Overview

As per the MHCTR and the MHCTR2006, the Medicines and Healthcare Products Regulatory Agency (MHRA) is the regulatory authority responsible for clinical trial approvals, oversight, and inspections in the United Kingdom (UK). The MHRA grants permission for clinical trials to be conducted in the UK in accordance with the MHCTR and the MHCTR2006.

According to GBR-57, the MHRA is an executive agency within the Department of Health and Social Care (DHSC), which grants the MHRA authority to regulate and license all medicines and medical devices within the UK. Per the G-CTAuth, the agency’s Clinical Trials Unit (CTU) focuses specifically on reviewing applications to conduct clinical trials of medicinal products.

Pursuant to MMDAct, the Secretary of State for DHSC is authorized to make clinical trials regulations and amend or supplement the law relating to human medicines, taking into consideration the safety of human medicines, the availability of human medicines, and the likelihood of the UK being seen as a favorable place to carry out research relating to human medicines, conduct clinical trials, or manufacture or supply human medicines.

Please note: United Kingdom is party to the Nagoya Protocol on Access and Benefit-sharing (GBR-5), which may have implications for studies of investigational products developed using certain non-human genetic resources (e.g., plants, animals, and microbes). For more information, see GBR-48.

Contact Information

MHRA
10 South Colonnade
Canary Wharf
LONDON
E14 4PU
UK

Phone: +44 020-3080-6000
Fax: +44 0203-118-9803
General Email: info@mhra.gov.uk

Clinical Research Office:
Email: clintrialhelpline@mhra.gov.uk
Phone: +44 020-3080-6456

In addition, the G-CTAuth includes other email addresses for specific purposes related to submissions.

Overview

In accordance with the MHCTR and the MHCTR2006, the Medicines and Healthcare Products Regulatory Agency (MHRA) is responsible for reviewing, evaluating, and approving applications for clinical trials using registered or unregistered investigational products (IPs). (Note: IPs are known as investigational medicinal products (IMPs) in the United Kingdom (UK)). The MPHFR and the G-CTApp specify that the scope of the MHRA’s assessment includes all clinical trials (Phases I-IV). The G-CTApp permits MHRA’s review process to be conducted in parallel with the ethics committee (EC) review, stating that an EC opinion may be obtained before, during, or after the MHRA application submittal. However, pursuant to the MHCTR and the MHCTR2006, the clinical trial must be authorized by the MHRA, and an EC established and recognized by the United Kingdom Ethics Committee Authority (UKECA) must provide a favorable opinion in relation to the trial prior to the trial’s commencement. (See the Ethics Committee topic for detailed information on the EC review and approval process.)

Brexit

Per the G-MHRASubmiss, Brexit, the EUCouncil-Brexit, the WithdrlAgrmt, and the G-AfterTransition, the UK withdrew from the European Union (EU) on January 31, 2020. The MHRA has updated and published clinical trials guidance that became effective on January 1, 2021; these guidance documents are referenced and described throughout this profile. G-AfterTransition summarizes the guidance to sponsors and researchers from January 1, 2021. Furthermore, the G-MHRASubmiss describes how to make regulatory submissions to the MHRA starting on January 1, 2021, including all clinical trial submissions (initial applications, substantial amendments, end-of-trial notifications and developmental safety update reports (DSURs)). Per the MHCTR-EUExit and as explained in GBR-115, the new guidance went into force via the MHCTR-EUExit (also known as the "Exit Regulations"). The Exit Regulations also update existing UK legislation by, for example, replacing references to EU databases with newly established UK databases. The GBR-114 explains that as a result of the Northern Ireland Protocol, different rules will apply in Northern Ireland than in Great Britain (which covers England, Wales, and Scotland). Broadly, Northern Ireland will continue to follow the EU regulatory regime (e.g., GBR-21), but its national competent authority will remain the MHRA. For broader information and a comprehensive Brexit “checker” of new rules in the UK, see GBR-60.

To help ensure the continuity of supply of investigational products for clinical trials from January 1, 2021, the BrexitLtr-IPs indicates that the UK will unilaterally recognize certain EU regulatory processes for a time-limited period. This recognition is known as “standstill.”

Per GBR-54, the EU Clinical Trials Regulation (GBR-21) is expected to come into application on January 31, 2022. Per the GBR-115, the UK is committed to being as aligned as possible with GBR-21. The MMDAct grants authority for regulations to be made that correspond or are similar to GBR-21. Per GBR-71 and GBR-86, GBR-21 will harmonize the rules for conducting clinical trials throughout the EU.

Clinical Trial Review Process

Application Submission

Per the G-MHRASubmiss, as of January 1, 2021, MHRA started new processes to submit regulatory and notification information to the UK. For clinical trial applications to the UK, including initial applications, substantial amendments, end-of-trial notifications, and DSURs, applicants must submit information through the UK’s national portals. Per the G-CTApp, the applicant must complete the clinical trial application form on the Integrated Research Application System (IRAS) (GBR-78) and submit the form via MHRA Submissions (GBR-13) with the rest of the required documents. Note, per GBR-18 and GBR-17, every clinical trial must include a unique European Clinical Trials Database (EudraCT) number (GBR-87). This number must be included on all clinical trial applications and as needed on other documents relating to the trial (e.g., safety reports). To obtain a EudraCT number, follow the instructions at GBR-17 and GBR-87. The steps for gaining access to MHRA Submissions (GBR-13) are contained in the G-MHRASubmiss and GBR-11. (See Clinical Trial Lifecycle topic, Submission Process subtopic for additional details.)

The MHCTR, the G-CTApp, and GBR-23 specify that the MHRA coordinates the clinical trial application process. Per GBR-23, upon receipt of a clinical trial application, the MHRA’s Clinical Trials Unit (CTU) validates it and sends the sponsor or his/her designated legal representative an acknowledgement. The G-CTApp states that MHRA has moved from paper to automated electronic communication. To ensure receipt of MHRA correspondence, applicants should add MHRA_CT_Ecomms@mhra.gov.uk to their safe sender email list. MHRA will only send official correspondence to the named applicant email address. If the application is valid, the CTU assessment period begins from the date of receipt (Day 0). If the application is not valid, the sponsor or his/her designated representative will be informed of the deficiencies, and he/she must provide a completely new application. According to the MHCTR, if the sponsor or his/her designated representative does not receive a request for additional information from the MHRA within 30 days, the application is considered as authorized. (See the Clinical Trial Lifecycle topic, Timeline of Review subtopic for additional details.)

In addition, as stated in the G-CTApp, certain first-in-human (Phase I) trials with specific risk factors may require the MHRA’s CTU to seek advice from an Expert Advisory Group/the Commission on Human Medicines before giving approval. See the G-CTApp for examples of which trials require expert advice and for detailed requirements.

Notification Scheme Submission

As set forth in the G-CTApp and GBR-23, in lieu of a standard application, a sponsor or his/her designated representative may submit a notification of a clinical trial to the MHRA under the Notification Scheme when conducting “Type A” trials. Type A trials are those in which the potential risk associated with an IP is determined to be no higher than that of standard medical care, and involve medicinal products licensed in any EU Member State that meet the following criteria:

• They relate to the licensed range of indications, dosage and form, or,
• They involve off-label use established by practice and supported by published evidence and/or guidelines

See the G-CTApp and GBR-23, for detailed Notification Scheme requirements.

Upon receipt of a valid notification, the MHRA will send an acknowledgement to the sponsor or his/her designated representative stating that the trial may proceed if it does not raise an objection within 14 days. If the MHRA does not send a Notification Objection letter, the acknowledgement serves as the authorization. The G-CTApp states that MHRA has moved from paper to automated electronic communication. To ensure receipt of MHRA correspondence, applicants should add MHRA_CT_Ecomms@mhra.gov.uk to their safe sender email list. MHRA will only send official correspondence to the named applicant email address.

If the MHRA raises objections, the submission is assessed as a standard request for authorization (refer to information under the Application Submission heading above), and the CTU initial assessment is performed within 30 days of receipt of a valid application.

Governance Approval

Per GBR-78, all project-based research must also apply for governance and legal compliance approvals from the appropriate lead UK Health Department. The Integrated Research Application System (IRAS) (GBR-78) facilitates this process. As described in GBR-96 and GBR-67, approval from the Health Research Authority (HRA) is required for all project-based research in the National Health Service (NHS) led from England or Wales. HRA and Health and Care Research Wales (HCRW) approval brings together the assessment of governance and legal compliance. For any new studies led from Scotland or Northern Ireland but have English and/or Welsh NHS sites, the national R&D coordinating function of the lead nation will share information with the HRA and HCRW assessment teams, who can issue HRA and HCRW approval for English and Welsh sites and thereby retain existing compatibility arrangements. Studies led from England or Wales with sites in Northern Ireland or Scotland will be supported through existing UK-wide compatibility systems, by which each country accepts the centralized assurances, as far as they apply, from national coordinating functions without unnecessary duplication. For details on HRA’s assessment criteria and standards for approval, see GBR-29.

(See the Clinical Trial Lifecycle topic, Submission Process and Submission Content subtopics for detailed submission requirements.)

Overview

As per the MHCTR, the MHCTR2006, the G-CTApp, and the G-MHRAFees, the sponsor or his/her designated representative is responsible for paying a fee to the Medicines and Healthcare Products Regulatory Agency (MHRA) to submit a clinical trial application for authorization. According to the G-MHRAPaymt, applicants do not need to attach proof of payment to applications. Applicants will receive an invoice to make a payment for the correct amount after validation of the application. Applicants must pay invoices upon receipt or they will incur penalty fees.

As delineated in the G-MHRAFees, the MHRA levies the following clinical trial processing fees, which will remain in effect through 2022:

• 3,060 British Pounds – Applications with an Investigational Medicinal Product (IMP) dossier

• 225 British Pounds – Applications without an IMP dossier

• 225 British Pounds – Clinical trial variation/amendment

• No cost – Phase IV notification

The G-CTApp further indicates that no fees are required for applications submitted and authorized under the Notification Scheme. However, if the MHRA raises an objection to the notification, the submission is treated as a standard request for authorization and an assessment of the submission is carried out with associated fees.

Instructions for Payment of Clinical Trial Application Fees

According to the G-MHRAPaymt, MHRA does not accept checks. Payments can be made electronically by bank transfer, credit card, or debit card. Bank transfers should be sent to:

Account Name: MHRA
Account Number: 10004386
Sort code: 60-70-80
Swift code: NWBKGB2L
IBAN: GB68NWBK60708010004386
Bank: National Westminster Bank

Bank address:
National Westminster Bank
RBS, London Corporate Service Centre, 2nd Floor
280 Bishopsgate
London
EC2M 4RB
UK

Credit or debit card payments may be made using MHRA’s online payments service (GBR-26).

Remittance advice notices can be sent to sales.invoices@mhra.gov.uk and should include the relevant invoice number on the remittance advice. MHRA cannot accept any documentation sent by postal mail service. Further information can be obtained by emailing sales.invoices@mhra.gov.uk or calling +44 (0)20 3080 6533 or +44 (0)30 3080 6533. G-MHRAPaymt further provides that invoice disputes/queries should be emailed to Clinical Trial Applications (CTA invoices) at ctdhelpline@mhra.gov.uk and cc: sales.invoices@mhra.gov.uk.

Overview

As set forth in GAfREC and GBR-9, the United Kingdom (UK) has a centralized recognition process for ethics committees (ECs), (known as research ethics committees (RECs) in the UK). Per GAfREC and GBR-9, the UK Health Departments have authorized the Research Ethics Service (RES) (GBR-62) in England, within the Health Research Authority (HRA), to serve as the lead administrative body to coordinate the development of operational systems for ECs. See GAfREC for more detail about HRA functions related to the RES in the United Kingdom. ECs are recognized or established by the United Kingdom Ethics Committee Authority (UKECA), the HRA, or the Ministers of Health Departments of the four (4) UK nations (England, Northern Ireland, Scotland, and Wales).

As stated in GAfREC, the RES encompasses England’s Department of Health and Social Care (DHSC), Northern Ireland’s Department of Health, the Scottish Government Health and Social Care Directorates, the Welsh Government’s Department of Health and Social Care as well as the ECs that are collectively recognized or established by these authorizing bodies. The UK Health Departments have authorized England’s HRA to perform some functions on behalf of the other head offices. A list of recognized ECs within the RES is available through GBR-95.

All recognized RES ECs are required to comply with the provisions delineated in GAfREC, the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), and GBR-9. However, specific ECs within the RES are recognized, or otherwise designated, to review certain types of research proposals. In accordance with the MHCTR and the MHCTR2006, ECs recognized to conduct reviews of clinical trials for investigational medicinal products (CTIMPs) are authorized by the statutory body, the UKECA, and are of central importance in this topic. Please refer to the Ethics Committee topic, Authorizing Body subtopic for additional details on the RES and the UKECA.

