Low-risk trials for children and pregnant women threatened by unnecessary strict regulations. Does the coming EU Clinical Trial Regulation offer a solution?

Investigator-initiated clinical trials are crucial for improving quality of care for children and pregnant women as they are often excluded from industry-initiated trials. However, trials have become increasingly time-consuming and costly since the EU Clinical Trial Directive entered into force in 2001. This directive made compliance with ICH-Good Clinical Practice Guidelines (ethical and quality standard for conducting human subject research) mandatory for all clinical trials, regardless of its risk-classification. By discussing two investigator-initiated, 'low-risk' drug trials, we aim to illustrate that compliance with all GCP requirements makes trials very laborious and expensive, while a clear rationale is missing. This discourages clinical researchers to start and carry out investigator-initiated research. However, the forthcoming EU Clinical Trial Regulation (No 536/2014) seems to provide a solution as it allows for less stringent rules for low-risk trials. We want to raise awareness for these developments in both the clinical research community and the European and national regulatory authorities. Implementation of this forthcoming Regulation regulatory policies should be done in such a way that investigator-initiated trials evaluating standard care interventions will become more feasible. This will allow us to obtain evidence on optimal and safe treatments, especially for groups that are underrepresented in medical research. What is Known • Investigator-initiated trials are indispensable for improving care for children and pregnant women as they are often excluded from industry-initiated trials • Trials have become increasingly time-consuming and costly because of mandatory compliance with ICH-GCP guidelines What is New • The forthcoming EU Clinical Trial Regulation allows less stringent rules for low-risk trials • The national legislator and regulatory authorities should recognize the importance of this opportunity and implement the Regulation in such a way that investigator-initiated trials will become more feasible.

[Medical-ethical review of multicenter studies can be obtained faster: new directive leaves room for improvement]. / Medisch-ethische toetsing van multicentrisch onderzoek kan sneller: nieuwe richtlijn biedt ruimte voor verbetering.

OBJECTIVE: To evaluate whether the speed at which multicenter studies can be launched in the Netherlands has been improved by the new External Review Directive. DESIGN: Cohort study. METHOD: We studied the time between requesting and granting a declaration of local feasibility of 7 multicenter studies under the new External Review Directive, which came into effect on 1 March 2012. We distinguished between centres that complied with the new directive and those that did not. We also compared the time to approval of local feasibility of these 7 studies with those of 13 studies that were launched under the old directive. RESULTS: Under the new procedure, the median time between issue of the approval letter by the primary evaluative centre and approval by the Board of Directors of the participating centre was 93 days: 50 days for centres that performed the procedure in accordance with the directive (31 applications) and 118 days for centres that did not perform the review in accordance with the new directive (79 applications). This difference was significant (log rank test; p = 0.003). Under the old procedure, the median time to approval was 103 days (336 applications). CONCLUSION: The new External Review Directive for multicenter studies provides a significant improvement in time to approval of local feasibility for multicenter trials in centres that commit to the new directive. However, the majority of hospitals have not yet complied with this directive, which still delays studies unnecessarily.