Investigational
Use Drugs
Definition:
Investigational use drugs are those compounds or mixtures
which have not been released by the Federal Food and Drug Administration or by
the legal authority of the respective country for general use.
Or
Investigational use drugs are defined as those, which are
being considered for, but not yet received, approval by the Federal Food and
Drug Administration/ legal authority of the respective country for human use.
Principles Involved in the Use of Investigational Drugs in
Hospitals
Hospitals and related health care institutions, the primary
centers for clinical studies on investigational drugs, must ensure the policies
and procedures for the safe use of these drugs are established and followed.
Basic Principles
Procedures in the use of investigational drugs should be
built around these basic principles:
1. An institution that is setting for investigational drug
studies must assure that such studies contain adequate safeguards for itself,
its staff, the scientific integrity of the study and, especially the patient.
In doing so, the institution must have written policies and
procedures for the approval, management and control of investigational drug
studies.
2. All investigational drug studies must meet accepted
ethical, legal and scientific standards and be conducted by appropriately
qualified investigators.
3. All patients who participate in investigational drug
studies must freely consent, in writing, to treat with the drugs. This consent
must be obtained from the patient or his legally authorized representative
before treatment is begun, and the patient has been fully informed about the
study objectives and the risks and benefits associated with the study drug
Guidelines for Institutions
4. The principal investigator is responsible for the proper
maintenance of the case report forms and all other records required in the
study by the drug sponsor, institution or Food and Drug Administration.
5. The institution’s drug control system must proper
packaging and labeling, ensure sufficient supply, storage condition, dose
preparation and administration, should well informed to the nursing staff about
the drug, inventory and control systems regarding investigational drugs
Guidelines for Institutions
The following recommendations serve as a guide to
develop investigational drug procedures
1. As required by
federal regulation, institutions in which clinical research is conducted, must
have an Institutional Review Committee, often titled as a “Committee on Human
Investigation” or Clinical research Committee”. This committee must evaluate
each proposed clinical research study in terms of its compliance with
recognized ethical, legal and scientific standards.
2. Investigational drugs must be used only under the
supervision of the principal investigator or authorized co-investigators, all
of whom must be members of the institution’s professional staff.
3. The principle investigator is responsible for obtaining
the written, informed consent of the patient to participate in the study. The
informed consent process must conform to current federal and state regulations.
Items must be addressed by the investigator
a) A fair representation of the nature of the study,
the expected benefits, and the risks or discomfort involved. Any compensation
or treatment that will be furnished in the event of injury should be described.
(Example: Rofecoxib-Vioxx, 2005)
b) A balanced description of the alternative treatment
available (Including their respective risks and benefits)
c) A general description of the study procedures and the
expected length of therapy with the drug.
d) A statement to the effect that : (1) the patient may
withdraw form the study at any time without penalty; and (2) the principal
investigator may remove the patient from the study if circumstances warrant.
e) The name of the drug(s), name and signature of the
patient and name and signature of the principal or co-investigator
f) A statement of who will have access to any study records
that contain the patient’s name.
4. The principal investigator is responsible for the proper
maintenance of the case report forms and all other records required in the
study by the drug sponsor, institution or Food and Drug Administration.
5. The institution’s drug control system must contain the
following elements regarding investigational drugs:
a) Drug must be properly packed in accordance with all
applicable standards and regulations
b) Drugs must be labeled properly so as to ensure their safe
use by the nursing staff and patient.
c) There must a
mechanism to ensure that sufficient supplies of the drugs are always available
in the institution for the duration of the studies.
d) Nurses should be informed about the drug’s pharmacology
(side effects), storage requirements, methods of dose preparation, and
administration, precautions to be taken, authorized prescribers etc
e) Records of the amounts of drug received from the sponsor
and its disposition must be maintained.
f) The institution’s records on investigational drug studies
should be designed so that various statistical reports may be generated
conveniently and expeditiously.
Guidelines for Pharmacist
The pharmacist is responsible to the institution and the
principal investigator for seeing that procedures for the control of
investigational drug as developed and implemented. Suggestions to accomplish
this are as follows:
1. A copy of the approved research protocol should be kept
in the pharmacy.