Ethics Committee Composition

As delineated in the MHCTR and GAfREC, a RES-recognized EC, which includes those recognized by UKECA, may consist of up to 18 members. Collectively, members must encompass the qualifications and experience required to review and evaluate the scientific, medical, and ethical aspects of a proposed clinical trial. The ECs should include a diverse mixture of members in terms of age, disability, gender, race, religion, and sexual orientation. One third of the committee must also be lay members, and half of the lay members must be persons who are not and never have been health care professionals, clinical researchers, or managers of clinical research (also known as lay members). Additionally, GAfREC states that a quorate meeting must be attended by at least seven (7) members and include the chair, at least one (1) expert member, and one (1) lay member. GBR-9 mirrors this requirement, but adds that when investigational products are reviewed, a lay member must be present. See GBR-113 for additional recommendations for composition.

Per GBR-9, in order to accommodate the United States’ (US) quorum definition pursuant to regulations for the protection of human subjects in research (45 CFR 46) and the Common Rule (45 CFR 46 Subpart A), the RES also makes special arrangements to review UK-based research funded by US Federal Government departments and their agencies. In such cases, the quorum is a majority of the EC. See the ClinRegs United States page, Ethics Committee topic for more information on ethics review requirements in the US.

As indicated in GAfREC, committee member appointments are valid for up to five (5) years. Appointments may be renewed; however, members should not normally serve more than two (2) consecutive terms of five (5) years on the same EC, and members may resign at any time. Members must maintain confidentiality regarding all ethical review related matters and refuse any projects in which they have a conflict of interest. See the MHCTR and GAfREC for additional EC composition requirements.

Terms of Reference,  Review Procedures, and Meeting Schedule

In addition to complying with composition requirements, GAfREC, GBR-113, and GBR-9 state that an EC must also adopt written standard operating procedures (SOPs). The SOPs should cover the entire review process from application submission to opinion and notification, amendments, and annual reporting. For detailed EC procedures and information on other administrative processes, see GAfREC, GBR-113, and GBR-9.

Overview

According to GAfREC, the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), and GBR-9, the primary scope of information assessed by ethics committees (ECs) recognized by the United Kingdom (UK) Health Departments’ Research Ethics Service (RES) (GBR-62) relates to maintaining and protecting the dignity and rights of research participants and ensuring their safety throughout their participation in a clinical trial. (Note: ECs are known as research ethics committees (RECs) in the UK).

As per GAfREC, the MHCTR, the MHCTR2006, the MHCTR2006-No2, and GBR-113, ECs must pay special attention to reviewing informed consent and to protecting the welfare of certain classes of participants deemed to be vulnerable. (See Informed Consent topic and the subtopics of Vulnerable Populations; Children/Minors; Pregnant Women, Fetuses & Neonates; Prisoners; and Mentally Impaired for additional information about these populations).

As indicated in GAfREC, the MHCTR, the MHCTR2006, GBR-113, and GBR-9, ECs are responsible for ensuring an independent, timely, and competent review of all ethical aspects of the clinical trial protocol. They must act in the interests of the potential research participants and the communities involved by evaluating the possible risks and expected benefits to participants; confirming the suitability of the investigator(s), facilities, and methods; and verifying the adequacy of confidentiality and privacy safeguards. See GAfREC, the MHCTR, the MHCTR2006 and GBR-9 for detailed ethics review guidelines.

Role in Clinical Trial Approval Process

As described in GBR-9, GBR-66, GBR-111, and GBR-95, the type of EC responsible for approval (known as a “favorable opinion” in the UK) within the RES depends on the type of research being conducted. As discussed in the preceding subtopic, ECs recognized to conduct reviews of clinical trials for investigational medicinal products (CTIMPs) must be authorized by the United Kingdom Ethics Committee Authority (UKECA). Per GAfREC, RES-recognized ECs established under Health Department policy within each of the four (4) UK nations (England, Northern Ireland, Scotland, and Wales) review research studies other than CTIMPs.

As indicated in the MHCTR, the MHCTR2006, and GAfREC, CTIMP applications require the favorable opinion of a UKECA-recognized EC, and approval by the Medicines and Healthcare Products Regulatory Agency (MHRA) prior to the sponsor or his/her designated legal representative initiating the trial. The G-CTApp permits MHRA’s review process to be conducted in parallel with the EC review, stating that an EC opinion may be obtained before, during, or after the MHRA application has been electronically submitted to the Integrated Research Application System (IRAS) (GBR-78). Therefore, to prepare an EC application, an IRAS account must be created. Per GBR-78, IRAS does not change the requirements for review, including authorizations or signatures, of any regulatory authority or National Health Service (NHS) body. Therefore, it requires different authorizations depending on the type of study and the applicable review bodies.

According to GBR-9, the chief investigator (CI) must submit the electronic application to IRAS on the same day that a booking is made to schedule an EC review through the NHS Research Ethics Committee (REC)’s Online Booking Service (GBR-95). (See the Clinical Trial Lifecycle topic, Trial Initiation subtopic for additional information.)

According to the MHCTR, GAfREC, and GBR-9, for all studies, the RES requires the CI to obtain only one (1) EC review (referred to as the “main EC”) for a project taking place in the UK, regardless of the number of sites. Furthermore, GBR-9 states that the CI should be based in the UK and that the REC may agree exceptionally to an application being submitted by a CI based outside the UK, but should consider as part of the ethical review whether adequate arrangements are in place for supervision of the study in the UK. The ethical review includes an assessment of the suitability of each site or sites at which the research is to be conducted in the UK. The site assessment is not a separate ethical review, but forms part of the single ethical review of the research. Management permission is still required from the organization responsible for hosting the research before it commences at any site. In the case of international studies, an application must be made to an EC in the UK, whether or not the study has a favorable ethical opinion from a committee outside the UK, and whether or not it has started outside the UK.

Per GBR-68, unless an application is being processed under the proportionate review service (see GBR-31), the applicant should attend the EC meeting if possible. The EC will notify the sponsor of its decision, usually within 10 working days of the EC meeting, and will make one (1) of the following decisions:

• Favorable opinion
• Favorable opinion with additional conditions
• Provisional opinion
• Unfavorable opinion

GAfREC, the MHCTR, and GBR-9 also state that the EC must give its opinion within 60 calendar days of receipt of a valid application. When an EC requires further information before confirming its opinion, it may give a provisional opinion and may make one (1) written request for further information, clarification, or changes to documentation. The time required for the EC to receive a complete response to its request does not count against the 60-day timeline. Certain studies, including gene therapy studies, will take 90 days, or 180 days if a specialist group or committee is consulted. For other exceptions, see GAfREC and the MHCTR. (See the Clinical Trial Lifecycle topic, Submission Process subtopic and Timeline of Review subtopic for detailed submission process requirements.)

Per GBR-116, a new fast-track research ethics review pilot opened in January 2021. The pilot is testing a rapid research ethics review for global clinical trials and phase I trials for any disease area (excluding trials that require review by the Gene Therapy Advisory Committee). The pilot—which runs until at least June 2021—tests whether the Health Research Authority (HRA), on behalf of the UK, can establish a sustainable model for providing rapid research ethics review. The pilot aims to provide a final opinion on applications within 15 calendar days, excluding the time for applicants to respond to any requests for further information after initial review. Clinical trials interested in joining the pilot should email fasttrack.rec@hra.nhs.uk for more information, and applications should be prepared using GBR-78.

While there is no stated expiration date for an EC approval in the MHCTR, GAfREC, or the Additional Resources, IRAS (GBR-78) requires identification of an expected end date for the study. A change to the definition of the end of the study is a substantial amendment. Extension of the study beyond the period specified in the application form is a non-substantial amendment. See GBR-98 for guidance on what changes qualify as a substantial amendment, which requires notification to the EC and MHRA.

Overview

As set forth in GAfREC, ethics committees (ECs) are not permitted to charge an application fee or seek any other financial contribution or donation for reviewing research proposals. Additionally, per GAfREC, EC members receive no payment for contributing to the application review process at scheduled meetings or for attending these meetings.

Overview

Research Ethics Service

As stated in GAfREC, the United Kingdom (UK) Health Departments’ Research Ethics Service (RES) (GBR-62) encompasses England’s Department of Health and Social Care (DHSC), Northern Ireland’s Department of Health, the Scottish Government Health and Social Care Directorates, the Welsh Government’s Department of Health and Social Care, as well as authorized ethics committees (ECs) (known as research ethics committees (RECs) in the UK). The UK Health Departments have authorized the Health Research Authority (HRA), which is sponsored by England’s DHSC, to serve as the lead administrative body to coordinate the development of RES operational systems for ECs recognized or established by the United Kingdom Ethics Committee Authority (UKECA), the HRA, or the Ministers of Health Departments of the four (4) UK nations (England, Northern Ireland, Scotland, and Wales), including their respective head offices.

A head office represents each of the health departments within the four (4) UK nations and serves as the appointing authority for the recognized ECs. Per GAfREC and GBR-62, within England’s DHSC, the HRA is the head office with appointing authority for the RES. The official RES head offices (i.e., appointing authorities) for the other nations are represented by the Health and Social Care Research and Development (HSC R&D) Division (GBR-90) within Northern Ireland’s HSC Public Health Agency; the Chief Scientist Office (CSO) (GBR-91) within the Scottish Government Health and Social Care Directorates; and the Ethics Service within the Health and Care Research Wales (HCRW) (GBR-93). The head offices work together to maintain a consistent approach in operating the RES ECs.

UK Ethics Committee Authority 

As set forth in the MHCTR, the MHCTR2006, and GAfREC, the UKECA is responsible for establishing, recognizing, and monitoring ECs that review applications for clinical trials of investigational medicinal products (CTIMPs). As indicated in the MHCTR and GBR-9, the UKECA recognizes two (2) types of ECs for new CTIMPs applications:

• Type 1: Reviews Phase I clinical trials in healthy volunteers taking place anywhere in the UK
• Type 3: Reviews clinical trials in patients taking place anywhere in the UK

New applications are no longer allocated for review by ECs with Type 2 recognition.

Per GAfREC and GBR-9, the HRA is responsible for providing advice, assistance, and operational support to all UK ECs recognized by the UKECA.

As indicated in GBR-97, the Four Nations Policy Leads Group is tasked with acting as the UKECA, among other duties. This group works together across the four (4) nations of the UK, and provides a coordinated research approvals system and consistent policy and good practice standards. The Four Nations Policy Leads Group meetings are held every two (2) months. See GBR-97 for upcoming meeting dates.

Health Research Authority 

In accordance with the CareAct2014 and GBR-61, the HRA is a non-departmental public body established in 2015 and sponsored by England’s DHSC to standardize regulatory practices relating to health and social care research, and to encourage safe and ethical research conducted across the UK. According to GAfREC and GBR-9, the UK Health Departments have authorized the HRA in England to serve as the lead administrative body to coordinate the development of RES operational systems for ECs recognized or established by the UKECA, the HRA, or the Ministers or Health Departments of the four (4) UK nations (including their respective head offices). The RES is a core function of the HRA.

As indicated in GAfREC and GBR-64, the HRA, in support of the RES and UKECA, supports two (2) main types of ECs in the UK:

• Authorized ECs – those authorized by the RES to review all applications except those relating to CTIMPs
• Recognized ECs – those recognized by the UKECA, a statutory body established under the MHCTR, to review applications relating to CTIMPs. Recognized ECs may also review non-CTIMP research.

Registration, Auditing, and Accreditation

As delineated in GAfREC and GBR-9, the RES is responsible for ensuring the quality of the ECs, including the UKECA ECs, through regular monitoring, auditing, and accrediting their operations and performance.

Overview

In accordance with the MHCTR, the MHCTR2006, the G-CTApp, and GBR-9, the United Kingdom (UK) requires the sponsor or his/her designated legal representative to obtain clinical trial authorization from the Medicines and Healthcare Products Regulatory Agency (MHRA) prior to initiating the trial. Per G-CTApprovedCountries, MHCTR-EUExit lists the countries where a clinical trial sponsor, or their legal representative, may be established; these countries are initially European Union (EU) and European Economic Area (EEA) countries. According to the G-CTApp, the clinical trial sponsor takes responsibility for the initiation, management, and financing (or arranging the financing) of that trial. Clinical trials can also be sponsored by two (2) or more persons or organizations, which is referred to as joint or co-sponsorship. GBR-103 provides that if a sponsor(s) is not established in the UK or on an approved country list (which initially includes EU/EEA countries), it is a statutory requirement to appoint a legal representative based in the UK or a country on the approved country list for the purposes of the trial. Details of the legal representative should be entered in the ‘legal representative’ section of the Integrated Research Application System (IRAS) (GBR-78). In all cases, evidence should be provided with the application that the legal representative is willing to take on that role and is established at an address in the UK or a country on the approved country list. For example, a copy of correspondence between the sponsor and legal representative on appropriately headed paper could be supplied, or a copy of a contract. Where the legal representative is also a co-sponsor, this should be separately recorded on the application form and details given of the allocation of sponsorship responsibilities. Evidence of insurance or indemnity cover should be provided.

