Project:

Trial Quality

overview icon Overview

JUST THINK | Monitoring and Quality by Design (QbD) in Clinical Trials

Applying a Quality by Design (QbD) approach to clinical trials helps prospectively identify important errors that could jeopardize the ability to protect patients during the trial and to obtain reliable results and meaningful information from the trial. “Quality in clinical trials”, therefore, is defined as the absence of errors that matter.

CTTI sought to identify best practices and develop methods and tools to apply principles of QbD to the scientific and operational design of clinical trials. To this end, CTTI issued official Recommendations for Monitoring and QbD as well as a Principles document to inform sponsors of those factors that are critical to quality and a QbD toolkit to assist in trial planning and operationalization.

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Discover Additional Deliverables Generated From This Project

Press Release

New Recommendations to Improve Quality in Clinical Trials

Highlighted Presentation

Clinical Quality-by-Design (QbD): Principles to Practice by Coleen Glessner at DIA 2015

Webinar

Translating quality by design principles into practice, part 3

Webinar

Translating quality by design principles into practice, part 2

Webinar

Translating quality by design principles into practice, part 1

Expert Meeting Materials

Workshop on Quality Risk Management: Understanding What Matters - Executive Summary of Meeting held January 29-30, 2014

Expert Meeting Materials

View materials from the Workshop on Quality Risk Management: Understanding What Matters, hosted January 28-29, 2013

Publication

Clinical Trials: Rethinking How We Ensure Quality published in Drug Information Journal

Expert Meeting Materials

Materials from the Workshop on Quality Risk Management: Understanding What Matters held September 20-21, 2012

Expert Meeting Materials

Materials from the Workshop on Quality Risk Management held August 23-24, 2011

Press Release

First Report from Public-Private Partnership Shows Variability in How Clinical Trials Are Monitored

Publication

Monitoring the quality of conduct of clinical trials: a survey of current practices by Morrison BW, Cochran CJ, White JG, Harley J, Kleppinger CF, Liu A, Mitchel JT, Nickerson DF, Zacharias CR, Kramer M, Neaton JD published in Clinical Trials

Expert Meeting Materials

Materials from CTTI's Expert Meeting, Developing effective quality systems in clinical trials: an enlightened approach, hosted October 13-14, 2010

Project Report

Quality objectives of monitoring

Poster

A CTTI Survey of Current Monitoring Practices - Presented May 17, 2010 at the annual meeting of the Society for Clinical Trials in Baltimore, MD

Expert Meeting Materials

Materials from the Panel Discussion, Quality Objectives of Monitoring, held November 4, 2009

“Optimized trial designs can help us deliver important medicines to patients more quickly. In the Development Design Center, we collaborate with product teams to design and plan streamlined studies. We do this in part by posing questions to the team that challenge assumptions and stimulate creative thinking. The CTTI QbD Project Critical to Quality Factors Principles Document is a valuable reference as we plan for these group discussions.”

Julie Dietrich, Director, Development Design Center, Amgen, Inc.

“CTTI inspired and enabled us to implement QbD principles at Pfizer. None of what we’ve done would have been possible without the backing, influence, and support of CTTI. It has been amazing to watch the dialogue in the industry change.”

 

Coleen Glessner, Vice President, Clinical Trial Process and Quality, Pfizer

“QbD is a concept whose time has come. The CTTI Principles Document provided a framework that helped Seattle Genetics practice QbD concepts and identify elements that are critical to quality.”

 

Marta Fields, Senior Director, Compliance and Quality Systems, Seattle Genetics

PCORnet, the national patient-centered clinical research network, is applying CTTI’s QbD principles in its clinical trials task force work.

Page 1 Project Progress

Identify Research Impediments
100%
Gather Evidence
100%
Analyze & Interpret Findings
100%
Develop Recommendations
100%
Disseminate & Implement
100%

in detail icon In Detail

Stakeholders across the clinical trial enterprise have expressed concern that the current model for conducting trials is unaffordable and unsustainable, and potentially impedes the generation of reliable evidence. Overcoming this inefficiency rests on improving protocol design, trial planning, and quality oversight.

CTTI first recognized the need for applying QbD methods to clinical trials while working to improve monitoring procedures. A key conclusion of the CTTI Monitoring Project was that clinical trial monitoring should be viewed as one component of an overall quality framework. Project participants, representing a broad cross-section of the clinical trials enterprise, agreed that widespread adoption of the QbD approach to trial planning, conduct, and oversight was needed to ensure trial quality and efficiency; however little information was available on how to apply QbD principles to clinical trial design.