2. Using the protocol and additional information supplied by
the principal investigator, the pharmacy should prepare an investigational drug
data sheet, which concisely summarizes for the medical, nursing and pharmacy
staffs information pertinent to use of the drug. This form should contain (a)
drug designation and common synonym, (b) dosage form and strength, (c) usual
dosage range including route of administration, (d) indication, (e) expected
therapeutic effect, (f) toxicities and their treatment etc.
3. Investigational drug supplies must be kept in the
pharmacy. The pharmacy should maintain an investigational drug inventory
record.
4. The dispensing of investigational drugs should be
integrated with the rest of the drug distribution system with respect of
packaging, labeling, profile maintenance, delivery and so forth.
5. Patient education and monitoring of therapy are two
clinical functions which are particularly important and applicable to
investigational drugs. These functions should be provided in a coordinated
fashion by the pharmacy and nursing staff and authorized investigator(s).
6. At the conclusion of the study, the pharmacy should
return all unused drugs to the principal investigator or sponsor.
7. The pharmacy should prepare for the institution’s
administrator an annual or semiannual statistical summary of investigational
drug use.
8. Drug costs and other expenses associated with
investigational drug studies should be properly allocated and reimbursed.
Classification of Drugs
The statement of Principles Involved in the Use of
Investigational Use Drugs in Hospitals espouses four distinct purposes:
1. To establish a drug classification.
2. To centralize pertinent information concerning drugs
available for research use.
3. To define the availability of such drugs to staff members
4. To establish a single stocking and dispensing unit within
the hospital.
One simple classification, which can be adapted to any
hospital research program, is to categorize –
Class A:
should contain all investigational use drugs that are in a preliminary
experimental stage. The use of drug in this category is usually restricted to
the principal investigator.
Class B: should consist of investigational use drugs
which have passed through the preliminary research stage. Usually, drugs in
this category are supplied to the department of pharmacy by the principal
investigator and are dispensed only upon his written prescription.
Class C: is limited to drugs approved by the USP, NF
or passed by the Federal FDA for commercial distribution. Drugs in this
category may be used within the hospital or its clinics if the physician
complies with some specific procedures.
Class D: drugs are preparations which have been
accepted for use in the hospital and are listed in the hospital formulary.
Another simple classification which can be adapted to any
hospital pharmacy operation-
1. General – An FDA-approved drug which as
recommended as essential for good patient care with a well-established usage,
once accepted, may be prescribed by all members of the attending and house staff.
2. Conditional – Certain drugs may be approved for a
conditional period of trial. A drug approved by the FDA for general use, but
which the Committee wishes to evaluate for given period before final
consideration, may be prescribed by all members of the attending and house
staff.
3. Investigational – Drugs which are not approved by
the FDA for use other than under controlled clinical settings must be approved
by the Research Advisory Committee. A protocol of any study involving drugs
must be submitted to the pharmacy.
Control of Investigational Use Drugs
All investigational drugs should be registered with the
Pharmacy and Therapeutics Committee. This may be accomplished by a letter from
the principal investigator, which provides the following information:
1. New drug number
2. Generic name
3. Manufacturer
4. Chemical Name
5. Proprietary name
6. General Chemistry
07. Pharmacology
08. Toxicology
09. Dose Range
10. Method of Administration
11. Antidote
12. Therapeutic use.
Many pharmacists have developed various forms which may be
used to disseminate the above information on an investigational use drug to the
various staff doctors and nurses. These forms are usually titled:
•
Physician’s Data Sheet on Investigational Drugs
•
Nurse’s Data Sheet on Investigational Drugs
•
Pharmacist’s Data Sheet on Investigational Drug
Physician’s Data Sheet
1. Name of the Investigational Drugs:
2. Manufacturer or other source:
3. Strength and Form of Investigational Drug:
4. Amount Received:
Date
Received:
Control
or Batch #
5. Pharmacologic and Therapeutic Properties, Dosage,
Precautions:
6. Arrangements which have made for its administration
Sig. Investigator
Nurse’s Data Sheet
1. Name of the Investigational Drugs:
2. Manufacturer or other source:
3. Strength and Form of Investigational Drug:
4. Pharmacologic and Therapeutic Properties, Dosage,
Precautions to be observed:
5. Arrangements which have made for its administration
Chief
Pharmacist
Pharmacist’s Data Sheet
Investigational Drug:——— Manufacture:——
Chief Investigator: ———————-
Date Physician Patient Rx.#
Amount Ward
——
————- ———- —–
———– ——–
—–
————- ———- —–
———– ——–
Identification of Investigational Use Drugs
Whenever Class A or class B drugs are dispensed from the
pharmacy, they should be labeled in such a manner as to differentiate them from
routine prescription drugs. In some hospitals, investigational use drug labels
are printed in red ink on white paper stock.
In
addition to commonly required information are:
(I)
Patient’s name
(II)
Data
(III)
Prescription number
(IV)
Doctor’s name and
(V)
Directions for use a space for the research drug
number is provided.
This
double set of number provides a two-way control relative to the identity of the
product dispensed.
Authorization for Treatment with Drug under Clinical
Investigation
The Law Department of the American Medical Association
states that drugs under clinical investigation should be administered only
where:
1. The informed consent of the patient or his/her authorized
representative has been obtained,
2. The physician is convinced of the reasonable accuracy of
his diagnosis and, if necessary, has confirmed it by adequate consultation and
3. Existing methods of treatment have proven unsatisfactory.
The physician is advised to confine his clinical
investigations of new drugs to those furnished by the reputable sources who
have supplied him with comprehensive written information concerning:
1. Animal experimentation
2. Previous clinical investigations, if any
3. Recommended dosages
4. Contraindication
5. Possible side effects to be watched for, and
6. The safety and possible usefulness of the drug from
existing data.
Authorization Form
I authorize Dr. X
……, the attending doctor /physician to treat Patient Name, with
the drug presently identify as YYYY for the following condition: Describe
symptoms of disease. It has been explain to me that the safety
and usefulness of the drug in the treatment.
I voluntarily consent to treat
with the drug and release the attending doctor/physician for liability from any
results that may occurs.
Witness—-
Signature—–
(Patient
or Authorized representative of the patient)
Consent Form
Patient’s
Name: Date:-
Project
title:
Description
of Product to be undertaken:
I have
fully explained to the patient…Name of the Patient….the nature and
purpose of the producer described above and such risks as are involved in its
performance.
————————-
Physician’s
Sign.
I have
fully informed or the risk and possible consequences involved in the
performance of the product described above, have been advised that unforeseen
results may occur and nevertheless hereby authorized Dr. X
Witness—- Patient
Sig./Authorized representative
Moreover,
the hospital pharmacist is urged to consult the hospital’s legal counsel for
the law applicable to the area in which the hospital is located.
Role of the Pharmacist in the Clinical Evaluation of a Drug
Once the pharmacologist has demonstrated a new compound to
be effective and safe in animal test, clinical trials are invariably commenced.
These trials usually proceed in two steps-preliminary and extended.
During the preliminary stage, the principal investigator
cautiously administers the drug to a limited number of selected patients and
closely follows the results. After having gained experience and confidence in
its use, the investigator is generally ready to conduct an extended
comprehensive evaluation of its efficacy.
During this stage, the pharmacist can play an important role
by assisting in the development of the protocol and the control of a double
blind test/study—having the experimental drug and placebo prepared exactly the
same dosage form and presentation. Neither the patient nor the doctor informed
as to whether the placebo and the potent article.
Clinical Investigation
The kind and extent of the investigational drug test are
crucial to producing the substantial scientific evidence of safety and
effectiveness needed to approve the drug for marketing. This evidence is
obtained in three phases:
•
Phase-I: to determine toxicities, metabolism,
absorption, elimination.
•
Phase-II: Initial trial on limited
patients for treatment (specific disease)
•
Phase-III: involve extensive clinical
Trial, information obtained from above
•
Phase – IV: Post marketing surveillance