The G-SubtlAmndmt delineates that a change in sponsor or legal representative for a UK trial is a substantial amendment requiring submission to both the MHRA and the ethics committee (EC). From January 1, 2021, where the sponsor is from the rest of the world and the legal representative is established in the UK, and there are sites in the EU/EEA, the sponsor will need to assign an EU/EEA legal representative for these sites via a substantial amendment to the relevant EU/EEA competent authorities. No amendment submission to the MHRA is required where the sponsor or legal representative for an ongoing trial is established in the EU/EEA as the UK will continue to accept this. Further, no amendment will need to be submitted in the UK if the sponsor retains the UK legal representative for the UK study. Similarly, no amendment will need to be submitted in the UK if a sponsor remains in the UK and a legal representative is added to cover EU/EEA sites.

The G-CTApp permits the MHRA’s review process to be conducted in parallel with the EC review, stating that an EC opinion may be obtained before, during, or after the MHRA application submittal. Note that per GBR-9, in the case of international studies, an application must be made to an EC in the UK, whether or not the study has a favorable ethical opinion from a committee outside the UK and whether or not it has started outside the UK.

Per the G-MHRASubmiss, as of January 1, 2021, the MHRA started new processes to submit regulatory and notification information to the UK. For clinical trial applications to the UK, including initial applications, substantial amendments, end-of-trial notifications, and developmental safety update reports (DSURs), applicants must submit information through UK’s national portals. The steps for gaining access to MHRA Submissions (GBR-13) are contained in the G-MHRASubmiss and GBR-11. Per the G-CTApp, the applicant must complete the clinical trial application form on the Integrated Research Application System (IRAS) (GBR-78) and form via GBR-13. Note, per GBR-18 and GBR-17, every clinical trial must include a unique trial number, a European Clinical Trials Database (EudraCT) number (GBR-87). This number must be included on all clinical trial applications and as needed on other documents relating to the trial (e.g., safety reports). To obtain a EudraCT number, follow the instructions at GBR-17 and GBR-87.

As described in GBR-78, other relevant approvals can be sought on the IRAS site. For example, applicants can request inclusion in the NIHR Clinical Research Network (NIHR CRN) Portfolio, which comprises high-quality clinical research studies that receive support services from the Clinical Research Network in England.

(See Clinical Trial Lifecycle topic, Submission Content subtopic for detailed submission content requirements).

Submitting the Clinical Trial Application

According to the G-CTApp, applicants must complete the clinical trial authorization application form on IRAS (GBR-78) and submit it via MHRA Submissions (GBR-13) with the rest of the required documents. GBR-17 indicates that, until further notice, the MHRA will still expect a EudraCT number to be in place to provide a unique reference for clinical trials. The steps for gaining access to MHRA Submissions (GBR-13) are in G-MHRASubmiss and GBR-11.

Per the GBR-17, the clinical trial application will be validated on receipt and an acknowledgement letter will be sent to the person submitting the application. If the application is valid, then the assessment period will begin. This starts from the date of receipt of a valid application. If the application is not valid, then the applicant will be told of the deficiencies. Nothing will happen to the application until the missing components are provided.

GBR-9 states that the chief investigator (CI) must submit the electronic application to IRAS on the same day that a booking is made to schedule an EC review through the NHS Research Ethics Committee (REC)’s Online Booking Service (GBR-95). Detailed instructions about submitting EC applications through IRAS are available at GBR-78 and GBR-94.

GBR-72 contains information for participants who would like to submit a clinical trial application via the Combined Ways of Working (CWoW). As of January 2021, the Health Research Authority (HRA) started accepting applications from new sponsor organizations. To express an interest, email cwow@hra.nhs.uk. Applications to the CWoW must be submitted using the appropriate section of IRAS. CWoW aims to have the National Health Service (NHS)/HRA work closely with MHRA and across the devolved administrations to develop a single application route and a coordinated ethics and regulatory review leading to a single UK decision on a clinical trial. For detailed guidance and participating ECs, see GBR-72.

Assembly and Number of Copies

According to the G-CTApp, applicants must complete the clinical trial authorization application form on IRAS (GBR-78), create XML and PDF versions of the MHRA application form, save and sign them electronically, and submit them via MHRA Submissions with the rest of the required documents. The steps for gaining access to MHRA Submissions are in G-MHRASubmiss and GBR-11. All documents must have copy and paste functionality. MHRA does not currently accept password-protected documents. The information in the submission package will be used to validate the application and incomplete applications will be rejected. In addition, the naming of files is important and clearly naming files will reduce validation issues. Refer GBR-78 for detailed IRAS guidance. (See Clinical Trial Lifecycle topic, Submission Content subtopic for documentation to be included in the application package.)

Clinical Trial Application Language Requirements

As delineated in the MHCTR, the clinical trial application and accompanying material must be provided in English.

Overview

As set forth in the MHCTR, the MHCTR2006, the G-CTApp, and GBR-9, the Medicines and Healthcare Products Regulatory Agency (MHRA) requires the sponsor or his/her designated legal representative to apply for clinical trial authorization, and the chief investigator (CI) to apply for a favorable opinion from a recognized ethics committee (EC). (See the Ethics Committee topic for detailed coverage of EC operations and responsibilities.)

MHRA Requirements

As specified in the G-CTApp, a clinical trial submission package to the MHRA should contain the following documents:

• A cover letter (when applicable, the subject line should state that the submission is for a Phase I trial and is eligible for a shortened assessment time, or if it is submitted as part of the notification scheme); this letter should clearly highlight the Purchase Order (PO) number to help MHRA invoice and allocate payments promptly and efficiently
• A clinical trial application form in PDF and XML versions
• A protocol document
• An investigator’s brochure (IB)
• An investigational medical product dossier (IMPD) or a simplified IMPD
• A summary of scientific advice obtained from the MHRA or any other regulatory authority, if available
• Manufacturer’s authorization, including the importer’s authorization and Qualified Person declaration on good manufacturing practice for each manufacturing site if the product is manufactured outside the European Union (EU) (See G-ImportIMPs and the Investigational Products topic, Manufacturing & Import subtopic for more information)
• A copy of the United Kingdom (UK) or the European Medicines Agency’s decision on the pediatric investigation plan and the opinion of the pediatric committee, if applicable
• The content of the labelling of the investigational medicinal product (IMP) (or justification for its absence)

Per the G-PIPs, UK marketing authorization holders who sponsor a study that involves the use of the authorized medicinal product in the pediatric population, must submit to the MHRA results of the study within six (6) months after the trial ended. Additional details and submittal details are in the G-PIPs and the G-PIPsProcess.

EC Requirements

As per the MHCTR, the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), and GBR-77, ECs require the CI to submit the following documentation for ethics approval:

• Application for an EC opinion (Note, per GBR-18, every clinical trial must include a unique trial number, a European Clinical Trials Database (EudraCT) number (GBR-87))
• A summary of the trial, including justification, relevance, and methodology to be used
• Research hypothesis
• Statistical analysis and justification for the numbers of participants to be recruited
• Protocol
• IB
• Peer review process details
• Sponsor name and contact information
• Financial arrangements for the trial (e.g., funding sources, participant reimbursement, compensation provisions in the event of trial-related injury or death, and insurance or indemnity coverage for sponsor and investigator(s)) (see Sponsorship topic, Compensation subtopic for additional information)
• Terms of agreement between sponsor and participating institution(s)
• Material to be used (including advertisements) to recruit potential research participants
• ICF and copies of materials to be provided to participants (See Informed Consent topic, Required Elements subtopic for additional information)
• Participant treatment plans
• Benefit/risk assessment for participants
• Investigator(s) Curriculum Vitaes (CVs)
• Trial design and suitability of facilities

Additionally, according to GBR-95, the CI must submit the electronic application to the Integrated Research Application System (IRAS) (GBR-78) on the same day that a booking is made to schedule an EC review through the National Health Service (NHS) Research Ethics Committee’s Online Booking Service (GBR-95). EC reviews are booked through the Online Booking Services and will be booked in the first available slot for an EC that is suitable for the type of study. ECs are geographically located across the UK. Applicants are strongly encouraged to attend meetings in person. Some studies must be reviewed by an EC that is flagged for the type of research to take place. Refer to GBR-95 for detailed submission and booking instructions.

Clinical Protocol

According to GBR-113, the clinical protocol should contain the following elements:

• Protocol Summary
• Sponsor or designated representative name and contact information
• Investigator(s) CV(s) and contact information
• Investigational Product description (See Investigational Products topic for detailed coverage of this subject)
• Form, dosage, route, method, and frequency of administration; treatment period
• Trial objectives and purpose
• Trial design, random selection method, and blinding level
• Participant selection/withdrawal
• Participant treatment
• Summary of potential risks and known benefits to research participants
• Safety and efficacy assessments
• Adverse event reporting requirements (See Clinical Trial Lifecycle topic, Safety Reporting subtopic for additional information)
• Statistics and methods to track trial data
• Sponsor specifications for direct access to source data/documents
• Quality control/quality assurance procedures and practices
• Ethical considerations
• Data management and recordkeeping
• Financing and insurance details
• Publication policy

For complete protocol requirements, refer to GBR-113.

Overview

Based on the MHCTR, the MHCTR2006, GAfREC, and GBR-9, the sponsor or his/her designated representative must submit an application for clinical trial authorization to the Medicines and Healthcare Products Regulatory Agency (MHRA)'s, and the chief investigator (CI) must submit an application to a recognized ethics committee (EC) to obtain a favorable opinion prior to the trial’s commencement. The G-CTApp permits MHRA’s review process to be conducted in parallel with the EC review, stating that an EC opinion may be obtained before, during, or after the MHRA application submittal to the Integrated Research Application System (IRAS) (GBR-78).

MHRA Approval

Clinical Trial Application Submission

As per the MHCTR and the G-CTApp, the MHRA review and approval process for a clinical trial application takes 30 days. For Phase I trials, the average is 14 days. According to the G-CTApp, if the sponsor or his/her designated representative is required to submit an amended application, the MHRA provides a response to the amendment within 60 days of receipt of the original application. Additionally, responses for Phase I healthy volunteer studies will be reviewed within an average of 14 days, and studies using gene therapy, somatic cell therapy (including xenogenic cell therapy) products or products containing genetically modified organisms will be reviewed within 90 days or receipt of the original application.

The MHCTR and the G-CTApp specify that the MHRA coordinates the clinical trial application process. The G-CTApp states that MHRA has moved from paper to automated electronic communication. To ensure receipt of MHRA correspondence, applicants should add MHRA_CT_Ecomms@mhra.gov.uk to their safe sender email list. MHRA will only send official correspondence to the named applicant email address. According to the MHCTR, if the sponsor or his/her designated representative does not receive a request for additional information from the MHRA within 30 days, the clinical trial application is treated as authorized.

In addition, as stated in the G-CTApp and GBR-35, certain first-in-human (Phase I) trials of investigational products with higher risk or greater elements of uncertainty require the MHRA to seek advice from the Clinical Trials, Biologicals, and Vaccines Expert Advisory Group (CTBVEAG) of the Commission on Human Medicines before approval for the trial can be given. See the G-CTApp and GBR-35 for detailed requirements.

Notification Scheme Submission

The G-CTApp indicates that in place of a standard application, a notification of a clinical trial may be submitted for “Type A” trials. This includes trials involving medicinal products licensed in any European Union (EU) Member State that meet the following criteria:

• they relate to the licensed range of indications, dosage and form, or,
• they involve off-label use established by practice and supported by published evidence and/or guidelines

Type A trials include studies in which the potential risk associated with an investigational medicinal product is determined to be no higher than that of standard medical care. See the G-CTApp for detailed Notification Scheme requirements.

Upon receipt of the notification, the MHRA sends an acknowledgement to the sponsor or his/her designated representative stating that the trial may proceed if an objection is not raised within 14 days. If the MHRA does not send a Notification Objection letter, the acknowledgement serves as the authorization. If the MHRA raises objections, the submission is treated as a standard request for authorization.

