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Guidance for Clinical Investigators, Industry, and FDA Staff Financial Disclosure by Clinical Investigators - PDF
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1 Guidance for Clinical Investigators, Industry, and FDA Staff Financial Disclosure by Clinical Investigators U.S. Department of Health and Human Services Food and Drug Administration Office of Good Clinical Practice Center for Drug Evaluation and Research Center for Biologics Evaluation and Research Center for Devices and Radiological Health February 2013
2 Guidance for Clinical Investigators, Industry, and FDA Staff Financial Disclosure by Clinical Investigators Additional copies are available from: Office of Communication, Division of Drug Information, Building 51, Room 2201 Center for Drug Evaluation and Research Food and Drug Administration New Hampshire Avenue, Bldg. 51, rm. 2201, Silver Spring, MD Tel: ; Fax: ; and/or Office of Communication, Outreach and Development, HFM-40 Center for Biologics Evaluation and Research Food and Drug Administration 1401 Rockville Pike, Rockville, MD Tel: or ; and/or Division of Small Manufacturers, International, and Consumer Assistance Center for Devices and Radiological Health Food and Drug Administration New Hampshire Avenue, Bldg. 66, rm. 4621, Silver Spring, MD U.S.A. Tel: or ; Fax: ; and/or Office of the Commissioner, Office of Good Clinical Practice Food and Drug Administration New Hampshire Avenue, Bldg. 32, rm. 5173, Silver Spring, MD U.S.A. Tel: ; Fax: ; tm U.S. Department of Health and Human Services Food and Drug Administration Office of Good Clinical Practice Center for Drug Evaluation and Research Center for Biologics Evaluation and Research Center for Devices and Radiological Health February 2013
3 TABLE OF CONTENTS I. INTRODUCTION... 1 II. BACKGROUND... 1 III. FINANCIAL DISCLOSURE REQUIREMENTS... 2 A. Definitions...2 B. Disclosable Financial Interests and Arrangements...4 C. Agency Actions...4 IV. QUESTIONS AND ANSWERS... 5 A. GENERAL...5 B. FORMS AND INFORMATION TO BE SUBMITTED...6 C. FINANCIAL INTERESTS AND ARRANGEMENTS SUBJECT TO DISCLOSURE...11 D. CLINICAL INVESTIGATOR...15 E. SPONSOR...17 F. APPLICANT...21 G. COVERED CLINICAL STUDY...23 H. FDA REVIEW...26 I. RECORDKEEPING...29 J. FDA INSPECTIONS...30 K. CONTACTS...31 APPENDIX... 32
4 Guidance for Clinical Investigators, Industry, and FDA Staff 1 Financial Disclosure by Clinical Investigators This guidance represents the Food and Drug Administration's (FDA's) current thinking on this topic. It does not create or confer any rights for or on any person and does not operate to bind FDA or the public. You can use an alternative approach if the approach satisfies the requirements of the applicable statutes and regulations. If you want to discuss an alternative approach, contact the FDA staff responsible for implementing this guidance. If you cannot identify the appropriate FDA staff, call the appropriate number listed on the title page of this guidance. I. INTRODUCTION This guidance is intended to assist clinical investigators, industry, and FDA staff in interpreting and complying with the regulations governing financial disclosure by clinical investigators, 21 CFR part 54. This document is a revision of the Guidance for Industry: Financial Disclosure by Clinical Investigators dated March 20, In order to address issues raised by the Office of the Inspector General (OIG), Department of Health and Human Services, in its report, OEI , The Food and Drug Administration s Oversight of Clinical Investigators Financial Information 2 as well as questions FDA has received from industry and the public, FDA issued a revised guidance in draft in May 2011 for public comment. Comments were received from 13 individuals and entities, which were considered in preparing this final guidance. FDA encourages applicants and sponsors to contact the agency for advice concerning specific circumstances regarding financial disclosures that may raise concerns as early in the product development process as possible. FDA's guidance documents, including this guidance, do not establish legally enforceable responsibilities. Instead, guidances describe the agency's current thinking on a topic and should be viewed only as recommendations, unless specific regulatory or statutory requirements are cited. The use of the word should in agency guidances means that something is suggested or recommended, but not required. II. BACKGROUND The Financial Disclosure by Clinical Investigators regulation (21 CFR part 54) requires applicants who submit a marketing application for a drug, biological product or device to submit certain information concerning the compensation to, and financial interests and arrangements of, any clinical investigator conducting clinical studies covered by the regulation (see generally the 1 This revised guidance was prepared by the Office of the Commissioner, with input from the Center for Drug Evaluation and Research (CDER), Center for Biologics Evaluation and Research (CBER) and Center for Devices and Radiological Health (CDRH). 2 The OIG s report is available at 1
5 purpose of the regulation at 21 CFR 54.1). The regulation, which became effective on February 2, 1999, applies to clinical studies submitted in a marketing application, including a supplement or amendment to an original application, that the applicant or FDA relies on to establish that the product is effective, and any study in which a single investigator makes a significant contribution to the demonstration of safety (21 CFR 54.2(e) and 54.3). The regulation requires applicants to certify the absence of certain financial interests and arrangements of clinical investigators that could affect the reliability of data submitted to FDA, or to disclose those financial interests and arrangements to the agency and identify steps taken to minimize the potential for bias (21 CFR 54.4(a)). If the applicant does not include certification and/or disclosure, or does not certify that it was unable to obtain the information despite exercising due diligence, the agency may refuse to file the application (21 CFR 54.4(c)). III. FINANCIAL DISCLOSURE REQUIREMENTS Under the applicable regulations, 3 an applicant is required to submit to FDA a list of all clinical investigators who conducted covered clinical studies and to identify those who are full-time or part-time employees of the sponsor of each covered study (21 CFR 54.4). For each clinical investigator who was not a full-time or part-time employee of a sponsor of the clinical study, the applicant must provide either a certification, using FORM