The Monitoring Project: “Effective and Efficient Monitoring as a Component of Quality Assurance in the Conduct of Clinical Trials” (2009-2011)

Quality by Design (QbD): “Workshops on Quality by Design (QbD) and Quality Risk Management (QRM) in Clinical Trial” (2011-2015)

  • Develop broad principles for QbD applicable across clinical trials
  • Provide hands-on opportunities for stakeholders involved in clinical trial development, implementation, and oversight to translate QbD principles into practice
  • Identify mechanisms to disseminate agreed principles and promising approaches identified during the workshops to a broad array of stakeholders
  • Using the QbD toolkit to build trial quality from the start will help minimize errors that matter and improve the overall integrity of the trial while increasing participant safety and credibility of results.
  • Focusing on critical aspects (e.g., those critical to quality factors [CQFs] defined in the Principles Document) of a trial will improve trial efficiency and also substantially reduce the burden of clinical trial conduct by relieving sponsors of a perceived obligation to mitigate every potential risk posed by a trial.
  • Literature review
  • Electronic survey
  • Expert meetings and workshops
    • CLICK HERE to view materials from the January 29-­30, 2014 Workshop on Quality Risk Management
    • CLICK HERE to view materials from the January 28-29, 2013 Workshop on Quality Risk Management
    • CLICK HERE to view materials from the September 20–21, 2012 Workshop on Quality Risk Management
    • CLICK HERE to view materials from the August 23-24, 2011 Workshop on Quality Risk Management
    • CLICK HERE to view materials from the October 13 - 14, 2010 Expert Meeting on Monitoring
    • CLICK HERE to view materials from the November 4, 2009 Expert Meeting on Monitoring
  • Qualitative Interviews

CTTI’s investigation of monitoring practices across sponsor companies found that practices vary widely and that choice of monitoring practices was often not based on empirical evidence. Experts agreed that the main objectives of monitoring practices were to ensure patient safety, represent key data accurately, comply with the protocol, and improve trial quality. Because monitoring is most effective when it can identify errors early so that corrective training can address issues, and should be tailored to the needs of a particular trial, risk-based monitoring was suggested as a more effective alternative.

During the investigation of monitoring practices and analyses of results, it became apparent that additional factors contribute to trial quality and efficiency. An expert working group suggested convening a follow-on Quality by Design (QbD) Project. QbD employs an approach to prospectively build quality into the scientific and operational design of clinical trials, such that important errors are prevented rather than remediated after the fact, and trials are feasible to conduct. Through evidence-gathering activities, CTTI described those factors that are “critical to quality” [CTQ] in CTTI’s Principles Document and include the following:

  • Protocol design
  • Feasibility
  • Patient safety
  • Study conduct
  • Study reporting
  • Third-party engagement

In addition to the factors mentioned above, the project recommended additional practices that contribute to successful application of QbD principles to clinical trials, including:

  • Creating a culture that values and rewards critical thinking and open dialogue about quality, and that goes beyond sole reliance on tools and checklists;
  • Focusing effort on activities that are essential to the credibility of the study outcomes;
  • Involving the broad range of stakeholders in protocol development and discussions around study quality; and
  • Prospectively identifying and periodically reviewing the critical to quality factors.

CTTI provided examples of successful application of these principles in the QbD Webinar Series and guidance on how to implement QbD in clinical trials in the QbD Toolkit.