Ethics Committee Approval

As specified in the MHCTR, GAfREC, GBR-9, and GBR-68, an EC must give its opinion within 60 calendar days of receipt of a valid application. When an EC requires further information before confirming its opinion, it may give a provisional opinion, and it is permitted to make one (1) written request for further information, clarification, or changes to documentation. The time it takes for the EC to receive a complete response to the request does not count against the 60-day timeline. Studies using gene therapy, somatic cell therapy (including xenogenic cell therapy) products or products containing genetically modified organisms will take 90 days, or 180 days if a specialist group or committee is consulted. For other exceptions, see GAfREC and the MHCTR.

As delineated in GBR-9, the CI is responsible for submitting an application to an EC via IRAS. GBR-95 indicates that the CI must submit the electronic application to IRAS on the same day that a booking is made to schedule an EC review through the National Health Service (NHS) Research Ethics Committee’s Online Booking Service (GBR-95).

Per GBR-9, the ethical review includes an assessment of the suitability of each site or sites at which the research is to be conducted in the United Kingdom (UK). The site assessment is not a separate ethical review, but forms part of the single ethical review of the research. Management permission is still required from the organization responsible for hosting the research before it commences at any site. In the case of international studies, an application must be made to an EC in the UK, whether or not the study has a favorable ethical opinion from a committee outside the UK, and whether or not it has started outside the UK. See the Ethics Committee topic, Scope of Review subtopic for additional information on the “main EC.”

Overview

In accordance with the MHCTR, the MHCTR2006, GAfREC, and GBR-9, a clinical trial can only commence after the sponsor or his/her designated representative receives authorization from the Medicines and Healthcare Products Regulatory Agency (MHRA) and the chief investigator (CI) receives an approval from a recognized ethics committee (EC). No waiting period is required following the applicant’s receipt of these approvals.

GBR-103 provides that if a sponsor(s) is not established in the United Kingdom (UK) or on an approved country list (which initially includes European Union (EU)/European Economic Area (EEA) countries), it is a statutory requirement to appoint a legal representative based in the UK or a country on the approved country list for the purposes of the trial. Per G-CTApprovedCountries, MHCTR-EUExit will refer to a list of countries where a sponsor of a clinical trial, or their legal representative, may be established; these countries are initially EU and EEA countries.

The G-CTApp permits MHRA’s review process to be conducted in parallel with the EC review, stating that an EC opinion may be obtained before, during, or after the MHRA application submittal. Furthermore, GBR-9 states that the CI should be based in the UK. In rare cases when this is not required, adequate arrangements must be in place for supervision of the study in the UK.

In addition, per the MHCTR and the G-CTApp, a Manufacturer’s Authorization for Investigational Medicinal Products (MIA(IMP)) must be obtained by the person responsible for the manufacture or importation of any investigational product (IP) (known as investigational medicinal product (IMP) in the UK) to be used in the trial. The sponsor or his/her designated representative must include a copy of the MIA(IMP) in the clinical trial application submission to the MHRA. (See Clinical Trial Lifecycle topic, Submission Content subtopic, and the Investigational Products topic, Manufacturing & Import subtopic for detailed submission and IMP requirements respectively).

As stated in the MHCTR, all investigators must possess appropriate qualifications, training, and experience. The trials should be conducted in compliance with the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), and laboratory practices for investigational products must comply with the UK-GLPs.

Governance Approval

Per GBR-78, all project-based research must also apply for governance and legal compliance approvals from the appropriate lead UK Health Department. The Integrated Research Application System (IRAS) (GBR-78) facilitates this process. As described in GBR-96 and GBR-67, approval from the Health Research Authority (HRA) is required for all project-based research in the National Health Service (NHS) led from England or Wales. HRA and Health and Care Research Wales (HCRW) approval brings together the assessment of governance and legal compliance. For any new studies that are led from Scotland or Northern Ireland but have English and/or Welsh NHS sites, the national research and development coordinating function of the lead nation will share information with the HRA and HCRW assessment teams, who can issue HRA and HCRW approval for English and Welsh sites and thereby retain existing compatibility arrangements. Studies led from England or Wales with sites in Northern Ireland or Scotland will be supported through existing UK-wide compatibility systems, by which each country accepts the centralized assurances, as far as they apply, from national coordinating functions without unnecessary duplication. For more information on HRA’s assessment criteria and standards for approval, see GBR-29.

Clinical Trial Agreement

According to GBR-107 and GBR-70, contracts and agreements should be in place prior to the initiation of a trial. GBR-107 provides model templates for industry-sponsored clinical trials with the NHS/Department of Health and Social Care (DHSC) participants in hospitals throughout the UK Health Services, which encompasses England, Northern Ireland, Scotland, and Wales. These 2021 model agreements replace the 2020 versions. See GBR-107 for the notes that provide further background, an overview of the changes from the 2020 versions, and more information on how and under which circumstances the templates should be used. While the 2020 versions of these templates will still be accepted in IRAS (GBR-78), applicants are encouraged to adopt the 2021 versions at their earliest opportunity. Versions older than March 2020 are no longer accepted with new IRAS submissions. Applicants are advised to use the templates without modification. Any proposed modifications will not be accepted unless first agreed to by the UK Contracting Leads. Proposing modifications to the templates is likely to result in significant delay. Feedback on the content of the templates and their use by sponsors should be provided to mCTA@hra.nhs.uk.

GBR-107 also provides the model non-commercial agreement (mNCA) template to meet the requirements of non-commercial sponsors and the NHS/DHSC bodies undertaking the research. This agreement has been developed as a single, UK-wide agreement template, meaning that it can be used irrespective of where the sponsor and research site are established. It is designed to be used without modification or negotiation. The mNCA has been developed for a range of interventional research scenarios, including clinical trials, medical device studies, research using patient data, and research using human tissue. The terms and conditions are suitable for all such scenarios and only the completion of highlighted sections, including the schedules of the agreement, will differ depending on the study involved.

Additional details and templates are available in GBR-107 and GBR-70.

Ethics Committee Confirmation of Review and Approval

The MHCTR and the MHCTR2006 mandate that the sponsor or his/her designated representative is responsible for ensuring that the CI has obtained confirmation of the EC’s approval. Per the G-CTApp, an EC opinion may be obtained before, during, or after the MHRA application has been electronically submitted to IRAS (GBR-78). Per GBR-9, the EC’s final opinion will be in a letter from the Chair of the Committee (or chair of the sub-committee in the case of proportionate review). It is also acceptable for the letter to be signed by a vice-chair or a member of the staff supporting the EC acting under delegated authority from the Chair. The letter is emailed to the applicant within the relevant time limit for review of the application. The final favorable opinion letter can be obtained from IRAS (GBR-78). The MHRA is notified automatically through its access to the HRA Assessment Review Portal (HARP), which is a database for authorized users (e.g., EC members and regulators) who manage or review studies submitted to the HRA.

As per the MHCTR and GBR-9, the sponsor or his/her designated representative should also notify the EC of any substantial amendments to the protocol, and submit all relevant documents in support of such amendments. These amendments may not be implemented without a favorable opinion from the EC. (See Ethics Committee topic, Scope of Review subtopic and Clinical Trial Lifecycle topic, Submission Content subtopic for additional details on the EC review and approval process).

Clinical Trial Registration

As per the G-CTReg and GBR-102, the sponsor or investigator is required to register the clinical trial in a publicly accessible database as a condition of a favorable ethical opinion. Registration should occur before the first participant is recruited and no later than six (6) weeks after recruitment of the first participant. Per GBR-102, HRA recognizes any register covered by the World Health Organization (WHO) list or the International Committee of Medical Journal Editors (ICMJE). The G-CTApp indicates that any favorable opinion given by a UK EC is subject to the clinical trial being registered on a publicly accessible database. In the long term, the HRA has made a commitment to register clinical trials on behalf of sponsors and researchers in its Make It Public research transparency strategy. Until this system is in place, the clinical trial should be registered on an established international registry such as the International Standardized Randomized Controlled Trial Number (ISRCTN) Registry (GBR-47) or ClinicalTrials.gov (GBR-49), to ensure the public is aware. If trial registration is deferred (for example if it is an adult phase I trial), then contact the HRA at study.registration@hra.nhs.uk.

The registry number(s), if available, should continue to be used in section A.5. of the application form in IRAS (GBR-78) when preparing the application. If this number is not available at the time of application, email the MHRA at clintrialhelpline@mhra.gov.uk with subject line “Clinical Trial Registration” within six (6) weeks of recruiting the first research participant. The applicant should also let the EC know the registration number as soon as possible.

Overview

According to GBR-1 and GBR-64, the following definitions provide a basis for a common understanding of the United Kingdom’s (UK’s) safety reporting requirements:

• Adverse Event (or Adverse Experience) (AE) – Any untoward medical occurrence in a participant, including occurrences which are not necessarily caused by or related to that product
• Adverse Drug Reaction (ADR) – Any untoward and unintended response in a participant to an investigational medicinal product which is related to any dose administered to that participant
• Serious Adverse Event (SAE), Serious Adverse Drug Reaction (SADR), or Unexpected Serious ADR – Any AE, ADR, or unexpected ADR that results in death, is life threatening, requires hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, or a congenital anomaly/birth defect
• Unexpected Adverse Drug Reaction (ADR) – An adverse reaction where the nature or severity is inconsistent with the applicable product information
• Suspected Unexpected Serious Adverse Reaction (SUSAR) – A suspected serious adverse reaction, which is also “unexpected,” meaning that its nature and severity are not consistent with the information about the medicinal product in question.

Per the G-CTAuth, the Medicines and Healthcare Products Regulatory Agency (MHRA) advises that the guidance on reference safety information (RSI) contained in GBR-30 (developed by the Clinical Trials Facilitation Group of the Heads of Medicines Agencies (HMA)) remains applicable. For clinical trials that are being conducted in the UK, an RSI cannot be used for expectedness until the RSI has been approved by MHRA. Additional SUSARs that occur before the new RSI is approved should be reported in the usual expedited manner. If sponsors wish to harmonize the implementation date of an RSI in a trial that includes European Union (EU) and UK sites, then they can use the date when approval is granted in all member states and the UK. In the interest of efficiency and harmonization for multinational trials, the MHRA recommends that amendments including changes to the RSI are submitted to the UK and EU at the same time. The RSI in place at the time the SUSAR occurred should be used to assess expectedness for follow-up reports.

Reporting Requirements for AEs/ADRs

Investigator Responsibilities

As specified in the MHCTR, GBR-1, and GBR-30, the investigator is responsible for reporting all SAEs/SADRs immediately to the sponsor. The report may be made orally or in writing, and followed by a detailed report no later than 24 hours after the event. When the reported event results in a participant’s death, the investigator must provide the sponsor with any requested information. According to the MHCTR, in cases where reporting is not immediately required according to the protocol or the Investigator’s Brochure (IB), the investigator should report an SAE/SADR within the appropriate timeframe based on the trial requirements, the seriousness of the SAE/SADR, and protocol or IB guidelines. Per GBR-1, the investigator and the sponsor share responsibility for the assessment and evaluation of adverse events with regard to seriousness, causality, and expectedness.

Sponsor Responsibilities

According to the MHCTR, the G-CTAuth, the MHCTR-EUExit, GBR-115, and GBR-99, the sponsor is required to record and report all relevant information about fatal or life-threatening SUSARs as soon as possible, but no later than seven (7) calendar days to the MHRA, to the institution in which the trial is being conducted, and to the ethics committee (EC). Any additional relevant information should be sent within eight (8) days of the initial report. The sponsor must also report any non-fatal or non-life-threatening SUSARs no later than 15 calendar days following first awareness of the event. Per GBR-1, the investigator and the sponsor share responsibility for the assessment and evaluation of adverse events with regard to seriousness, causality, and expectedness. Per the G-CTAuth, sponsors must report all UK-relevant SUSARs to the MHRA. The agency’s definition of ‘UK-relevant’ includes:

• SUSARs originating in the UK for a trial
• SUSARs originating outside the UK for a trial
• If the sponsor is serving as a sponsor of another ongoing trial outside the UK involving the same medicinal product
• SUSARs involving the same medicinal product if the sponsor of the trial outside the UK is either part of the same mother company or develops the medicinal product jointly, on the basis of a formal agreement, with the UK sponsor

Per the G-CTAuth and the G-SftyRpts, sponsors must submit Development Safety Update Reports (DSURs) to the MHRA. G-CTAuth specifies that the DSUR should take into account all new available safety information received during the reporting period. The DSUR should include:

• A cover letter listing all relevant clinical trial numbers of trials covered by the DSUR and an email address for correspondence (Note, per GBR-18, every clinical trial must include a unique European Clinical Trials Database (EudraCT) number (GBR-87))
• An analysis of the participant’s safety in the concerned clinical trial(s) with an appraisal of its ongoing risk/benefit
• A listing of all suspected serious adverse reactions (including all SUSARs) that occurred in the trial(s)
• An aggregate summary tabulation of SUSARs that occurred in the concerned trial(s)

At the end of the DSUR reporting period, the sponsor may assess the new safety information that has been generated and submit any proposed safety changes to the Investigator’s Brochure as a substantial amendment. This amendment must be supported by the DSUR and approved before the RSI is changed.