FDA 3454, that none of the financial interests or arrangements described in 21 CFR 54.4(a)(3) (see Section III.B. below) exists, or completely and accurately disclose, using FORM FDA 3455, the nature of those interests and arrangements to the agency and describe any steps taken to minimize the potential for bias resulting from those interests and arrangements (21 CFR 54.4(a)). If the applicant acts with due diligence to obtain the required information but is unable to do so, the applicant may certify that it acted with due diligence but was unable to obtain the information and include the reason the information could not be obtained (21 CFR 54.4). FDA generally expects that applicants will be able to provide this information. Under 21 CFR (c), (b)(5) and (c), a sponsor is required to obtain clinical investigator financial information before allowing the clinical investigator to participate in a covered clinical study. Under 21 CFR 54.4(b), each clinical investigator who is not a full-time or part-time employee of the sponsor of the covered clinical study is required to provide the sponsor with sufficient accurate financial information to allow for complete disclosure or certification and to update this information if any relevant changes occur during the study and for one year following its completion. A. Definitions Clinical Investigator For purposes of part 54, clinical investigator means a listed or identified investigator or subinvestigator who is directly involved in the treatment or evaluation of research subjects, including the spouse and each dependent child of the investigator or subinvestigator. (See 21 CFR 54.2(d).) See Section IV.D, Clinical Investigator, for additional information. Clinical investigators are included in the definition even if they did not participate for the entire length of the study. If a clinical investigator did not participate in the entire study, 3 21 CFR parts 54, 312, 314, 320, 330, 601, 807, 812, 814, and 860 2
6 information collected should be for the period of time he or she participated in the study and for one year following the end of his or her participation. Covered clinical study The part 54 regulations define covered clinical study to mean any study of a drug or device in humans submitted in a marketing application or reclassification petition subject to this part that the applicant or FDA relies on to establish that the product is effective (including studies that show equivalence to an effective product) or any study in which a single investigator makes a significant contribution to the demonstration of safety. This would, in general, not include phase 1 tolerance studies or pharmacokinetic studies, most clinical pharmacology studies (unless they are critical to an efficacy determination), large open safety studies conducted at multiple sites, treatment protocols and parallel track protocols. (See 21 CFR 54.2(e).) This definition includes clinical studies submitted in support of new drug applications (NDAs) submitted under section 505(b) of the Federal Food, Drug, and Cosmetic Act (FD&C Act), abbreviated new drug applications (ANDAs) under section 505(j) of the FD&C Act, premarket notification submissions under section 510(k) of the FD&C Act, reclassification petitions under section 513 of the FD&C Act, premarket approval applications (PMAs) under section 515 of the FD&C Act, and biologics licensing applications (BLAs) submitted under section 351 of the Public Health Services Act (PHS Act), as well as studies submitted in support of amendments or supplements to any such applications. (See 21 CFR 54.3 and 54.4(a).) Covered clinical studies would generally not include expanded access under section 561 of the FD&C Act. If an applicant is unsure of whether a particular study is included in this definition, it may consult with FDA as to which clinical studies constitute covered clinical studies for purposes of complying with financial disclosure requirements. (21 CFR 54.2(e).) See Section IV.G, Covered Clinical Study, for additional information. Applicant Applicant means the party who submits a marketing application to FDA for approval of a drug, device or biologic product or who submits a reclassification petition. The applicant is responsible for submitting the required certification and disclosure statements. (See 21 CFR 54.2(g).) Note that for purposes of financial disclosure the term applicant includes submitter and the term application includes 510(k) submission. See Section IV.F, Applicant, for additional information. Sponsor of the covered clinical study For purposes of part 54, sponsor of the covered clinical study means a party supporting a particular study at the time it was carried out. (See 21 CFR 54.2(h).) A covered clinical study may have more than one sponsor for whom financial information will need to be collected. For example, if one party designed and conducted the covered clinical study, a second party provided funding, and a third party provided the test product, there would be three sponsors of the covered clinical study. However, if the third party in this example was reimbursed for the test product, it would not be considered a sponsor of the covered clinical study and the study would be considered to have two sponsors. Note also that the definition of sponsor for purposes of part 54 is different than the definition of sponsor for purposes of investigational new drug applications (INDs) and investigational device exemptions applications (IDEs) (see 21 CFR 312.3(b) and 812.3(n)). See Section IV.E, Sponsor, for additional information. 3
7 B. Disclosable Financial Interests and Arrangements The financial interests, arrangements, and payments that must be disclosed (see 21 CFR 54.4(a)(3), referred to herein as disclosable financial interests and arrangements ) are described below. 4 Note that the dollar amounts that trigger reporting are the combined financial interests of the investigator, spouse, and dependent children. 1. Any compensation made to the investigator by any sponsor of the covered clinical study in which the value of compensation could be affected by study outcome. 2. A proprietary interest in the tested product including, but not limited to, a patent, trademark, copyright or licensing agreement. 3. Any equity interest in any sponsor of the covered clinical study, i.e., any ownership interest, stock options, or other financial interest whose value cannot be readily determined through reference to public prices. The requirement applies to interests held during the time the clinical investigator is carrying out the study and for one year following completion of the study. 