trial testing the use of an opioid antagonist (extended-release naltrexone) versus opioid agonists (buprenorphine or methadone) for opioid use disorders among individuals living with HIV. This case study discusses the processes and challenges associated with use of a single IRB. These lessons are also informed by other single IRB experiences within the CTN. The intention of the NIH single IRB policy is to facilitate efficient IRB processes. Advanced planning and transparent communication, however, are critical to avoid stalling IRB approval and protocol implementation. Research teams need to account for local IRB willingness to cede to a single IRB and understand the variations in interpretations of abbreviated reviews. In order to facilitate the effective use of single IRBs, recommendations include assigning staff at each study site for IRB submission coordination and interaction with the lead site IRB staff, training investigators and key regulatory staff on expectations for working with single IRBs, dedicating a regulatory specialist at the lead site to manage the process, developing a communication plan, and supporting the development of strong working relationships with local regulatory staff and the single IRB. The CTN experiences with single IRBs may provide insights for other investigators.
Collapse
Affiliation(s)
- Ceilidh Nichols
- Oregon Health & Science University-Portland State University School of Public Health Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., CSB669, Portland, OR 97239-3088, USA
| | - Lynn E. Kunkel
- Oregon Health & Science University-Portland State University School of Public Health Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., CSB669, Portland, OR 97239-3088, USA
| | - Robin Baker
- Oregon Health & Science University-Portland State University School of Public Health Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., CSB669, Portland, OR 97239-3088, USA
| | - Eve Jelstrom
- The Emmes Corporation, Rockville, MD, 401 N Washington St # 700, Rockville, MD 20850, USA
| | - Megan Addis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste. 1600, Seattle, WA 98101, USA
| | - Kim A. Hoffman
- Oregon Health & Science University-Portland State University School of Public Health Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., CSB669, Portland, OR 97239-3088, USA
| | - Dennis McCarty
- Oregon Health & Science University-Portland State University School of Public Health Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., CSB669, Portland, OR 97239-3088, USA
| | - P. Todd Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR 3181 SW Sam Jackson Park Rd, Portland, OR, 97239-3088, USA
| |
Collapse
|
2
|
Crow RA, Hart KA, McDermott MP, Tawil R, Martens WB, Herr BE, McColl E, Wilkinson J, Kirschner J, King WM, Eagle M, Brown MW, Hirtz D, Lochmuller H, Straub V, Ciafaloni E, Shieh PB, Spinty S, Childs AM, Manzur AY, Morandi L, Butterfield RJ, Horrocks I, Roper H, Flanigan KM, Kuntz NL, Mah JK, Morrison L, Darras BT, von der Hagen M, Schara U, Wilichowski E, Mongini T, McDonald CM, Vita G, Barohn RJ, Finkel RS, Wicklund M, McMillan HJ, Hughes I, Pegoraro E, Bryan Burnette W, Howard JF, Thangarajh M, Campbell C, Griggs RC, Bushby K, Guglieri M. A checklist for clinical trials in rare disease: obstacles and anticipatory actions-lessons learned from the FOR-DMD trial. Trials 2018; 19:291. [PMID: 29793540 PMCID: PMC5968578 DOI: 10.1186/s13063-018-2645-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/12/2018] [Indexed: 11/11/2022] Open
Abstract
Background Trials in rare diseases have many challenges, among which are the need to set up multiple sites in different countries to achieve recruitment targets and the divergent landscape of clinical trial regulations in those countries. Over the past years, there have been initiatives to facilitate the process of international study set-up, but the fruits of these deliberations require time to be operationally in place. FOR-DMD (Finding the Optimum Steroid Regimen for Duchenne Muscular Dystrophy) is an academic-led clinical trial which aims to find the optimum steroid regimen for Duchenne muscular dystrophy, funded by the National Institutes of Health (NIH) for 5 years (July 2010 to June 2015), anticipating that all sites (40 across the USA, Canada, the UK, Germany and Italy) would be open to recruitment from July 2011. However, study start-up was significantly delayed and recruitment did not start until January 2013. Method The FOR-DMD study is used as an example to identify systematic problems in the set-up of international, multi-centre clinical trials. The full timeline of the FOR-DMD study, from funding approval to site activation, was collated and reviewed. Systematic issues were identified and grouped into (1) study set-up, e.g. drug procurement; (2) country set-up, e.g. competent authority applications; and (3) site set-up, e.g. contracts, to identify the main causes of delay and suggest areas where anticipatory action could overcome these obstacles in future studies. Results Time from the first contact to site activation across countries ranged from 6 to 24 months. Reasons of delay were universal (sponsor agreement, drug procurement, budgetary constraints), country specific (complexity and diversity of regulatory processes, indemnity requirements) and site specific (contracting and approvals). The main identified obstacles included (1) issues related to drug supply, (2) NIH requirements regarding contracting with non-US sites, (3) differing regulatory requirements in the five participating countries, (4) lack of national harmonisation with contracting and the requirement to negotiate terms and contract individually with each site and (5) diversity of languages needed for study materials. Additionally, as with many academic-led studies, the FOR-DMD study did not have access to the infrastructure and expertise that a contracted research organisation could provide, organisations often employed in pharmaceutical-sponsored studies. This delay impacted recruitment, challenged the clinical relevance of the study outcomes and potentially delayed the delivery of the best treatment to patients. Conclusion Based on the FOR-DMD experience, and as an interim solution, we have devised a checklist of steps to not only anticipate and minimise delays in academic international trial initiation but also identify obstacles that will require a concerted effort on the part of many stakeholders to mitigate. Electronic supplementary material The online version of this article (10.1186/s13063-018-2645-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rebecca A Crow
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | | | | | - Rabi Tawil
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Barbara E Herr
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | - Wendy M King
- University of Rochester Medical Center, Rochester, NY, USA
| | - Michele Eagle
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | - Mary W Brown
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Hanns Lochmuller
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | - Emma Ciafaloni
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | | | | | | | - Iain Horrocks
- Greater Glasgow and Clyde NHS Yorkhill Hospital, Glasgow, UK
| | - Helen Roper
- Birmingham Heartlands Hospital, Birmingham, UK
| | | | - Nancy L Kuntz
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | | | | | | | | | | | | | | | | | - Giuseppe Vita
- University of Messina AOU Policlinico Gaetano Martino, Messina, Italy
| | | | | | | | | | - Imelda Hughes
- Royal Manchester Children's Hospital, Manchester, UK
| | | | | | - James F Howard
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Craig Campbell
- Children's Hospital London Health Sciences Centre, London, Canada
| | | | - Kate Bushby
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK.
| |
Collapse
|