A shortened DSUR is available for approved trials under MHRA’s notification scheme that are not part of a multi-study development program. Phase 4 national (UK only) trials of licensed products, which commanded a low fee from the MHRA, and where all participants have completed treatment and are only in the follow-up stage will also be suitable for submission of a short format DSUR. As an alternative to producing a full DSUR for these trials, the Health Research Authority Annual Progress Report (GBR-27) may be used.

Per GBR-99, a sponsor or investigator may take appropriate urgent safety measures (USMs) to protect research participants against any immediate hazard to their health or safety, without prior authorization from a regulatory body. The main EC, and the MHRA for clinical trials for investigational medicinal products (CTIMPs), must be notified immediately (no later than within three (3) days) in the form of a substantial amendment that such measures have been taken and the reasons why. The G-CTAuth states that the sponsor should call the MHRA’s Clinical Trials Unit at 020 3080 6456 to discuss the issue with a safety scientist, ideally within 24 hours of measures being taken, but no later than three (3) days. If key details are not available during the initial call, then the sponsor should inform MHRA no later than three (3) days from the date the measures are taken by email to clintrialhelpline@mhra.gov.uk. Written notification in the form of a substantial amendment is also required. The substantial amendment covering the changes made as part of the USM is anticipated within approximately two (2) weeks of notification to the MHRA. Any potential reason for delay of substantial amendment submission should be discussed and agreed upon with the MHRA at the time of initial notification or through a follow-up call. Submission of the substantial amendment must not be delayed by additional changes outside of those taken and required as an urgent safety measure. Unrelated and unacceptable changes may result in rejection. Submissions should be made using MHRA Submissions (GBR-13) via the Human Medicines Tile then selecting ‘Clinical Trial’ as the Regulatory Activity and ‘CT - Amendment’ from the Regulatory sub activity dropdown list.

See the G-CTAuth, the MHCTR, GBR-1, GBR-30, and GBR-99 for detailed reporting requirements for the investigator and sponsor.

Form Completion & Delivery Requirements

Per the G-CTAuth and the G-SftyRpts, SUSARs during clinical trials should be reported to the MHRA in one (1) of the following ways:

• MHRA’s eSUSAR website (GBR-50) - Before using the eSUSAR website, users should complete the eSUSAR registration form (download from GBR-50) and email it to esusar@mhra.gov.uk with the subject line ‘eSUSAR registration’.
• MHRA Gateway (which replaces the EudraVigilance Gateway) - To gain access to the MHRA Gateway, which is used to submit bulk reports, users must first register via MHRA Submissions (GBR-13). The steps for gaining access to MHRA Submissions are contained within the G-MHRASubmiss and GBR-11.

If applicable, the user will need to dual report UK-relevant SUSARs to the Clinical Trial Module in the European Medicines Agency’s (EMA) EudraVigilance System, as well as to other national competent authorities, using the European submission routes.

G-SftyRpts states that with respect to the DSUR, sponsors should use MHRA Submissions (GBR-13) via the Human Medicines Tile, and select ‘Development Safety Update Report’ as the Regulatory Activity and ‘Original Submission’ from the Regulatory sub activity dropdown list. Acknowledgements of receipt for DSUR submissions are generated by MHRA Submissions where a confirmation of submission is emailed to the reporter.

 See the G-CTAuth, G-SftyRpts, GBR-50, and GBR-99 for more details on submittal and delivery requirements.

Data Monitoring Committee (DMC)

The International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113) recommends establishing a DMC to assess the progress of a clinical trial, including the safety data and the critical efficacy endpoints at intervals, and to recommend to the sponsor whether to continue, modify, or stop a trial.

Overview

As indicated in the G-CTAuth, GBR-65, and GBR-9, the investigator and the sponsor share responsibility for submitting progress reports on the status of a clinical trial and for submitting a final study report upon the trial’s completion. These requirements comply with the progress and final reporting requirements delineated in the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113).

Interim and Annual Progress Reports

In accordance with GBR-65 and GBR-9, the chief investigator (CI) is responsible for submitting progress reports annually, or more frequently if requested by the ethics committee (EC), on the status of a clinical trial. Per GBR-65, a progress report should be submitted to the EC 12 months after the date on which the favorable opinion was given. Progress reports are only required for studies that are more than two (2) years in duration and for Research Tissue Bank and Research Databases. There is no requirement to submit a progress report for proportionate review studies and where the study is two (2) years or less in duration. The form (GBR-27) should be completed in typescript and signed by the Chief Investigator. An electronic copy should be emailed to the EC within 30 days of the end of the reporting period.

Health Research Authority (HRA)-approved research projects that have also been reviewed by an EC should submit regular progress reports to the HRA using the guidance outlined for ECs above.

Final Report

As per the MHCTR and the G-CTAuth, the sponsor must notify the Medicines and Healthcare Products Regulatory Agency (MHRA) and the EC in writing that a clinical trial has ended within 90 days of the conclusion of the trial. The G-CTAuth further specifies that a declaration of the end of a clinical trial should be sent to the MHRA within 90 days of the global end of the trial and within 15 days of the global premature end of the trial. The submission must include an end of trial form (contained in G-CTAuth and GBR-24) and a cover letter. Note that only the global end-of-trial notification is required to be submitted. However, a facility may inform MHRA of the local (UK) end of trial via the end-of-trial notification form, but these local notifications will not be officially acknowledged and the MHRA Submissions automatic email confirmation should be considered as evidence of submission. If a local end of trial is submitted, we would still expect to receive relevant safety updates and substantial amendments for the ongoing trial until the global end of trial notification is received. T. An exemption to this requirement must be requested via a substantial amendment for approval. The amendment must clearly state to what documents the proposal relates and provide a robust rationale for the request. All safety documentation must be submitted unless there are no other trials ongoing with the same product in the UK. Any trial activities (such as follow-ups, visits) must be completed before the submission of the global end-of-trial declaration form. It is not possible to submit amendments to the trial or the DSUR once the global end-of-trial declaration form has been received by the MHRA. If the end-of-trial declaration has been received within a reporting period, or within 60 days following the data lock point, the corresponding DSUR will not be required. Sponsors must submit end-of-trial declarations using MHRA Submissions (GBR-13). G-MHRASubmiss and GBR-11 outline the steps for gaining access to MHRA Submissions.

Per the G-CTAuth and the G-CTReg, the timeframe for publishing the summary of results is within one (1) year of the end of trial. Sponsors should publish summary results within this timeframe in the public register(s) where they registered the clinical trial. While it is not required to submit this clinical trial summary report to the MHRA, sponsors must send a short confirmation email to CT.Submission@mhra.gov.uk once the results-related information has been uploaded to the public register and provide the relevant link. The G-CTAuth specifies that the subject line of the email notification must state ‘End of trial: result-related information: EudraCT XXXX-XXXXXX-XX’ once the result-related information has been uploaded to the public register. If the clinical trial is not on a public register or the results will not be published in the register (for example an adult phase I study), summary results should be submitted to MHRA via MHRA Submissions (GBR-13). An acknowledgement letter will not be sent for this submission. Sponsors of trials conducted in UK that are already registered in the European Union (EU) Register are able to submit results to EudraCT. The MHRA will not be able to update the status of the study in the EU system.

As per GBR-9, the investigator is also required to submit a summary of the final study report to the main EC within one (1) year of the trial’s conclusion. There is no standard format for final reports. However, the minimum information to be provided to the EC should include whether the trial achieved its objectives, the main findings, and arrangements for publication or dissemination of research.

Overview

As per the MHCTR, the MHCTR2006, the G-CTApp, GBR-103, GBR-9, GBR-2, and the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), the sponsor is defined as an individual, company, institution, or organization who takes ultimate responsibility for the initiation, management, and financing (or arranging the financing) of a trial. The sponsor must ensure that the trial design meets appropriate standards, and arrange for the trial to be properly conducted and reported. In addition, per GBR-101, the sponsor is the individual, organization, or partnership that takes on overall responsibility for proportionate, effective arrangements being in place to set up, run, and report a research project.

In accordance with GBR-113, the United Kingdom (UK) also permits a sponsor to transfer any or all of its trial-related duties and functions to a contract research organization (CRO) and/or institutional site(s). However, the ultimate responsibility for the trial data’s quality and integrity always resides with the sponsor. Any trial-related responsibilities transferred to a CRO should be specified in a written agreement. The CRO should implement quality assurance and quality control. Per the G-CTApp and the GBR-103, a clinical trial sponsor needs to be established in the UK or a country on an approved country list which initially includes the European Union (EU)/European Economic Area (EEA) countries. If this is not the case, then the sponsor must have a legal representative who is so established. The GBR-103 specifies that details of the legal representative should be entered in the ‘legal representative’ section of Integrated Research Application System (IRAS) (GBR-78). The legal representative:

• May be an individual person or a representative of a corporate entity
• Does not have to be a legally qualified person
• Should be willing to act as the agent of the sponsor in the event of any legal proceedings instituted (e.g., for service of legal documents)
• Should be established at an address in the UK or a country on the approved country list
• Does not assume any of the legal liabilities of the sponsor(s) for the trial by virtue of the role of legal representative and does not therefore require insurance or indemnity to meet such liabilities; but may, in some cases, enter into specific contractual arrangements to undertake some or all of the statutory duties of the sponsor in relation to the trial, in which case the legal representative would also be regarded as a co-sponsor and would then require insurance or indemnity cover

The MHCTR also permits two (2) or more parties to take responsibility for the sponsor’s functions. When this applies, the MHCTR requires one (1) of the parties to submit the clinical trial application for authorization to the Medicines and Healthcare Products Regulatory Agency (MHRA), and to specify who is responsible for carrying out the following functions:

• Communications relating to substantial amendments, modified amendments, and the conclusion of the trial
• Communications relating to urgent safety measures
• Pharmacovigilance reporting

Per the G-SubtlAmndmt, the UK requires the sponsor or legal representative of a clinical trial to be in the UK or a country on an approved country list that will initially include the EU and EEA countries. A change in sponsor or legal representative for a UK trial is a substantial amendment requiring submission to both the MHRA and the ethics committee.

For purposes of data protection requirements, the UK-GDPR, the UK-DPAct, and the G-GDPR delineate that the sponsor acts as the “controller” in relation to research data. This is because the sponsor determines what data is collected for the research study through the protocol, case report form, and/or structured data fields in a database. GBR-7 provides guidance on key data protection requirements to consider in the post-Brexit environment. Among other things, it describes how data can continue to flow to and from the UK, as well as controller responsibilities.

Overview

In accordance with the MHCTR, the MHCTR2006, the G-CTApp, GBR-2, and GBR-9, the sponsor or his/her designated representative is responsible for submitting a clinical trial application to the Medicines and Healthcare Products Regulatory Agency (MHRA) to obtain authorization to conduct a clinical trial. GBR-103 provides that if a sponsor(s) is not established in the United Kingdom (UK) or on an approved country list (which initially includes European Union (EU)/European Economic Area (EEA) countries), it is a statutory requirement to appoint a legal representative based in the UK or a country on the approved country list for the purposes of the trial. Per the G-CTApprovedCountries, the MHCTR-EUExit will refer to a list of countries where a sponsor of a clinical trial, or their legal representative, may be established; these countries are initially EU and EEA countries. The G-SubtlAmndmt delineates that a change in sponsor or legal representative for a UK trial is a substantial amendment requiring submission to both the MHRA and the ethics committee (EC). From January 1, 2021, where the sponsor is from the rest of the world, and the legal representative is established in the UK, and there are sites in the EU/EEA, the sponsor will need to assign an EU/EEA legal representative for these sites via a substantial amendment to the relevant EU/EEA competent authorities. No amendment submission to the MHRA is required where the sponsor or legal representative for an ongoing trial is established in the EU/EEA as the UK will continue to accept this approval. Further, no amendment will need to be submitted in the UK if the sponsor retains the UK legal representative for the UK study. Similarly, no amendment will need to be submitted in the UK if a sponsor remains in the UK and a legal representative is added to cover EU/EEA sites.

Per the G-MHRASubmiss, as of January 1, 2021, MHRA implemented new processes to submit regulatory and notification information to the UK. For clinical trial applications to the UK, including initial applications, substantial amendments, end-of-trial notifications, and developmental safety update reports (DSURs), applicants must submit information through UK’s national portals. The G-MHRASubmiss and GBR-11 provide steps for gaining access to MHRA Submissions (GBR-13).