4. Any equity interest in any sponsor of the covered study if the sponsor is a publicly held company and the interest exceeds $50,000 in value. The requirement applies to interests held during the time the clinical investigator is carrying out the study and for one year following completion of the study. 5. Significant payments of other sorts (SPOOS) are payments that have a cumulative monetary value of $25,000 or more and are made by any sponsor of a covered study to the investigator or the investigator s institution during the time the clinical investigator is carrying out the study and for one year following completion of the study. This would include payments that support activities of the investigator (e.g., a grant to the investigator or to the institution to fund the investigator s ongoing research or compensation in the form of equipment), exclusive of the costs of conducting the clinical study or other clinical studies, or to provide other reimbursements such as retainers for ongoing consultation or honoraria. See Section IV, Questions C.4, C.5, and C.6 for additional information on SPOOS. C. Agency Actions The agency may refuse to file a marketing application that does not contain the financial information required by 21 CFR part 54 or a certification by the applicant that the applicant has 4 These are the requirements for studies begun on or after the effective date of the part 54 regulations, February 2, For older studies, the disclosure requirements vary based on the study s status as of the effective date of the regulation. For studies that were completed prior to February 2, 1999, disclosure of financial interests and arrangements described in paragraphs 1 through 3 is required. For studies ongoing as of February 2, 1999, disclosure of financial interests and arrangements described in paragraphs 1 through 4 is required as well as payments as described in paragraph 5 that were made on or after February 2, (See Federal Register, volume 63, December 31, 1998, page ) 4
8 acted with due diligence to obtain the information but was unable to do so stating a sufficient reason. (21 CFR 54.4(c).) If FDA determines that the financial interests or arrangements of any clinical investigator raise a serious question about the integrity of the data, FDA will take any action it deems necessary to ensure the reliability of the data (21 CFR 54.5(c)) including: 1. Initiating agency audits of the data derived from the clinical investigator in question; 2. Requesting that the applicant submit further analyses of data, e.g., to evaluate the effect of the clinical investigator's data on the overall study outcome; 3. Requesting that the applicant conduct additional independent studies to confirm the results of the questioned study; and 4. Refusing to treat the covered clinical study as providing data that can be the basis for an agency action. IV. QUESTIONS AND ANSWERS A. GENERAL A.1. Q: Why did FDA develop the financial disclosure regulations? A: In June 1991, the Inspector General of the Department of Health and Human Services submitted a management advisory report 5 to FDA stating that FDA's failure to have a mechanism for collecting information on "financial conflicts of interest" of clinical investigators who study products that undergo FDA review could constitute a material weakness under the Federal Managers Financial Integrity Act. As stated in the preamble to the final rule, although FDA determined that a material weakness did not exist, the agency did conclude that there was a need to address this issue through regulation. 6 During the rulemaking process, FDA also learned about potentially problematic financial interests and arrangements through published newspaper articles, Congressional inquiries, and public testimony and comments. Based on the information gathered, FDA determined that it was appropriate to require the submission of certain financial information with marketing applications that, in part, rely on clinical data. 5 Office of the Inspector General (OIG), Department of Health and Human Services (DHHS), Management Advisory Report Financial Involvement of Clinical Investigators with Sponsors of Research Leading to Food and Drug Administration Marketing Approval, June 1991, OI-HQ The final rule was published in the Federal Register, Vol. 63, February 2, 1998, pages The referenced statement appears on page
9 A.2. Q: What is the purpose of FDA s review of clinical investigator financial disclosure information and how can sponsors minimize bias? A: FDA s review of clinical investigator financial disclosure information alerts FDA staff to financial interests and arrangements that could lead to bias in covered clinical studies. The financial disclosure process also provides FDA with information regarding whether and to what extent the sponsors have taken steps to minimize the risk of bias. An important means of minimizing the potential for bias resulting from such financial interests and arrangements is through proper study design (see 21 CFR 54.5(b)). For example, using randomization and blinding helps to minimize the potential for bias in assigning subjects to receive the test article or placebo and in assessing study outcomes and analyzing results. Similarly, having someone with no financial interests or arrangements evaluate study endpoints, especially in an unblinded study, can help minimize potential bias in assessing therapy outcomes. FDA staff consider the financial disclosure information and the methods the sponsor used to minimize bias during the review of marketing applications to assess the reliability of the clinical data (see 21 CFR 54.1). Additionally, because sponsors of studies conducted under INDs and IDEs are required to collect financial information from clinical investigators prior to study initiation, 7 sponsors can work with FDA to minimize any potential bias. FDA strongly encourages sponsors of studies not conducted under an IND/IDE to collect financial information prior to study initiation for the same reasons. B. FORMS AND INFORMATION TO BE SUBMITTED B.1. Q: What financial disclosure information is to be included in a marketing application? A: The application must contain a list of all clinical investigators who conducted each covered clinical study (21 CFR 54.4). For purposes of this list, investigators and subinvestigators who meet the definition of clinical investigator in 21 CFR 54.2(d) must be included. Note that the term clinical investigator includes the spouse and each dependent child of a clinical investigator (21 CFR 54.2(d)). This list must also identify those clinical investigators who are full or part-time employees of the sponsor of the covered study (21 CFR 54.4). If a spouse or dependent child is an employee of a sponsor, that clinical investigator should be identified as an employee for purposes of financial disclosure. For each clinical investigator who is not identified as an employee of the sponsor, one of the following must be submitted (21 CFR 54.4(a)): 7 21 CFR (c)(4), (b)(5), and (c) 6
