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The Value of Continuity: Program-level DSMBs

In the realm of pharmaceutical development, ensuring the safety and efficacy of new treatments is paramount. One crucial aspect of this process involves establishing data safety monitoring boards (DSMBs) (also known as data monitoring committees [DMCs]) to oversee clinical trials.

Traditionally, pharmaceutical sponsors have formed a new DSMB for each individual trial. However, there’s a growing recognition of the benefits of utilizing the same DSMB members to oversee multiple trials within an entire therapeutic program.

This shift to a single DSMB for a therapeutic program not only ensures continuity of experience but also offers potential cost savings and efficiency gains.

Continuity of Experience

Imagine a pharmaceutical company is embarking on a series of clinical trials for a particular therapeutic area, such as oncology or neurology. By utilizing the same DSMB members across all trials in the series, the members develop a deep understanding of the drug, its mechanisms, and potential safety concerns specific to the therapeutic area.

This continuity of experience enables the DSMB to provide the pharmaceutical company with more nuanced and informed recommendations throughout the entire program.

Moreover, familiarity with the drug and its development process allows DSMB members to detect subtle changes or trends in safety data over time.

This long-term perspective is invaluable in assessing the overall risk-benefit profile of the drug, especially in cases where adverse events may manifest only after prolonged exposure or in specific patient populations.

Faster Setup

Establishing a new DSMB can take months for member identification, charter development, technology system setup, and other setup activities. (Though some independent providers can set up a DSMB in as little as six to eight weeks.)

Utilizing the same board members for multiple trials can substantially reduce the setup time required as members are already contracted, technology systems are already established, members are trained on those systems, prior charters can be leveraged, and many other advantages.

DSMBs retained to support every trial in a program can be set up and ready to cover the next trial within a couple of weeks.

Cost Savings

Forming a new DSMB for each individual trial demands time and resources. Setting up a DSMB involves identifying qualified experts, negotiating contracts, and ensuring compliance with regulatory requirements for each board.

By contrast, utilizing the same DSMB members across multiple trials streamlines this process and reduces administrative burdens.

Furthermore, ongoing engagement with the same DSMB members may lead to more efficient communication channels and decision-making processes. As the board becomes familiar with the company’s protocols and reporting mechanisms, discussions can be more focused, potentially accelerating the pace of clinical development.

Recent FDA Draft Guidance

The importance of continuity in data monitoring is underscored by the 2024 FDA draft guidance on DMCs. This draft guidance highlights and expands on the benefits the Food and Drug Administration (FDA) sees in having a single DMC oversee an entire therapeutic program, rather than focusing solely on individual trials.

The FDA’s added emphasis on program-level oversight reflects a broader recognition of the complexities involved in modern drug development.

Therapeutic programs often involve multiple trials conducted across different geographical regions and patient populations. In such scenarios, a single DSMB can provide consistent oversight and ensure harmonized safety monitoring practices across all trials in the program.

Utilizing the same DSMB members across therapeutic programs offers numerous advantages. Continuity of experience facilitates deeper insights into safety data, while potential cost savings and efficiency gains enhance overall trial management.

Moreover, recent FDA guidance on DMCs reinforces the importance of program-level oversight in ensuring the safety and efficacy of new treatments. Sponsors and contract research organizations (CROs) should thoughtfully consider leveraging these safety and efficiency advantages and engage a DSMB at the therapeutic program level.

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