According to the G-CTApp, applicants must complete the clinical trial authorization application form on the Integrated Research Application System (IRAS) (GBR-78). IRAS enables researchers to enter the information required by all UK review bodies only once, rather than having to complete several separate application forms to obtain these permissions and approvals. (See the Clinical Trial Lifecycle topic, Submission Content subtopic for documentation to be included in the application package.)

In addition to the completed application, per the MHCTR and the G-CTApp, the sponsor or his/her designated representative must provide the MHRA with a copy of the EC opinion (if available), the clinical protocol, the investigator’s brochure, a signed declaration by the investigators, a certificate of good manufacturing practice for the manufacture of the trial medicine, and other documentation covered in the Clinical Trial Lifecycle topic, Submission Content subtopic.

Overview

As set forth in the MHCTR and the MHCTR2006, it is a legal requirement for an insurance and indemnity provision to be made to cover the liability of the investigator and sponsor for trial related injuries. The MHCTR does not ascribe responsibility to the sponsor or his/her designated representative to obtain insurance and indemnity. However, GBR-2, GBR-103, and GBR-101, state that the sponsor or his/her designated representative is responsible for ensuring adequate insurance and indemnity arrangements are in place to cover the sponsor’s and the investigator’s potential liability, and for providing a copy of this coverage in the clinical trial application submission.

In addition, according to GBR-2, the sponsor or his/her designated representative must ensure that the research covered by the National Health Service (NHS)'s indemnity policy is in place for each publicly funded participating study site. See GBR-33 for detailed information on the NHS indemnity responsibilities for clinical negligence involving investigators and participants. GBR-33, specifically addresses the sponsor’s or his/her designated representative’s requirement to insure or indemnify the investigator participating in industry-sponsored Phase I clinical trials.

The International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113) also guides sponsors on providing insurance. See the Sponsorship topic, Compensation subtopic and Informed Consent topic, Compensation Disclosure subtopic for specific details related to sponsorship compensation obligations.

Overview

As specified in the MHCTR, the sponsor or his/her designated representative is responsible for providing compensation to research participants and/or their legal heirs in the event of Phase I trial-related injuries or death. According to GBR-33, the sponsor or his/her designated representative may be required to follow the principles set forth in the Association of the British Pharmaceutical Industry (ABPI)’s guidelines to comply with the United Kingdom (UK)’s participant compensation and treatment requirements due to Phase I trial-related injuries. The guidelines state that the sponsor should furnish written assurance to the investigator that the sponsor will agree to pay compensation to participants and/or his/her legal heirs in the event of trial-related injuries or death whenever a causal relationship with participation is demonstrated. The investigator, in turn, communicates this information to the relevant ethics committees (ECs).

The International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113) also provides guidance for sponsors on providing compensation to research participants in the event of trial-related injuries or death. The sponsor must explain to participants the compensation and/or treatment available to them in the event of trial-related injuries. See the Informed Consent topic, Compensation Disclosure subtopic for additional information.

Overview

As stated in the MHCTR, the MHCTR2006, and GBR-92, the sponsor is responsible for maintaining quality assurance (QA) and quality control (QC) systems with written standard operating procedures (SOPs) to ensure that trials are conducted and data are generated, recorded, and reported in compliance with the protocol and the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113). The sponsor is required to obtain agreement from all involved parties to ensure direct access to all trial related sites, source data/documents, reports for monitoring and auditing purposes, and inspection by domestic and foreign regulatory authorities. QC should be applied to each stage of data handling to ensure that all data are reliable and have been correctly processed.

The sponsor must also obtain the investigator(s) and the institution(s) agreement to:

• Conduct the trial in compliance with GBR-113 and the protocol agreed to by the sponsor and approved by the ethics committee (EC)
• Comply with data recording and reporting procedures
• Permit monitoring, auditing, and inspection
• Retain essential documents until the sponsor informs them that they are no longer needed

MHCTR2006 requires the sponsor to notify the Medicines and Healthcare Products Regulatory Agency (MHRA) of serious breaches of good clinical practice (GCP) or the trial protocol. A serious breach is defined as one that is likely to effect to a significant degree: the safety or physical or mental integrity of the trial participants; or the scientific value of the trial. Per G-MHRA-SeriousBreaches, the sponsor, or delegated party, should notify the MHRA GCP Inspectorate within seven (7) days of becoming aware of a serious breach. Further, the sponsor should investigate and take action simultaneously after the MHRA notification. Notifications should primarily be sent to the following email address: GCP.SeriousBreaches@mhra.gov.uk.

Data Protection

Per the UK-GDPR, the UK-DPAct, and the G-GDPR, the sponsor (known as the “controller” in data protection legislation) must comply with the principles of the data protection legislation:

• Lawfulness, fairness, and transparency
• Purpose limitation
• Data minimization
• Accuracy
• Storage limitation
• Integrity and confidentiality (security)
• Accountability

The sponsor must show that each activity of processing data has a lawful basis under this legislation, in addition to the common law basis. For health and social care research, the lawful basis is determined by the type of organization that is the data controller for the processing:

• For universities, National Health Service (NHS) organizations, Research Council institutes, or other public authority, the processing of personal data for research should be a “task in the public interest.”
• For commercial companies and charitable research organizations, the processing of personal data for research should be undertaken within “legitimate interests.”

As described in the G-GDPR, with regard to transparency, the sponsor should understand whether personal data is collected indirectly from a third party or directly, as these determine the actions to take to comply with data protection requirements. In most cases, the sponsor will need to provide transparency information about the legal basis and other details of processing personal data. See the table in G-GDPR, which sets out the specific transparency requirements for personal data. In addition, GBR-100 contains a series of templates by the Health Research Authority (HRA) with suggested transparency language. Further, the sponsor should take measures to ensure data is processed securely, giving consideration to security, storage, and pseudonymization/anonymization when possible. For details on complying with security and storage requirements, see GBR-100. For additional information about consent and individual rights, see the Informed Consent topic, Documentation Requirements and Required Elements subtopics.

Per the UK-GDPR and the UK-DPAct, the data protection legislation introduces a duty requiring public authorities or bodies to appoint a data protection officer (DPO); a DPO may be required for non-public entities if they carry out certain types of processing activities. The DPO assists the sponsor with monitoring internal compliance, informs and advises on data protection obligations, provides advice regarding Data Protection Impact Assessments (DPIAs), and is a point of contact for participants and the supervisory authority. See G-GDPR for guidance related to DPIAs.

For more information on data protection requirements following the United Kingdom’s (UK) transition out of the European Union (EU), see GBR-16 and GBR-7.

Electronic Data Processing System

To safeguard personal data within electronic health record (EHR) systems, G-EHRAccess provides guidance on updating these systems to ensure access by sponsors and their representatives (e.g., monitors and investigators) is limited to only the records of clinical trial participants and that this access is auditable.

According to GBR-113, when using electronic trial data handling processing systems, the sponsor must ensure and document that the electronic data processing system conforms to the sponsor’s established requirements for completeness, accuracy, reliability, and consistency of intended performance. To validate such systems, the sponsor should use a risk assessment approach that takes into consideration the system’s intended use and potential to affect human subject protection and reliability of trial results. In addition, the sponsor must maintain SOPs that cover system setup, installation, and use. The SOPs should describe system validation and functionality testing, data collection and handling, system maintenance, system security measures, change control, data backup, recovery, contingency planning, and decommissioning. With respect to the use of these computerized systems, the responsibilities of the sponsor, investigator, and other parties should be clear, and the users should receive relevant training.

Records Management

As set forth in GBR-113, sponsor-specific essential documents should be retained until at least two (2) years after the last approval of a marketing application, until there are no pending or contemplated marketing applications, or at least two (2) years have elapsed since the formal discontinuation of the investigational product’s clinical development. The sponsor should inform the investigator(s) and the institution(s) in writing when trial-related records are no longer needed.

However, per the MHCTR2006, the sponsor and the chief investigator must ensure that the documents contained in the trial master file are retained for at least five (5) years following the trial’s completion. The documents must be readily available to the MHRA upon request, and be complete and legible. The sponsor should ensure that trial participant medical files are also retained for at least five (5) years after the trial’s conclusion.

In addition, GBR-113 states that the sponsor and investigator/institution should maintain a record of the location(s) of their respective essential documents including source documents. The storage system used during the trial and for archiving (irrespective of the type of media used) should allow for document identification, version history, search, and retrieval. The sponsor should ensure that the investigator has control of and continuous access to the data reported to the sponsor. The investigator/institution should have control of all essential documents and records generated by the investigator/institution before, during, and after the trial.

Audit Requirements

As part of its QA system, GBR-113 notes that the sponsor should ensure the trial is monitored. If or when the sponsor performs an audit, the purpose of the audit should be to evaluate trial conduct and compliance with the protocol, SOPs, GBR-113, and other applicable regulatory requirements. The sponsor should appoint auditors to review the clinical trial. The sponsor should ensure that the auditors are qualified by training and experience, and auditor’s qualifications should be documented. The sponsor must also ensure that the audit is conducted in accordance with his/her own SOPs and the auditor observations are documented. The sponsor should develop a systematic, prioritized, risk-based approach to monitoring clinical trials. The extent and nature of monitoring is flexible and permits varied approaches that improve effectiveness and efficiency. The sponsor may choose on-site monitoring, a combination of on-site and centralized monitoring, or, where justified, centralized monitoring. The sponsor should document the rationale for the chosen monitoring strategy (e.g., in the monitoring plan).

Premature Study Termination/Suspension

The G-CTAuth states that the MHRA has the authority to suspend or terminate a trial. In addition, the sponsor can contact the MHRA to put a trial on temporary halt or terminate a trial. If a sponsor suspends a trial temporarily, the MHRA must be notified. The notification should be made as a substantial amendment using the notification of amendment form (GBR-25), clearly explaining what has been stopped and the reasons for the suspension. Substantial amendments relating to temporary suspension must be submitted using MHRA Submissions (GBR-13) via the Human Medicines Tile and selecting ‘Clinical Trial’ as the Regulatory Activity and ‘CT – Amendment’ from the Regulatory sub activity dropdown list. The G-MHRASubmiss and GBR-11 provide the steps for gaining access to MHRA Submissions (GBR-13). To restart a trial that has been temporarily suspended, the sponsor must make the request as a substantial amendment using the notification of amendment form, providing evidence that it is safe to restart the trial.

Per the G-CTAuth and GBR-18, to terminate a trial, the sponsor must complete the end of trial declaration form (GBR-24) and include a brief explanation of the reasons for ending the trial, particularly when the trial has been terminated early. This form must be submitted using MHRA Submissions (GBR-13) via the Human Medicines Tile and selecting ‘Clinical Trial’ as the Regulatory Activity and ‘CT –EOT’ from the Regulatory sub activity dropdown list. GBR-18 specifies that the sponsor must make the end of trial notification to regulatory authorities (MHRA in the UK) and ECs of all countries with sites within 90 days.

According to GBR-113, if it is discovered that noncompliance significantly affects or has the potential to significantly affect participant protection or reliability of trial results, the sponsor should perform a root cause analysis and implement appropriate corrective and preventive actions. Further, the sponsor should also inform the EC promptly and provide the reason(s) for the termination or suspension.

Multicenter Studies

As delineated in GBR-113, in the event of a multicenter clinical trial, the sponsor must ensure that:

• All investigators conduct the trial in strict compliance with the protocol agreed to by the sponsor
• The case report forms (CRFs) are designed to capture the required data at all multicenter trial sites
• Investigator responsibilities are documented prior to the start of the trial
• All investigators are given instructions on following the protocol, complying with a uniform set of standards to assess clinical and laboratory findings, and completing the CRFs
• Communication between investigators is facilitated

Data Monitoring Committee (DMC)

GBR-113 recommends establishing a Data Monitoring Committee (DMC)to assess the progress of a clinical trial, including the safety data and the critical efficacy endpoints at intervals, and to recommend to the sponsor whether to continue, modify, or stop a trial.

Overview

As set forth in the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), the sponsor is responsible for selecting the investigator(s) and the institution(s) for the clinical trial, taking into account the appropriateness and availability of the study site and facilities. The MHCTR2006 indicates that the sponsor must also ensure that the investigator(s) are qualified by training and experience. Additionally, the sponsor must define and allocate all study related duties and responsibilities to the relevant parties participating in the study.

As delineated in the MHCTR, the MHCTR2006, GBR-113, and GBR-35, prior to entering into an agreement with the investigator(s) and the institution(s) to conduct a study, the sponsor should provide the investigator(s) with the protocol and an investigator’s brochure. Per GBR-113, if a multicenter trial is going to be conducted, the sponsor must organize a coordinating committee or select coordinating investigators.