10 1. FORM FDA 3455, Disclosure Statement, 8 for each clinical investigator who, or whose spouse or dependent child, had disclosable financial interests in and/or arrangements with any sponsor of the covered clinical study. The form should include an attachment with detailed information about those financial interests and arrangements (for example, the nature of the contingent payment or the equity holdings of the investigator, or the investigator's spouse or dependent child, that exceeded the threshold) and a description of the steps taken to minimize the potential for bias resulting from the disclosed financial interests and arrangements (21 CFR 54.4(a)(3)). See Section IV.C for additional information; 2. FORM FDA 3454, Certification, for any clinical investigator who has no disclosable financial interests in or arrangements with any sponsor of the covered clinical study (21 CFR 54.4(a)(1)); the applicant may append a list of investigator names to a single FORM FDA 3454 for those investigators with no disclosable financial interests or arrangements; or 3. If the applicant was unable to obtain some or all of the financial information needed to disclose or certify for a clinical investigator, the applicant must identify any disclosable financial interests or arrangements of which it is aware, certify that it acted with due diligence to obtain the information (listed as option 3 on FORM FDA 3454), and include an attachment identifying the reason why any missing information could not be obtained (21 CFR 54.4). FDA expects that in the vast majority of cases, applicants will be able to provide a complete financial Certification or Disclosure Statement and that the need to certify that they acted with due diligence will be rare. See Question B.7 and Question F.2 for additional information on due diligence. FDA encourages applicants to submit financial disclosure information in a format that will ensure all required information is included. For example, applicants should provide the total number of investigators in the study and a table indicating, for each clinical investigator listed who is not identified as an employee, whether they are providing a Certification (FORM FDA 3454), a Disclosure Statement (FORM FDA 3455) or certification that they acted with due diligence but were unable to obtain the information (option 3 on FORM FDA 3454). Applicants should also ensure that all required attachments, as identified above, are included. Applicants with questions about acceptable formats for submitting the financial disclosure information should contact the Center representatives identified in Question K.1. 8 As an alternative to a separate FORM FDA 3455 for each clinical investigator with information to disclose, applicants may submit a single FORM FDA 3455, with attachments clearly identifying all clinical investigators with information to disclose and, for each investigator, identifying the study, the specific details of their financial interests and arrangements and the steps taken to minimize the potential for bias. Applicants with questions about alternative formats should contact the Center representatives identified in Question K.1. 7
11 B.2. Q: May an applicant rely upon the policies and procedures of the clinical investigator s institution for disclosure, review and management of financial conflicts of interest of their employees (including spouse and dependent children)? A: Each applicant is responsible for disclosing or certifying as required by 21 CFR part 54. Compliance with institutional policies or procedures by an investigator is not a substitute for compliance with part 54. Although a clinical investigator s institution may take steps to manage a clinical investigator s financial interests and arrangements, in order to minimize study bias, FDA must make its own evaluation of the clinical investigator s financial interests and arrangements (21 CFR 54.5). When a clinical investigator has disclosable financial interests and arrangements, the disclosure statement submitted to FDA is required to include a description of any steps taken to minimize the potential for bias resulting from any of the disclosed financial interests and arrangements (21 CFR 54.4(a)(3)(v)). A description of the steps taken by the institution to minimize bias should be included with the disclosure statement, if pertinent. See Section IV, Question D.7 for additional information. B.3. Q: Where in a marketing application for a drug or a biological product should an applicant include the certification or disclosure forms and attachments? A: Applicants using the format described in FORM FDA 356h (Application to Market a New Drug, Biologic, or an Antibiotic Drug for Human Use) should include the clinical investigator list and financial certification and/or disclosure forms and attachments as part of item 19 (Financial Information) of the application. 9 Applicants using the Common Technical Document (CTD) format should include this information in Module B.4. Q: Where should the information be included in a device marketing application? A: Applicants should submit the clinical investigator list and financial certification/disclosure forms and attachments according to the format outlined in the appropriate submission guidance Application to Market a New Drug, Biologic, or an Antibiotic Drug for Human Use, available at 10 The ectd Backbone Files Specification for Module 1, available at missions/ucm pdf. 11 For premarket notification submissions, see Guidance for Industry and FDA Staff: Format for Traditional and Abbreviated 510(k)s, available at For premarket approval applications, see Guidance for Industry and FDA Staff: Premarket Approval Application Filing Review, available at 8
