McLaren Health Care
Research Data and Safety Monitoring

Types of Data or Events

• Describe data or events that will be captured under the Data Monitoring Plan

Responsibilities and Roles for Gathering, Evaluating and Monitoring the Data

• Including data related to unanticipated problems and adverse events
• Roles of the investigators, research coordinators, research sponsor, monitoring entity, statistical consultant, etc.
• Who will verify data accuracy, by what method, and how frequently?
• Who will verify compliance with the protocol, how, and how often?

Information About the Monitoring Entity

• Description (e.g. individual Medical Monitor, Data Monitoring Committee (DMC) consisting of <number> members, etc.)
• Information about each member - e.g. name, credentials, title, organization, contact information (unless there is no Sponsor)
• Mechanisms to assure independence of judgment

Reporting Adverse Events and Unanticipated Problems to the Monitoring Entity

• Timeframes for reporting
• What mechanism will be used to report (specify forms and procedures)
• Who will prepare and submit the form

Assessments

• Frequency with which monitoring entity will review and assess the data or events captured under the Data Monitoring Plan(e.g., monthly, quarterly, etc.). Monitoring entity will review data and events according to assessment criteria for "unanticipated problems involving risks to participants or others" (i.e., as to whether they are unexpected, related and harmful)

Criteria for Action

• Description of specific triggers that will dictate when an action.
• Description of Stopping Rules

Procedures for Communicating–dissemination of safety information As Appropriate

• How outcomes of monitoring entity reviews will be communicated to the IRB, research sponsor, and any other entities (e.g. other study sites)

The Plan, as appropriate to the risks, size and complexity of the study, might address the following:

as appropriate to the risks, size and complexity of the study, might address the following:

1. Types of data or events that are to be captured under the monitoring plan.
2. Responsibilities and roles for gathering, evaluating and monitoring the data.
3. Information about the monitoring entity
4. Time frames for reporting adverse events and unanticipated problems to the monitoring entity.
5. The frequency of assessments of data or events captured by the monitoring plan.
6. Definition of specific triggers or stopping rules that serve as the criteria for action.
7. As appropriate, procedures for communicating to the IRB, the study sponsor, and other appropriate entities the outcome of the reviews by the Monitoring Entity.

NIH Sponsored Research

The NIH has established a policy that requires each of its Institutes and Centers (IC) to have a system for the appropriate monitoring of the conduct of clinical trials to ensure the safety of participants and the validity and integrity of the data for all NIH-supported or conducted clinical trials. Investigators must comply with monitoring requirements of the relevant funding agency in addition to those of the PHRC.

The establishment of DSMBs is required for multi-site clinical trials involving interventions that entail potential risk to the participants. This would include, in most cases, phase III clinical trials. A phase III trial frequently compares a new treatment to a standard treatment or to no treatment, and treatment allocation may be randomly assigned and the data masked. These studies usually involve a large number of participants followed for longer periods of treatment exposure. While short-term risk is usually slight, one must consider the long term effects of a study agent or achievement of significant safety or efficacy differences between the control and study groups for a masked study.

An IC may require a DSMB to perform monitoring functions. This DSMB would be composed of experts relevant to the study and would regularly assess the trial and offer recommendations to the IC concerning its continuation. For more information on NIH Policy, see below:

Data and Safety Monitoring Plan (DSMP) should include the following:

1. the type of data or events that are to be captured under the monitoring plan.
2. who will be responsible for monitoring the data collected, including data related to unanticipated problems and adverse events, and their respective roles (e.g., the investigators, the research sponsor, a coordinating or statistical center, an independent medical monitor, a DSMB/DMC, and or some other entity).
3. the time frames for reporting adverse events and unanticipated problems to the monitoring entity, such as the research sponsor, coordinating or statistical center, independent medical monitor, or DSMB/DMC.
4. the frequency of assessments of data or events captured by the monitoring plan. This can be points in time (3 months, 6 months etc..) or after a specific number of participants are enrolled.
5. definition of specific triggers or stopping rules that will dictate when some action is required. Stopping rules are predetermined guidelines that are used to determine that the study should be altered or stopped, based on review of study related events that occur during the conduct of the study. Stopping rules should be specific about the endpoints that will be used and the decisions that will be made. Studies may be stopped, for example, when there is a greater than expected rate of morbidity or mortality or when the experimental arm of a head to head comparison study is shown to be better or worse statistically than the standard care arm.
6. as appropriate, procedures for communicating to the IRB, the study sponsor, and other appropriate entities the outcome of the reviews by the monitoring entity.
7. the plan should describe the oversight of the research participant’s safety and welfare and how unanticipated problems involving risks to participants or others, and adverse events will be characterized and reported. The plan may also outline the stopping rule criteria. The plan should be tailored to the nature, size, and complexity of the research, the expected risks, and the type of subject population being studied. See Data Monitoring Plan Template, below.

The monitoring entity should be described in the Data Monitoring Plan submitted with the New Protocol Application. The monitoring entity is an identified individual or group assigned to conduct interim monitoring of accumulated data from research activities to assure the continuing safety of research participants, relevance of the study question, appropriateness of the study, and integrity of the accumulating data. Membership should include expertise in the relevant field of study, statistics and research design. The monitoring entity might be the Project Director (or PI), a Data Monitoring Board, or an equivalent body such as an industry-sponsored Data Monitoring Committee (DMC), a NIH sponsored cooperative group, a coordinating or statistical center, a monitoring committee formed by a sponsor other than NIH, or a Medical Monitor (an individual rather than a DMC). Depending on the needs of the study the monitoring can be any of the following:

Investigator

The principal investigator could perform this function. This type of plan is appropriate when the study involves a small number of subjects; the study is conducted only at one site; and the range of possible study events that could have an important impact on the risks and benefits of research participants is narrow. In such cases, continuous monitoring of events by the investigator, and prompt reporting of toxicity to the IRB and, when applicable, the FDA, the NIH, or others, may be adequate.

Monitor/Monitoring Group

A qualified and objective individual or group not directly involved with the design and conduct of the study (e.g., safety officer, designated Medical Monitor or Monitoring Group) could perform this function. These individuals may or may not be employees of MHC or its subsidiary hospitals or the study sponsor. However, conflict of interest is an important consideration when employees of the study sponsor have the primary responsibility for monitoring data from the standpoint of scientific integrity and participant safety.

This type of plan is often appropriate to monitor data and safety for research studies that involve:

• endpoints that are not serious irreversible events;
• an intervention (for example, to relieve symptoms) that is not high risk and the effects of which would not generally be so compelling as to ethically warrant early termination for effectiveness;
• short term treatments where effects are evaluated over periods of a few days to a few months; and
• a smaller number of subjects where the study is completed quickly and the risk can be adequately assessed through simple comparisons.

In these studies, valuable secondary objectives such as characterization of the effect (i.e., magnitude, duration, time to response), assessment of the effect in population subsets, comparison of several doses/or comparison of the new product to an active control can be ethically pursued even when the conclusion regarding the primary efficacy outcome is clear. Early termination for effectiveness is rarely appropriate in such studies. First, the study may be essentially completed by the time any interim analysis to evaluate effectiveness could be undertaken. Second, the effectiveness of an intervention, for example, to relieve symptoms, would not generally be so compelling as to override the need to collect the full amount of safety data, or to collect other information of interest and importance that characterizes the effect.

Data and Safety Monitoring Board (DSMB)/Data Monitoring Committee (DMC)

An independent Data and Safety Monitoring Board (DSMB)/Data Monitoring Committee (DMC) external to the trial organizers and investigators could perform this function. A DSMB/DMC is a formal committee that is established specifically to monitor data throughout the life of a study to determine if it is appropriate, from both the scientific and ethical standpoint, to continue the study as planned.