GBR-113 recommends establishing a Data Monitoring Committee (DMC) to assess the progress of a clinical trial, including the safety data and the critical efficacy endpoints at intervals, and to recommend to the sponsor whether to continue, modify, or stop a trial.

Per GBR-63, on June 5, 2019, the United Kingdom (UK) launched the UK Local Information Pack. Researchers working with National Health Service (NHS)/ Health and Social Care in Northern Ireland (HSC) organizations will use one (1) consistent package to support study setup and delivery across the UK. The Statement of Activities (used in England and Wales) and the Site Specific Information form (used in Northern Ireland and Scotland) are being replaced with a UK-wide Organizational Information document. The Organizational Information document will be a component of the Integrated Research Application System (IRAS) (GBR-78) form submission and will be required as part of the UK Local Information Pack for both commercial and non-commercial research. GBR-106 provides guidance, background information, and templates of the commercial and non-commercial versions of the Organizational Information document.

Foreign Sponsor Responsibilities

GBR-103 provides that if a sponsor(s) is not established in the UK or on an approved country list (which initially includes European Union (EU)/European Economic Area (EEA) countries), it is a statutory requirement to appoint a legal representative based in the UK or a country on the approved country list for the purposes of the trial. Per the G-CTApprovedCountries, the UK published a list of countries where a sponsor of a clinical trial, or their legal representative, may be established; currently listed countries are those in the EU and EEA. The G-SubtlAmndmt delineates that a change in sponsor or legal representative for a UK trial is a substantial amendment requiring submission to both the MHRA and the ethics committee (EC), pursuant to the guidelines in the G-CTAuth. Where the sponsor is from the rest of the world, and the legal representative is established in the UK, and there are sites in the EU/EEA, the sponsor will need to assign an EU/EEA legal representative for these sites via a substantial amendment to the relevant EU/EEA competent authorities. No amendment submission to the MHRA is required where the sponsor or legal representative for an ongoing trial is established in the EU/EEA as the UK will continue to accept this approval. Further, no amendment will need to be submitted in the UK if the sponsor retains the UK legal representative for the UK study. Similarly, no amendment will need to be submitted in the UK if a sponsor remains in the UK and a legal representative is added to cover EU/EEA sites.

Additional foreign sponsor requirements are listed in Section 5.2 of GBR-113.

Overview

In all United Kingdom (UK) clinical trials, a freely given informed consent must be obtained from each participant in accordance with the requirements set forth in the MHCTR, the MHCTR2006, and the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113). As per the MHCTR, the MHCTR2006, and GBR-9, the informed consent form (ICF) is viewed as an essential document that must be reviewed and approved by an ethics committee (EC) recognized by the United Kingdom Ethics Committee Authority (UKECA) (henceforth referred to as a “recognized EC”) and operating according to standard operating procedures (GBR-9) issued by England’s Health Research Authority (HRA). The ICF must be provided to the EC with the clinical trial application. (See the Informed Consent topic, Required Elements subtopic for details on what should be included in the form.)

The MHCTR and G-ConsentPIS, state that the investigator(s) must provide detailed research study information to the participant and/or his/her legal representative(s) or guardian(s). The MHCTR and G-ConsentPIS also specify that the oral and written information concerning the trial, including the ICF, should be easy to understand and presented without coercion or unduly influencing a potential participant to enroll in the clinical trial. The participant, and his/her legal representative(s) or guardian(s), should also be given adequate time to consider whether to participate. Per G-ConsentPIS, the Participant Information Sheet (PIS) supports the consent process to help ensure participants have been adequately informed. In addition, the PIS forms part of the transparency information that must be provided to participants under the data protection legislation for the use and processing of personal data. Per the UK-GDPR, UK-DPAct, and G-GDPR, consent to participate in research is not the same as consent as the legal basis for processing personal data under the data protection legislation. For more information about the sponsor’s and investigator’s responsibilities to comply with the data protection requirements (e.g., transparency, safeguards, and data rights), see the Sponsorship topic.

As provided in G-ConsentPIS, consent can be documented electronically or in writing. A physical or electronic copy of the signed consent form will still need to be provided to the participant. To record consent electronically, electronic signatures will be needed. Because there are different forms and classifications of electronic signatures, the researcher should determine what is appropriate for the particular study. GBR-6 sets out the legal and ethical requirements for seeking and documenting consent using electronic methods (also known as eConsent in the UK), as well as expectations regarding the use of electronic signatures. eConsent enables potential research participants to be provided with the information they need to make a decision via a tablet, smartphone or digital multimedia. It also enables their informed consent to be documented using electronic signatures. This approach can supplement the traditional paper-based approach or, where appropriate, replace it.

Re-Consent

According to GBR-113, the EC should approve any change in the ICF due to a protocol modification before such changes are implemented. The participant and/or his/her legal representative(s) or guardian(s) will also be required to re-sign the revised ICF and receive a copy of any amended documentation.

Language Requirements

As stated in the MHCTR, applications to the EC and the Medicines and Healthcare Products Regulatory Agency (MHRA) and any accompanying material, such as the ICF content, should be presented in English.

Documentation Copies

The MHCTR states that the participant and/or the participant’s legal representative(s) or guardian(s), and the investigator(s) must sign and date the ICF. Where the participant is illiterate, and/or his/her legal representative(s) or guardian(s) is illiterate, verbal consent should be obtained in the presence of and countersigned by an impartial witness.

Overview

As delineated in the MHCTR, the MHCTR2006, and the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), prior to beginning a clinical trial, the chief investigator (CI) is required to obtain a favorable opinion from a recognized ethics committee (EC) for the written informed consent form (ICF) and any other information being provided to the research participant and/or his/her legal representative(s) or guardian(s).

No Coercion

As per the G-ConsentPIS and GBR-113, none of the oral and written information concerning the research study, including the written ICF, should contain any language that causes the participant and/or his/her legal representative(s) and/or guardian(s) to waive or to appear to waive his/her legal rights, or that releases or appears to release the investigator(s), the institution, the sponsor, or their representatives from their liabilities for any negligence.

Participant Information Sheet

Per the G-ConsentPIS, the Participant Information Sheet (PIS) supports the consent process to help ensure participants have been adequately informed. In addition, the PIS forms part of the transparency information that must be provided to participants under the data protection legislation for the use and processing of personal data. As indicated in the G-GDPR and GBR-100, the Health Research Authority (HRA) has developed a series of templates to help organizations comply with the data protection legislation. The requirements vary depending on the point of collection of personal data (directly or indirectly) and the timing of the study (i.e., before or after May 25, 2018).

Per the UK-GDPR and the UK-DPAct, consent to participate in research is not the same as consent as the legal basis for processing under the data protection legislation. For more information about the sponsor’s and investigator’s responsibilities to comply with the data protection requirements (e.g., the lawful basis to hold and use personal data, transparency, safeguards, and data rights), see the Sponsorship topic.

Per GBR-31, the HRA guides researchers and ECs in taking a proportionate approach to seeking consent. A proportionate approach adopts procedures commensurate with the balance of risk and benefits so that potential participants are not overwhelmed by unnecessarily lengthy, complex, and inaccessible information sheets. Participants should be provided with succinct, relevant, truthful information in a user-friendly manner that promotes their autonomy. Specifically, the methods and procedures used to seek informed consent and the level of information provided should be proportionate to:

• The nature and the complexity of the research
• The risks, burdens, and potential benefits (to the participants and/or society
• The ethical issues at stake

Informed Consent Form Required Elements

Based on the MHCTR, the G-ConsentPIS, and GBR-113, the ICF should include the following statements or descriptions, as applicable. (Note: the regulations provide overlapping and unique elements so each of the items listed below will not necessarily be in each source.):

• The study purpose, procedures, and duration
• Study title and the study IRAS ID are clearly displayed
• Approximate number of participants involved in the trial
• The participant’s responsibilities in participating in the trial
• Trial treatment schedule and the probability for random assignment to each treatment
• Experimental aspects of the study
• Any foreseeable risks or discomforts to the participant, and when applicable, to an embryo, fetus, or nursing infant
• Any benefits or prorated payment to the participant or to others that may reasonably be expected from the research; if no benefit is expected, the participant should also be made aware of this
• A disclosure of appropriate alternative procedures or treatments, and their potential benefits and risks
• Compensation and/or medical treatment available to the participant in the event of a trial-related injury
• Any additional costs to the participant that may result from participation in the research
• That participation is voluntary, the participant may withdraw at any time, and refusal to participate will not involve any penalty or loss of benefits, or reduction in the level of care to which the participant is otherwise entitled
• The extent to which confidentiality of records identifying the participant will be maintained, and the possibility of record access by the Medicines and Healthcare Products Regulatory Agency (MHRA), the ECs, the auditor(s), and the monitor(s)
• That the participant and/or his/her legal representative(s) or guardian(s) will be notified if significant new findings developed during the study may affect the participant's willingness to continue
• Individuals to contact for further information regarding the trial, the rights of trial participants, and whom to contact in the event of trial-related injury
• Foreseeable circumstances under which the investigator(s) may remove the participant without his/her consent

ICF examples and templates are provided in the G-ConsentPIS.

(See the Informed Consent topic, Compensation Disclosure and Vulnerable Populations subtopics and the Specimens topic, Consent for Specimen subtopic for further information.)

For more information about informed consent required elements, see GBR-113, GBR-100, GBR-31, and GBR-69.

Overview

In accordance with the MHCTR, the G-ConsentPIS, and GBR-35, the informed consent form (ICF) should contain a statement describing the compensation or medical treatment a participant can receive for participating in a clinical trial.

Compensation for Participation in Research

As stated in the MHCTR and the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), ethics committees should consider, in particular, the provision of indemnity or compensation in the event of injury or death attributable to the trial.

Compensation for Injury

As per the MHCTR and GBR-113, the ICF should contain a statement advising the participant of available compensation and medical treatment in the event of any trial-related injury in a clinical trial.

(See the Informed Consent topic, Required Elements subtopic for additional details on what should be included in the ICF, and the Sponsorship topic, Compensation subtopic for information on sponsor requirements.)

Overview

In accordance with the MHCTR, the MHCTR2006, the G-ConsentPIS, and the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), the United Kingdom’s (UK’s) ethical standards promote respect for all human beings and safeguard the rights of research participants. The MHCTR states that a participant’s rights must also be clearly addressed in the informed consent form (ICF) and during the informed consent process.

The Right to Participate, Abstain, or Withdraw

As set forth in the MHCTR, the G-ConsentPIS, and GBR-113, the participant or his/her legal representative(s) or guardian(s) should be informed that participation is voluntary, that he/she may withdraw from the research study at any time, and that refusal to participate will not involve any penalty or loss of benefits to which the participant is otherwise entitled.

The Right to Information

As delineated in the MHCTR, the G-ConsentPIS, and GBR-113, a potential research participant and/or his/her legal representative(s) or guardian(s) has the right to be informed about the nature and purpose of the research study, its anticipated duration, study procedures, any potential benefits or risks, any compensation for participation or injury/treatment, and any significant new information regarding the research study.

The Right to Privacy and Confidentiality

As per the MHCTR and GBR-113, the arrangements to protect participants’ privacy should be provided in the application to the ethics committee, and the ICF should inform potential participants of any potential risk to their confidentiality.

Per the UK-GDPR, the UK-DPAct, the G-GDPR, and GBR-89, participants have the right to be informed about the collection and use of their personal data. This is a key transparency requirement under the data protection legislation. The UK-GDPR specifies what data individuals have the right to be informed about (i.e., privacy information). In addition, as delineated in the UK-GDPR, the UK-DPAct, the G-GDPR, and GBR-89, the participant has certain data rights, which are limited by a range of exemptions. These exemptions must be balanced with what is fair to participants. As indicated in the G-GDPR, exemptions to data subject rights are not automatic, but must be considered on a study-by-study basis. It is important, therefore, to take into account the relevance of data rights to a particular study in the Participant Information Sheet (PIS) when offering or limiting the rights available to research participants. If data rights have been previously offered or limited to participants that are not appropriate under UK-GDPR, then the PIS may need to be revised as a non-substantial amendment. For more information about the sponsor’s (called the “controller” in the UK-GDPR) data protection requirements, see the Sponsorship topic, Quality, Data & Records Management subtopic.

The Right of Inquiry/Appeal

The MHCTR and GBR-113 state that the research participant and/or his/her legal representative(s) or guardian(s) should be provided with contact information for the sponsor and the investigator(s) to address trial-related inquiries.