12 B.5. Q: How should the financial information be submitted? A: The financial information is required to be submitted using FORMS FDA 3454 and/or 3455 (21 CFR 54.4(a)), which are available on the Web at the following Internet address: (Forms are listed in numerical order). B.6. Q: Who, specifically, is responsible for signing the financial certification/disclosure forms? A: The forms are to be signed and dated by the chief financial officer or other responsible corporate official or representative of the applicant. FDA recommends that the other responsible corporate official or representative be a senior official who has the authority to ensure the information is collected and reported accurately. Depending on company structure, such an individual could be the person in charge of regulatory or clinical affairs. B.7. Q: What does FDA mean by the term due diligence? A: "Due diligence" is a measure of activity expected from a reasonable and prudent person under a particular circumstance, in this case, collecting information about financial interests or arrangements. FDA expects that applicants will typically be able to obtain the required information because investigators are required to provide financial disclosure information to sponsors before participating in a clinical study. (21 CFR 54.4, (c), (c) and (b)(5).) In the rare circumstance where applicants are unable to obtain required financial information, applicants must certify that they acted with due diligence and explain why the information was not obtainable (21 CFR 54.4). If all of the information required to make a complete certification or disclosure is not available from a sponsor, applicants should make appropriate efforts to obtain the information by other means. That may mean contacting an individual investigator or subinvestigator directly. If an investigator s whereabouts are unknown, for example because the investigator left a study prior to its completion or prior to one year following completion of the study, FDA recommends that sponsors and/or applicants try to locate the clinical investigator. Sponsors and applicants should exercise reasonable judgment regarding the appropriate amount of effort to expend when attempting to contact investigators, which may include consideration of the role of the investigator in the study and the importance of the investigator s data contribution. In most cases, FDA suggests that more than one attempt at contacting an investigator would be appropriate and that more than one method of contact be attempted. FDA also recommends that each attempt to contact the investigator be documented, for example, by maintaining copies of s and letters and documenting telephone calls and conversation by written memoranda. FDA also suggests that sponsors and applicants consider using a method of contacting investigators that allows verification of receipt, such as certified mail or reliable courier service that provides notice of recipient s receipt 9
13 of a letter. When such methods are used, copies of the delivery notice or undeliverable notice should be maintained. If an investigator is no longer at the institution where the study was conducted, FDA recommends that the sponsor or applicant make a reasonable attempt to locate the investigator, for example, by requesting contact information from the institution where the study was conducted or the institution with which the investigator was affiliated, contacting professional associations the investigator may have been affiliated with, and/or conducting Internet searches. If a clinical investigator cannot be located or information for some other reason cannot be obtained from the investigator, the sponsor should have access to certain disclosable financial information and arrangements, for example, payments made specifically to the investigator or information related to product sales that may generate royalties due to the investigator. On request from an applicant, sponsors should check their records for such information and, subject to any privacy laws (noting that other countries laws may differ from United States law), the sponsor should then provide disclosable information to the applicant. In addition, and as necessary, efforts should be made to obtain disclosable financial information from other reasonably available, reliable, public sources of information. For example, information on proprietary interests in the test product, such as patents and trademarks, should be available from publicly available sources. 12 Another possible source of information is the clinical investigator s institution, which may have collected financial information and, if consistent with their policies, may release this information to the applicant upon request. Appropriate certifications, disclosures, and/or explanations should be provided to FDA on the basis of information obtained. See Question F.2 for additional information. An applicant must exercise due diligence whether a covered study is conducted at foreign or domestic sites. The agency expects that a reasonable and prudent applicant will take affirmative steps at the first opportunity to see that the financial information required for a complete certification or disclosure under part 54 is collected and maintained. This is not only to ensure that the applicant will be able to make a complete submission but also to ensure that the study sponsor will take steps to protect the study against possible bias. See Questions E.3, E.5, and F.3 for additional information. B.8. Q: Is clinical investigator financial disclosure information required in IND or IDE applications? A: No, IND/IDE sponsors are not required to submit information regarding clinical investigator financial interests or arrangements in IND or IDE applications. They are, however, required to collect this information before a clinical investigator participates in a clinical study (see 21 CFR (c)(4), (b)(5), and (c)(5)), and 12 Such sources include the Patent and Trademark Office website and, once available, the federal reporting website proposed by the Centers for Medicare & Medicaid Services as required by Section 6002 of the Patient Protection and Affordable Care Act. See the final rule, Transparency Reports and Reporting of Physician Ownership or Investment Interests, Federal Register, Vol. 78, February 8, 2013, page
