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Guidelines for Clinical Trials in Uganda. Jasper Ogwal-Okeng Gulu University Research Workshop 3 rd -6 th March 08. Clinical Trials. Evaluation of a Product for Clinical Effects Safety and Effectiveness Product can be Drugs Vaccines. Phases of Clinical Trials.
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Guidelines for Clinical Trials in Uganda Jasper Ogwal-Okeng Gulu University Research Workshop 3rd-6th March 08
Clinical Trials • Evaluation of a Product for Clinical Effects • Safety and Effectiveness • Product can be • Drugs • Vaccines
Phases of Clinical Trials • Phase I: Healthy volunteers • Phase IIa: Early phase II • Phase IIb: Late phase II • Phase III: RCT, blinded • Phase IV: Pharmacovigilance
Phase I • Follows successful pharmacological and toxicological studies in animals • Healthy volunteers • Safety and pharmacokinetic data obtained (not efficacy-since no symptoms) • Start with 1/5th or 1/10th maximum tolerated dose in the most sensitive animal species • Placebo and double-blinded
Phase II Studies • First administered to patients • Phase II a (Early phase II) • Potential benefits and side effects • Establish dose range for phase IIb • Phase IIb (Late phase II) • Establish efficacy in specific disease • Compare efficacy and side effects with other drugs for same conditions
Phase III studies • Randomized, controlled, double-blind ed • Sufficient sample size for statistical evaluation of efficacy and safety. • Successful phase III trial leads to New Drug Submission (NDS) • NDS requests permission to market new drug
Phase IV • After drug obtained marketing license • Monitored for • Rare side effects • Chronic toxicity e.g. cancer after many people- years of use • Previously unknown interactions • Potential new therapeutic use • Dose modifications
Guidelines for Clinical Ttrials in Uganda • All medicines used in Uganda should be registered with National Drug Authority (NDA) • Written approval of NDA needed for clinical of drugs (registered/unregistered) used in Uganda • Guidelines gives procedures of application for clinical Trials
APPLICATION SUBMISSION, REVIEW AND EVALUATION • Procedures for submission • Procedures for Review and Approval • Institutional Review Boards • Amendments to Trial Protocol • Inspection/Audit by NDA • Reports and Final Review
Procedure for Application submission • To Executive Secretary/Registrar NDA • Fee and structure • Clinical Trial application form • Documents accompanying application form (Appendices 1-17)
Review and Approval of Applications • Completeness-form, document and fee • Application reference number • Supplementary Data and updates • Expert Review (appointed by NDA) • Approval by NDA’s Clinical Trials Committee (CTC) • Approval communicated in writing • Post Trial Review
Institutional Review Boards • Established in the institution where research is done • Ensures safety, integrity and human rights issues • CTC of NDA oversees all IRBs • NDA approves application after IRB and NCST approvals
Amendments to Trial Protocol • May be partial or complete. • Urgent-Change and inform IRB, NCST,NDA • Otherwise resubmit to NDA and wait decision
Inspection/Audit by NDA • To verify monitoring and audit of protocol • Facilities • Research staff • Compliance with protocol • Serious Adverse Events being reported
Reports and Final Review • Reporting of Serious Adverse Events • Interim and Final Trial Reports • Dissemination and Publication • Archiving
CLINICAL TRIAL LICENSE (CTL) • Approval for importation/manufacture of CT commodities given after CT approval • Products that require CTL • Procedures for Application for CTL • Conditions for CTL • Importation and Release of Investigational Product (IP) • Documentation for IP Release
Products that Require CTL • Unregistered products, including placebos • Registered • Used/assembled in different form from approved form • Used for unapproved indication • Used to gain further information about approved use • Local product manufactured for Clinical Trial
Application Procedures for CTL • Who to apply: • Principal Investigator • Sponsor (authorized person from a pharmaceutical company)
Attachments • Format for Clinical Trial Protocol • Investigator’s brochure • Guide for labeling clinical trial medicines • Letter of authorization • Clinical Trial application form • Format for clinical trial reports • Declaration by Investigators • Check list for required documentation