Project Team Members

Rolesort descending Name Affiliation Project
Project Manager Annemarie Forrest Clinical Trials Transformative Initiative QbD
Team Leader Martin Landray University of Oxford, CTSU Monitoring
Team Leader Briggs Morrison Pfizer Inc Monitoring
Team Leader David Nickerson Pfizer Inc Monitoring
Team Leader Melissa Robb Food and Drug Administration Monitoring
Team Leader Rachel Sherman Food and Drug Administration Monitoring
Team Leader Mark Behm AstraZeneca Pharmaceuticals LP QbD
Team Leader Coleen Glessner Alexion QbD
Team Leader Martin Landray University of Oxford, CTSU QbD
Team Leader Ann Meeker-O'Connell Johnson and Johnson Pharmaceutical Research Development QbD
Team Leader Briggs Morrison Development Syndax QbD
Team Leader Jean Mulinde Food and Drug Administration QbD
Team Leader Stephanie Shapley Food and Drug Administration QbD
Team Member Jules Mitchel Target Health Inc. QbD
Team Member Jules Mitchel Target Health, Inc. Monitoring
Team Member David Nickerson Pfizer Inc. QbD
Team Member Jim Neaton University of Minnesota Monitoring
Team Member Richard Ohye University of Michigan QbD
Team Member Ray Policare Amgen Monitoring
Team Member Julian Rimmer ICON Monitoring
Team Member Ileana Pina Montefiore Medical Center QbD
Team Member Norman Stockbridge Food and Drug Adminstration Monitoring
Team Member Ellen Pinnow Food and Drug Administration QbD
Team Member Craig Wozniak GlaxoSmithKline Monitoring
Team Member Tejashri Purohit-Sheth Food and Drug Administration QbD
Team Member Cynthia Zacharias Bristol-Myers Squibb Monitoring
Team Member Eric Richardson Food and Drug Administration QbD
Team Member John Alexander Duke University QbD
Team Member David Rodin Pfizer Inc. QbD
Team Member Angeles Alonso Garcia European Medicines Agency QbD
Team Member Daniel Rose Pulmonary Fibrosis Foundation QbD
Team Member Patrick Archdeacon Food and Drug Adminstration QbD
Team Member Peter Scheimann Widler & Schiemann AG QbD
Team Member Tim Baldwin National Institutes of Health QbD
Team Member Tamara Shipman St. Jude Medical QbD
Team Member Leslie Ball Food and Drug Administration QbD
Team Member Ken Sprenger Pfizer Inc QbD
Team Member David Breiter Covidien Vascular Therapies QbD
Team Member Fergus Sweeney European Medicines Agency QbD
Team Member Oana Brosteanu Universitaet Leipzig QbD
Team Member James Tcheng Duke University QbD
Team Member Robert Campbell Children's Hospital of Philadelphia QbD
Team Member Robert Temple Food and Drug Administration QbD
Team Member Brenda Aker Biosense Webster, Inc. (paid employee of J&M) Monitoring
Team Member Lynda Chick Bristol-Myers Squibb QbD
Team Member Jean Toth-Allen Food and Drug Administration QbD
Team Member Kathy Beaver Medtronic Monitoring
Team Member Theodora Cohen Harvard Clinical Research Institute QbD
Team Member Spiros Vamvakas European Medicines Agency QbD
Team Member Mark Behm AstraZeneca Pharmaceuticals LP Monitoring
Team Member Sabrina Comic-Savic The Medicines Company QbD
Team Member Roseann White Abbott Vascular QbD
Team Member Sandra Benton Food and Drug Administration Monitoring
Team Member Jason Connor Berry Consultants QbD
Team Member Beat Widler Widler & Schiemann AG QbD
Team Member Alex Boddy Sanofi-Aventis Monitoring
Team Member Xiangchen (Bob) Cui Vertex Pharmaceuticals QbD
Team Member Chrissy Cochran Food and Drug Administration Monitoring
Team Member Dan Delaney CR Bard, Inc QbD
Team Member Susan Donahue PMG Research, Inc Monitoring
Team Member Jaques Demotes ECRIN QbD
Team Member Christine Drabick Food and Drug Administration Monitoring
Team Member Dianne Dorman National Organization for Rare Diseases QbD
Team Member Jennifer Giangrande Roche Monitoring
Team Member John Farley Food and Drug Administration QbD
Team Member Joe Griffin Food and Drug Administration Monitoring
Team Member Cyrus Guidry Johnson & Johnson Devices QbD
Team Member Joan Harley Training Extension Monitoring
Team Member Allen Heller Pharma Study Design QbD
Team Member Debby Holmes ICON Monitoring
Team Member Janet Hietshetter Dystonia Medical Research Foundation QbD
Team Member Cythnia Kleppinger Food and Drug Administration Monitoring
Team Member Heather Jorajuria Genetech-a Member of the Roche Group QbD
Team Member An Liu A and L Consulting, LLC Monitoring
Team Member Michael Lincoff Cleveland Clinic Coordinating Center for Clinical Research QbD
Team Member Debra Madden Food and Drug Administration Monitoring
Team Member Ted Lystig Medtronic QbD
Team Member Clare Matti Duke University Monitoring
Team Member Danica Marinac-Dabic Food and Drug Administration QbD
Team Member Robert McCormick Pharmaceutical Product Development (PPD) Monitoring
Team Member Roxana Mehran Mt. Sinai Medical Center QbD
Team Member Paula McKeever Food and Drug Administration Monitoring