14 clinical investigators are required to disclose financial information to sponsors (see 21 CFR (d) and (d)). The information need not be submitted to FDA until a marketing application is submitted containing the results of the covered clinical study (21 CFR 54.4). Study sponsors are encouraged to consult with FDA prior to and during clinical studies about the management of specific situations involving potential bias on the part of a clinical investigator. During these consultations, FDA staff should focus on the protection of research subjects and the minimization of bias from all potential sources. C. FINANCIAL INTERESTS AND ARRANGEMENTS SUBJECT TO DISCLOSURE C.1. Q: What information about a financial interest or arrangement should be disclosed to the agency? For example, if an investigator owns more than $50,000 of stock in a publicly held company, can the applicant just disclose that there is an interest that exceeds the $50,000 threshold or is it necessary to disclose in written detail the interest or arrangement in question? A: The applicant must make a complete and accurate disclosure (21 CFR 54.4(a)(3)). The specific details of the financial interest or arrangement, including its size and nature, should be disclosed as should any steps taken to minimize the potential for study bias resulting from the interest or arrangement. In describing financial interests, for example, the applicant might list: stock valued at $77,000, speaking fees of $7,500, consulting fees of $22,000, and a grant of $125,000 and include a discussion of the specific steps taken to minimize potential bias. Sponsors should request that clinical investigators provide sufficient detail about their financial disclosure information to allow the appropriate disclosures to be made. C.2. Q: Should a clinical investigator report all fluctuations above and below the $50,000 level during the course of the investigation and one year after completion of the study? A: In light of the potential volatility of stock prices, FDA recognizes that the dollar value of an investigator's equity holding in a sponsoring company is likely to fluctuate during the course of a study. Clinical investigators should report an equity interest when the investigator becomes aware that the holding has exceeded the threshold and the investigator should use judgment in updating and reporting on fluctuations in equity interests exceeding $50,000. FDA does not expect the investigator to report when an equity interest fluctuates below that threshold. See Question E.4 for additional information. C.3. Q: Are equity interests in mutual funds and 401(k)s reportable? A: FDA expects that equity interests held in publicly traded mutual funds will not be reportable in the vast majority of cases. If, however, an investigator would have control 11
15 over buying or selling stocks in a mutual fund, equity interests held in such publicly traded mutual funds would be reportable. If an investigator holds an equity interest in a sponsor over $50,000 in a 401(k) or equivalent account, and has control over whether to buy or sell the interest, the equity interest is reportable. C.4. Q: How do significant payments of other sorts (SPOOS) relate to the variety of payments the sponsor might make to an individual or institution for various activities? A: The term "significant payments of other sorts" was intended to capture substantial payments or other support that has a value of more than $25,000 provided to an investigator or institution that could create a sense of obligation to the sponsor. These payments do not include payments for the cost of conducting the clinical study of the product under consideration or clinical studies of other products, under a contractual arrangement, but do include other payments made directly to the investigator or to an institution for direct support of the investigator. Significant payments of other sorts would include, for example, payments, retainers and honoraria from a sponsor to a clinical investigator for activities such as participating on committees, providing consultation, or serving as a preceptor (21 CFR 54.2(f)). Grants to fund ongoing research, including laboratory activities and equipment, and compensation in the form of actual equipment for the laboratory/clinic would also be considered significant payments of other sorts. This means that if an investigator were given equipment or money to purchase equipment for use in the laboratory/clinic but not in relation to the conduct of the clinical study, payment would be considered a significant payment of other sorts (21 CFR 54.4(a)(3)(ii)). If, however, the investigator were provided with computer software or money to buy software needed for use in the clinical study, that payment would not need to be reported. Payments made to the institution that are not made on behalf of the investigator and are not specifically targeted towards the investigator generally would not need to be reported. Under certain circumstances, however, a grant made to an institution would be considered targeted towards the investigator (and therefore considered reportable); for example, if the grant is worded in such a way that only the investigator could fulfill it. Finally, payments that meet the criteria for significant payments of other sorts that are made to other researchers at the institution, who are not part of the covered study, do not need to be reported. 12
16 C.5. Q: Are payments made to investigators to cover travel expenses (such as transportation, lodgings and meal expenses) reportable as significant payments of other sorts (SPOOS)? A: Generally, reasonable payments made to investigators to cover reimbursable expenses such as transportation, lodgings and meals do not fall within the definition of SPOOS and, therefore, would not need to be reported. Payment for other expenses that are generally considered outside of normal reimbursable expenditures and not expenses necessary to conduct the study would be considered SPOOS. Such payments would include, for example, entertainment costs, travel costs associated with transporting and/or providing lodgings and meals for family members, and other payments that exceed reasonable expectations (for example, if an investigator was flown to a resort location for an extra week of vacation). These types of expenses are reportable and should be tracked as SPOOS. FDA understands that such payments may be limited or prohibited by industry ethical codes. 