Investigator-Initiated Study

Background

Qmed Consulting was asked to help set up and manage an EU clinical study for eighty patients with an irreversible and life-threatening disease. The investigational product was originally approved for a different indication, but as this particular trial proposed a new indication, all regulatory approvals were required in order to start the study.

The Challenge

The principal investigator and Scandinavian-based sponsor of the study had no previous experience setting up European clinical trials and was also facing a heavy workload as director of department in the hospital where he worked.

A number of obstacles were presented in this particular study:

  • Diversity of work procedures and limited access to necessary equipment
    Countries outside of Scandinavia operate differently than countries within Scandinavia. In terms of clinical practice, this means that not all diagnostic tests are available in all centres.
  • Different investigator agreements and additional local agreements
    Countries outside of Scandinavia may require a different style of investigator agreement and may also require additional agreements depending on local requirements.
  • Varied study insurance requirements
    Study insurance is required in countries outside of Scandinavia for investigator-initiated clinical trials.
  • Country-specific regulatory submission documents and approvals
    Regulatory submissions in countries outside of Scandinavia require documents that are not always present in Scandinavian submissions; therefore additional approvals may be required (e.g. R&D approval in the UK).
  • Complexity and volume of study documentation
    A large amount of study-specific documentation is required for a clinical trial: protocol, protocol summaries, investigator brochures, patient information and consent forms, patient safety cards, patient diaries, etc.
  • Study registration requirements
    Each study must be registered within an internationally-recognised clinical trials database (e.g. clinicaltrials.gov).
  • Permanent communication factors
    Regular communication is required with study centres to collect the necessary documents for regulatory submissions and to organise the onset of the study.
  • Database requirements
    A database must be created for data management and CRFs must be written for the study.
The Solution

Qmed Consulting was appointed as the CRO for this investigator-initiated study due to their comprehensive clinical research experience, successful track record, accessible Scandinavian-based location, and extensive European network.

Qmed Consulting began the project by discussing the study outline with the sponsor and appointing roles and responsibilities. The sponsor admitted that he had a limited amount of time due to his demanding work schedule.

A weekly conference call was arranged at the beginning of each week to go through each member’s required action items. A weekly progress report was then sent out by Qmed Consulting at the end of each week to show the progress made.

Qmed Consulting agreed to write as much of the study documentation as possible, giving the sponsor the opportunity to review any documents that he thought necessary. A steering committee was organised to write the protocol and to ensure that a European standpoint was maintained. Qmed Consulting organised the distribution of drafts to the steering committee and followed up with members that had not yet responded.

Qmed Consulting organised the necessary translations for each country involved and liaised with the sites where certain documents had to be modified according to local requirements (e.g. patient information sheets and consent forms).

Much time was spent corresponding with the company that provided the investigational product and funding for the study. This was necessary to collect the specific product documentation required for the regulatory submissions (investigator brochure, product details, etc.). This required constant communication with various departments within the manufacturing company.

Regulatory submissions for the Regulatory Authorities and Ethics Committees were prepared in both English (Regulatory Authority submissions) and local languages (Ethics Committee submissions). This involved creating separate folders that corresponded to the requirements of each regulatory body in each country. Although there are similarities among the documentation, the set-up and presentation of the submissions vary from country to country.

Qmed Consulting organised an investigator meeting so that the sponsor could bring all investigators together to discuss the product and details of the study. The travel arrangements, meeting room, equipment, and presentations were coordinated so that the meeting would run as efficiently as possible.

Qmed Consulting also acted as primary contact for the electronic database team to ensure that the database was constructed in accordance with protocol standards. Qmed Consulting also assisted with the production of edit checks and a help manual.

Conclusion

An investigator-initiated study is challenging for both the investigator and the CRO, as there is no industrial partner to assist with the preparation and review of the long list of required documentation. This particular study presented a fascinating opportunity to set up and run a trial for a very specialized group of patients who have limited treatment options.

By setting up communication channels that were convenient to the sponsor (weekly calls, weekly progress reports, and limited email communication), a close working relationship was established.

Qmed Consulting was able to act as a barrier to all unnecessary correspondence and was able to take on the time-consuming administrative duties of the clinical trial.

On account of Qmed Consulting’s highly experienced consultants and their ability to efficiently conduct clinical studies for investigational products, the sponsor was able to:

  • Reduce the time and cost to complete the study.
  • Achieve clinical study milestones through experience-based organisation and planning.
  • Accelerate turnaround of scientific publications and scientific podium presentations.
  • Increase efficiency as a result of consultant’s privileged and long-term relationships with hospitals.

This collaboration of medical excellence with industrial experience led to a win-win situation. The sponsor was able to delegate all set-up and maintenance tasks to Qmed Consulting, so that he could focus his expertise on patient care and innovative assessments of new treatments in clinical trials.