In general, an independent DSMB/DMC is the most appropriate way to monitor data and safety for studies that involve:

• Large numbers of subjects where risk may better be assessed through statistical comparisons of treatment groups;
• Blinded study treatment groups where the validity and integrity of the study may be adversely affected by having an individual or group associated with the design and conduct of the study break the blind;
• Multiple clinical sites where there is a need for investigators to submit reports of adverse events to a central reporting entity, such as a coordinating center or statistical center, responsible for preparing timely summary reports of adverse events for distribution among the clinical sites, and to the IRBs;
• High risk interventions where death or severe disability is a major risk of research participation; and/or
• Controlled trials with mortality or major morbidity as a primary or secondary endpoint where increased morbidity or mortality may better be assessed through statistical comparisons of morbidity or mortality among treatment groups.

DSMBs/DMCs are typically made up of individuals who have expertise in the field, experience in the conduct of clinical trials, and/or statistical knowledge, and who do not have any serious conflicts of interest, such as financial interests that could be substantially affected by the outcome of the trial, strong views on the relative merits of the interventions under study, or relationship with the sponsor or those in trial leadership positions that could be considered reasonably likely to affect their objectivity.

DSMBs/DMCs meet at least annually or more often depending on the nature of the trial being monitored. DSMBs/DMCs can monitor the timeliness of accrual, the quality of data collection and management, and the accumulating outcomes to assure the safety of participants and the scientific integrity of the study.

Regardless of data and safety monitoring plans by the sponsor or others, the principal investigator is ultimately responsible for protecting the rights, safety, and welfare of subjects under his/her care and for ensuring that the study is conducted at his/her investigative site in accordance with the IRB-approved protocol, and applicable regulations and requirements of the IRB.

Data and safety monitoring is the process for reviewing accumulated outcome data from an ongoing research study to ensure the continuing safety of current participants and those yet to be enrolled, as well as an effort to ensure the continuing validity and scientific merit of the research study. Data and safety monitoring plans provide a framework for how the safety and welfare of research participants will be followed during the course of the research study.

Data and safety monitoring is the process for reviewing accumulated outcome data from an ongoing research study to ensure the continuing safety of current participants and those yet to be enrolled, as well as an effort to ensure the continuing validity and scientific merit of the research study. Data and safety monitoring plans provide a framework for how the safety and welfare of research participants will be followed during the course of the research study.

The strategy outlined prospectively is used to asses the assumptions made in the trial design and the continued assurance of the safety and welfare of subjects. This is called a Data Safety Monitoring Plan (DSMP). A systematic review and evaluation of accumulated outcome data and events on enrollment numbers, reportable event data (including adverse reactions and unanticipated problems) and the overall compliance with the protocol is essential in most therapeutic trials involving risk to subjects.

Please note a Data Safety Monitoring Plan does not always require oversight by a Committee or Board. What is a Monitoring Entity? (below) explains the differences between a DSMP and a Data Safety Monitoring Committee.

A Data and Safety Monitoring Plan (DSMP) should be tailored to the nature, size, and complexity of the research protocol, the expected risks of the research, and the type of subject population being studied. Appropriate DSMPs may fall anywhere along a continuum from monitoring by the principal investigator or group of investigators to the establishment of an independent Data and Safety Monitoring Board (DSMB)/Data Monitoring Committee (DMC). See ‘What is a Monitoring Entity?’ Section V below for further explanation.

A Data and Safety Monitoring Plan (DSMP) should be tailored to the nature, size, and complexity of the research protocol, the expected risks of the research, and the type of subject population being studied. Appropriate DSMPs may fall anywhere along a continuum from monitoring by the principal investigator or group of investigators to the establishment of an independent Data and Safety Monitoring Board (DSMB)/Data Monitoring Committee (DMC). See ‘What is a Monitoring Entity?’ Section V below for further explanation.

A Data Monitoring Plan is required for:

• all studies considered greater than minimal risk
• multi-site research where one or all of the MHC subsidiary hospitals is/are the coordinating site
• studies where there is an NIH or FDA requirement for a plan
• studies when requested by the IRB

The review of this data on a consistent basis will allow for the overall understanding of the safety and effectiveness profile. A plan tells the IRB who, what, when and how the evaluation of accumulated outcome data will take place. This helps the IRB understand how the overall safety of the trial will be monitored during the course of the trial.