13 To the extent such payments are made, they would be SPOOS. C.6. Q: Is the dollar amount that triggers reporting of significant payments of other sorts (SPOOS) cumulative over the course of the study or is it based on the amount received on an annual basis? A: The $25,000 threshold amount for reporting SPOOS is based on the cumulative amount of SPOOS received by the clinical investigator (including payments made to the spouse and dependent children) over the course of the study and for one year following completion of the study. C.7. Q: Does FDA have expectations about how the financial information should be collected? Will FDA consider it acceptable practice for a company to use a questionnaire to collect financial information from investigators rather than constructing an internal system to collect and report this information? A: FDA regulations do not prescribe a particular method for collecting financial information from investigators. Sponsors/applicants have the flexibility to collect the information in the most efficient and least burdensome manner that will allow for complete and accurate certifications and disclosures. They may use questionnaires completed by the clinical investigators and/or information already available to the sponsor, as appropriate. FDA does not require sponsors to establish elaborate systems to collect and track financial information. If sponsors intend to use a questionnaire to collect financial information from investigators, FDA recommends that they develop forms suited to that purpose. FORM FDA 3455 was designed for applicants to use to report financial information they collected from clinical investigators to FDA. It does not include the background 13 Examples of industry ethical codes would be the Principles on Conduct of Clinical Trials and Communication of Clinical Trials Results from the Pharmaceutical Research and Manufacturers of America (PhRMA) and the Code of Ethics on Interactions with Health Care Professionals from the Advanced Medical Technology Association (AdvaMed). 13
17 information needed for clinical investigators to be aware of the financial information to be provided. For example, there is no statement that the reporting requirements apply to the spouse and dependent children as well as to the investigator; no information as to the dollar amounts triggering reporting of equity interests or SPOOS; and no statement that the investigator must report the details of the financial interests and arrangements, not just a statement, for example, of equity interest greater than $50,000. In addition, when there is more than one sponsor for financial disclosure purposes, the investigator should be apprised that the dollar amounts triggering reporting apply separately to each sponsor. This type of explanatory information should be provided to the clinical investigators to ensure that the financial disclosure information collected is as accurate and complete as possible. Please see the Appendix for considerations for collecting financial disclosure information from clinical investigators. C.8. Q: The regulation requires that investigators provide information on financial interests and arrangements during the course of the study and for one year after completion of the study (see 21 CFR 54.4(b)). What does during the course of the study mean? What does "completion of the study" mean? A: During the course of the study refers to the time from the date the clinical investigator entered into an agreement with the sponsor to conduct the study until the completion of the study. For the purposes of financial disclosure under part 54, completion of the study means that all study subjects have been enrolled and follow-up of primary endpoint data on all subjects has been completed in accordance with the clinical protocol. Many studies have more than one phase (e.g., a study could have a short-term endpoint and a longer term follow-up phase). Completion of the study here refers to the part of the study that is being submitted in the application. If there were a subsequent application based on longer term data, completion of the study would be defined using completion of follow-up for the longer term data. An applicant is not required to submit updated financial information to FDA after submission of the application, but applicants must retain complete records (21 CFR 54.6). Where there is more than one study site, the sponsor may consider completion of the study to occur when the last study site is complete, or may consider each study site individually as it is completed. C.9. Q: What if the sponsor changes during the course of the study or within one year of completion of the study, for example, through purchase or merger? A: Agency regulations require that an IND/IDE sponsor collect financial information from all clinical investigators and that clinical investigators promptly update this information if any relevant changes occur during the course of the investigation and for one year following completion of the study (21 CFR 54.4, (c)(4), (d), (c)(5) and (d)). Therefore, if the study sponsor changes during the course of the study, the clinical investigators will need to update their financial disclosure information relevant to the new sponsor. The new sponsor is responsible for collecting this information, and to ensure that the new sponsor has complete financial disclosure information, the new sponsor should seek this information from the original sponsor, and the agency encourages the original sponsor to share their records with the new sponsor. 14
18 With respect to covered clinical studies conducted outside the United States not pursuant to an IND or IDE (such as studies submitted pursuant to or ), the agency expects applicants to take affirmative action, at the earliest opportunity, to see that this information is collected and available to make a complete disclosure and/or certification under part 54. D. CLINICAL INVESTIGATOR D.1. Q: Who is included in the definition of clinical investigator? A: Under part 54, clinical investigator means only a listed or identified investigator or subinvestigator who is directly involved in the treatment or evaluation of research subjects (21 CFR 54.2(d)). This definition is intended to identify the individuals for whom reporting under this regulation is required. Generally, these individuals are considered to be the investigators and subinvestigators taking responsibility for the study at a given study site. The definition also includes the spouse and each dependent child of such an investigator or subinvestigator. It should be noted that hospital staff, including nurses, residents, fellows, and office staff who provide ancillary or intermittent care but who do not make direct and significant contribution to the data are not meant to be included under the definition of clinical investigator. Additionally, individuals who only collect specimens or perform routine tests (such as blood pressure, EKG, x-ray) are not meant to be included under the definition of clinical investigator for purposes of financial disclosure. D.2. Q: How does the definition of clinical investigator in the financial disclosure regulation (21 CFR part 54) relate to the definition in the IND regulations (21 CFR part 312)? A: For drugs and biological products, an investigator under 21 CFR part 312 is defined as an individual who actually conducts a clinical investigation (i.e., under whose immediate direction the drug is administered or dispensed to a subject). In the event an investigation is conducted by a team of individuals, the investigator is the responsible leader of the team. Subinvestigator includes any other individual member of that team. (21 CFR 312.3(b).) For purposes of the financial disclosure regulation, a clinical investigator is an investigator or subinvestigator who is directly involved in the treatment or evaluation of research subjects (21 CFR 54.2(d)). Therefore, the term clinical investigator in this context would generally include anyone who fits any of the following criteria: signs the FORM FDA 1572 (Statement of Investigator), is identified as an investigator in initial submissions or protocol amendments under an IND, or is identified as an investigator in the marketing application. This could include individuals identified as subinvestigators 15
19 on a FORM FDA For studies not conducted under an IND, the sponsor will need to identify the investigators and subinvestigators they consider covered by the regulation and provide FORMS FDA 3454 and/or 3455 as appropriate. FDA expects that there will be at least one such person at each clinical site. If other individuals are responsible for a study at a site, those persons should also be included as clinical investigators. D.3. Q: How does the definition of clinical investigator in the financial disclosure regulation (21 CFR part 54) relate to the definition in the medical device regulations (21 CFR part 812)? A: For medical devices, investigator is defined under 21 CFR part 812 as an individual under whose immediate direction the subject is treated and the investigational device is administered, including follow-up evaluations and treatments. Where an investigation is conducted by a team of individuals, the investigator is the responsible leader of the team. (21 CFR 812.3(i).) In general, investigators and subinvestigators sign "investigator agreements" in accordance with 21 CFR (c), and it is these individuals whose financial interests and arrangements should be reported as they would fall under the definition at 21 CFR 54.2(d). For studies not conducted under an FDA-approved IDE (that is, a nonsignificant risk IDE or an exempt study), the sponsor would need to identify the investigators and subinvestigators they consider covered by the regulation and provide FORMS FDA 3454 and/or 3455, as appropriate. We expect that there will be at least one such person at each clinical site. D.4. Q: Is it necessary to collect financial information on spouses and dependent children of clinical investigators? A: Yes. The definition of clinical investigator in 21 CFR part 54 includes the spouse and dependent children of the investigators and subinvestigators who are required to report. Therefore, the financial interests and arrangements of the spouse and each dependent child of each investigator and subinvestigator are to be included in the disclosure (21 CFR 54.2(d)). The dollar amount that triggers reporting is the total of the financial interests of the investigator, spouse, and dependent children (21 CFR 54.2(d)). If a spouse or dependent child is an employee of the sponsor, the clinical investigator should be identified as an employee of the sponsor and no further disclosure is required. (See 21 CFR 54.4.) D.5. Q: Who is considered a dependent child? A: For purposes of clinical investigator financial disclosure under part 54, a dependent child is the investigator s child (whether by blood or adoption), stepchild or foster child who is unmarried, and for whom the investigator provides more than one-half of the 14 For guidance on who should be listed as an investigator or subinvestigator on Form FDA 1572, please see FDA s Information Sheet Guidance, Frequently Asked Questions Statement of Investigator (Form FDA 1572) available at 16
20 child s support. This would include a child who, at any time during the course of the study and for one year following completion of the study, is under the age of 19, under the age of 24 if a full-time student, or who is permanently and totally disabled. Such a child would generally have the same principal residence as the investigator. D.6. Q: What obligations does the clinical investigator have under the financial disclosure regulations? A: Clinical investigators are to provide sponsors sufficient accurate financial information to allow the applicant to submit complete and accurate certification or disclosure statements (see 21 CFR 54.4, (c)(4), (d), (c)(5) and (d)). Clinical investigators must provide this information to sponsors and also promptly update the information if any relevant changes occur during the course of the investigation and for one year following the completion of the study (see 21 CFR 54.4(b), (c)(4), (d), (c)(5) and (d)). See also Question C.2. D.7. Q: May a clinical investigator rely on the information he/she provided to comply with his/her institution s policies and procedures pertaining to financial conflicts of interest to comply with the investigator obligations for financial disclosure under FDA s regulations? A: The financial information a clinical investigator provides to his/her institution is based on the institution s requirements, which may not be sufficient to meet FDA s regulations. FDA s regulations require the clinical investigator to provide sufficient and accurate financial information to the sponsor to allow the sponsor to submit complete and accurate certification or disclosure statements under FDA s clinical investigator financial disclosure regulations (21 CFR 54.4(b)). However, if an investigator determines that the financial information he/she provided to his/her institution adequately fulfills the disclosure requirements in FDA s regulations, a clinical investigator could provide the same information to the sponsor. The clinical investigator would still need to commit to promptly updating the financial information if any relevant changes occur during the course of the study and for one year following completion of the study (21 CFR 54.4(b)). E. SPONSOR E.1. Q: How does the definition of sponsor in the financial disclosure regulation (21 CFR part 54) relate to the definition in the IND/IDE regulations (21 CFR parts 312 and 812)? A: In 21 CFR part 54, the term sponsor of the covered clinical study means the party supporting a particular study at the time it was carried out (21 CFR 54.2(h)). FDA interprets support to include those who provide material support, for example, monetary support or the test product under study. (See Question E.9 for further explanation of material support. ) This differs from the meaning of sponsor in other FDA regulations (such as 21 CFR parts 312 and 812), where the sponsor may be the 17