The Right to Safety and Welfare

The MHCTR, the MHCTR2006, and GBR-113, state that a research participant’s rights, safety, and well-being must take precedence over the interests of science and society.

Overview

The MHCTR, the MHCTR2006-No2, the MHCTR-BSQ, GBR-3, and the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), make provisions to protect the rights of a research participant during the informed consent process when a clinical trial of an investigational product is complicated by special circumstances. Special circumstances include medical emergencies and when a participant is mentally incapacitated.

Medical Emergencies

As delineated in the G-ConsentPIS, GBR-3, and GBR-4, in an emergency, if the signed informed consent form (ICF) cannot be obtained from the research participant, the consent of his/her legal representative(s) or guardian(s) should be obtained. If the prior consent of the participant or his/her legal representative(s) or guardian(s) cannot be obtained, the participant’s enrollment should follow measures specified in the protocol, and the ethics committee (EC) must provide documented approval in order to protect the participant’s rights, safety, and well-being. The participant or his/her legal representative(s) or guardian(s) should provide consent as soon as possible.

The MHCTR-BSQ amends the MHCTR and creates an exception for minors participating in a trial where urgent treatment is required and prior consent cannot be obtained. This situation also requires the EC to issue its approval beforehand.

Mentally Incapacitated Persons

The MHCTR2006-No2 amends the MHCTR and creates an exception to the general rule in England, Northern Ireland, and Wales that incapacitated adults cannot be included in a clinical trial under medical emergencies. If the treatment to be provided is a matter of urgency and obtaining prior consent is not possible, incapacitated adult participants may be included in the trial once EC approval has been obtained. In Scotland, the provisions of Section 51 of the AIA2000 govern the inclusion of adults lacking capacity in research.

The G-ConsentPIS states that the UK allows adults not able to consent for themselves to be recruited into clinical trials without prior consent in emergency situations if the following conditions exist:

• Treatment needs to be given urgently
• It is also necessary to take urgent action to administer the drug (IMP) for the purposes of the trial
• It is not reasonably practicable to obtain consent from a legal representative
• The procedure is approved by an EC
• Consent is sought from a legal representative as soon as possible

Overview

As per the MHCTR, GBR-3, GBR-4, and the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), in all United Kingdom (UK) clinical trials, research participants selected from vulnerable populations must be provided additional protections to safeguard their health and welfare during the informed consent process. GBR-3, GBR-4, and GBR-35 characterize vulnerable populations as those who are dependent on others and are unable to express their opinion freely or make their own decisions. These participants may include children, persons with mental or physical incapacities, persons with incurable diseases, persons in nursing homes, unemployed or impoverished persons, patients in emergency situations, ethnic minority groups, homeless persons, nomads, prisoners, detainees, refugees, members of a group with a hierarchical structure, such as students, subordinate hospital and laboratory personnel, pharmaceutical industry employees, members of the armed forces, and persons kept in detention.

See the Informed Consent topic, and the subtopics of Children/Minors; Pregnant Women, Fetuses & Neonates; and Mentally Impaired for additional information about these vulnerable populations.

Overview

According to the MHCTR, a minor is an individual under 16 years of age. However, per GBR-4, in situations where the MHCTR does not apply, a minor is an individual under 18 years of age.

As set forth in the MHCTR, the MHCTR2006, the G-ConsentPIS, GBR-4, GBR-9, and the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), when the research participant is a minor, informed consent should be obtained from his/her legal representative(s) and/or guardian(s). As per GBR-4, legally, the researcher needs only to obtain consent from one (1) person with parental responsibility; however, consent from all legal representative(s) and/or guardians is encouraged.

Additionally, precautions against possible physical and mental harms should be exercised. All pediatric participants should be informed to the fullest extent possible about the study in language and terms that they are easily able to understand. The rights of the minors should also be respected for their voluntary decision to participate in a clinical study.

The MHCTR, the MHCTR2006, GBR-4, GBR-9, and GBR-35 state that a study may only be conducted on minors if several conditions are fulfilled including:

• An ethics committee (EC), following consultation with pediatric experts, has endorsed the protocol
• The legal representative(s) and/or guardian(s) has had an interview with the investigator(s) to understand the trial objectives and risks, been provided with a point of contact for further information, and been informed of the right to withdraw the minor from the trial at any time
• No incentives or financial inducements are given to the minor or his/her legal representative(s) and/or guardian(s) except in the event of trial-related injury or loss
• The trial relates directly to a condition from which the minor suffers, or, is of such a nature that it can only be carried out on minors
• The participant(s) will derive some direct benefit from their participation in the trial
• The trial is necessary to validate data obtained in other trials involving persons able to give informed consent, or, by other research methods
• The trial has been designed to minimize pain, discomfort, fear, and any other foreseeable risk in relation to the disease and the minor’s stage of development

See the MHCTR, the MHCTR2006, GBR-4, and GBR-9 for detailed requirements. The G-ConsentPIS provides style guidance and suggestions for presenting age-appropriate information in the participant information sheet.

Assent Requirements

As delineated in GBR-4, if a minor is deemed competent to give assent to decisions about participation in research, the investigator(s) must obtain that assent in addition to the consent of his/her legal representative(s) and/or guardian(s). If the child does not assent, this should be respected.

Furthermore, GBR-4 states that a minor’s ability to assent or consent is based on his/her ability to understand and assess options, rather than on his/her age. For a minor to be able to have the capacity to make a particular decision, he/she must be able to:

• Comprehend and retain information material to the decision, especially the consequences of having or not having any intervention
• Use and weigh this information in a decision-making process
• Reach and communicate a decision

In addition, GBR-4 specifies that if the competent minor specifically asks for the family not to be involved, and they cannot be persuaded otherwise, his/her privacy should be respected.

Overview

The G-ConsentPIS states that in studies where there could be harm to an unborn child and/or risk to an infant when breastfeeding the Participant Information Sheet (PIS) should provide specific advice to potential participants about the risks of becoming pregnant, of fathering a child or of breastfeeding while taking part in the research.

For women, researchers must give a clear warning to potential participants when there is a risk of harm to an unborn child or risk when breastfeeding. The information should include the need for pregnancy testing, contraceptive requirements, and how to report a pregnancy during the study. The PIS should also provide information about what will happen if a participant becomes pregnant, including whether and how the researcher will monitor the pregnancy. This would include access to the mother's and/or child's notes, and any possible follow up of the child including post-natal examinations.

For men, researchers must provide clear warnings and advice if the research treatment could damage sperm and consequently pose a risk to possible pregnancies. Information concerning the importance of careful contraception and what to do if their partner becomes pregnant is essential. Specific advice for pregnant partners may be needed, including information on any compensation arrangements.

Further, the G-ConsentPIS finds that the risk of harm caused during pregnancy is most likely when recruiting young people to a clinical trial for an investigational medicinal product (CTIMP). In this case, there should be consent from someone over the age of 16, and the following should be done:

• Discuss the risk of pregnancy, pregnancy testing and the use of appropriate contraception with their parents (or his/her legal representative(s) and/or guardian(s)) during the consent process and with young potential participants as part of the assent process
• Consider local social beliefs
• Involve pediatricians and the ethics committee in preliminary discussions if this is a concern
• Consult young people when designing consent and writing information
• Respect the young person's autonomy but encourage involvement of the parents
• Be aware that in CTIMPs, it is the parents of children under 16 who legally provide consent, and this will include consent to pregnancy testing and discussion of contraception
• Information needs to go beyond "We will do a pregnancy test…" to include, what in broad terms, will happen

As set forth in GBR-35, any research studies involving women capable of becoming pregnant and breastfeeding women require additional safeguards to ensure the research conforms to appropriate ethical standards and upholds societal values. According to GBR-35, the following conditions are required for research to be conducted with this population:

• Reproductive toxicology studies have been completed and the results support conducting a trial, or, there is a good reason not to conduct the reproductive toxicology studies and/or the risk of pregnancy is minimized (e.g., because she agrees to adhere to a highly effective method of contraception); Women using a hormonal contraceptive, such as “the pill,” should use an alternative method of contraception until the possibility of an interaction with the investigational product has been excluded
• The female participant is not pregnant according to her menstrual history and a pregnancy test, and is not at risk of becoming pregnant during, and for a specified interval, after the trial
• The female participant is warned about the potential risks to the developing child should she become pregnant, and she is tested for pregnancy during the trial, as appropriate
• The female is tested for pregnancy before dosing starts and possibly during the trial, as appropriate

Overview

Per the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), prisoners are considered vulnerable because incarceration could affect their ability to make a voluntary decision regarding participation in research. A research study involving prisoners should ensure that these prospective participants are informed and are given the opportunity to make their own decisions without any interference from a higher authority. The ethics committee must also ensure that the study will be independently monitored to assure the dignity and rights of the prisoners involved in the research.

Overview

As per the MHCTR and GBR-9, a recognized ethics committee (EC) within the Health Research Authority (HRA), must approve the participation of adult research participants who are incapable by reason of physical and mental capacity to give consent, and must obtain advice from professionals with expertise in handling this patient population.

The MHCTR and the G-ConsentPIS, specify that when a study involves adult participants with mental incapacities, informed consent should be obtained from his/her legal representative (s) and/or guardian(s). This consent should only be provided once the legal representative(s) or guardian(s) has had an interview with the investigator(s) to understand the trial objectives and risks, been provided with a point of contact for further information, and been informed of the right to withdraw the participant from the trial at any time. The G-ConsentPIS provides additional country-specific information on legal representative requirements.

As delineated in the MHCTR, a clinical trial of an investigational product may involve participants with mental incapacities under the following conditions:

• The participant has received information according to his/her capacity of understanding regarding the trial, its risks, and its benefits
• No incentives or financial inducements are given to the participant or his/her legal representative(s) and/or guardian(s) except in the event of trial-related injury or loss
• The trial relates directly to a condition from which the participant suffers, or, is of such a nature that it can only be carried out on participants with mental incapacities
• The participant(s) will derive some direct benefit from their participation in the trial, or produce no risk at all
• The trial is necessary to validate data obtained in other trials involving persons able to give informed consent, or, by other research methods
• The trial has been designed to minimize pain, discomfort, fear, and any other foreseeable risk in relation to the disease and the participant’s stage of development

See the MHCTR, G-ConsentPIS, and GBR-9 for detailed requirements.

Overview

As delineated in the MHCTR, the Guideline for Good Clinical Practice E6(R2) (GBR-113), GBR-9, and GBR-35, an investigational product (IP), referred to as an investigational medicinal product (IMP) in the United Kingdom (UK), is defined as a pharmaceutical form of an active substance or placebo being tested or used as a reference in a clinical trial. This includes a product with a marketing authorization when it is used or assembled (formulated or packaged) in a different way from the approved form; when used for an unapproved indication; or when used to gain further information about an approved use.

Overview

According to the MHCTR, the MHCTR2006, the G-CTApp, and the G-GMP-GDP, the Medicines and Healthcare Products Regulatory Agency (MHRA) is responsible for authorizing the manufacture and import of investigational products (IPs) (known as investigational medicinal products (IMPs) in the United Kingdom (UK)) to be used in a trial. A Manufacturer’s Authorization for Investigational Medicinal Products (MIA(IMP)) must be obtained by the person responsible for the manufacture or importation of any IP to be used in the trial. The sponsor or his/her designated representative must include a copy of the MIA(IMP) in the clinical trial application submission to the MHRA. The applicant must complete the form listed in GBR-28 to obtain an MIA(IMP) from the MHRA. The MHCTR defines “manufacturing authorization” to include importing and assembly authorizations, as applicable. The G-CTApp states that if an IP is manufactured outside the European Union (EU), the clinical trial application should include an MIA(IMP), importer authorization, and qualified person (QP) declaration on good manufacturing practice (GMP) for each site. The MHRA will approve the manufacture or import of an IP after the clinical trial application has been approved.

As per the MHCTR, the MHCTR2006, the G-GMP-GDP, and GBR-15, and the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), the MIA(IMP) holder must also comply with the GMP guidelines and provide an IMP Certificate of Analysis. In addition, the MHCTR, the MHCTR2006, and the G-GMP-GDP, specify that the holder of an MIA(IMP) must always have the services of at least one (1) Qualified Person (QP) at his/her disposal. The QP must satisfy the qualification and experience requirements delineated in the aforementioned sources. The QP’s primary legal responsibility is to certify batches of IPs prior to using in a clinical trial, or prior to releasing for sale and placing on the market. See Part 6 and Schedule 6 of the MHCTR for detailed applicant requirements.

In accordance with the G-ImportIMPs, the sponsor of a UK clinical trial using IPs imported from countries on the list of approved countries (G-CTApprovedCountries), must require the MIA(IMP) holder to put in place an assurance system to check these IMPs have been certified by a QP in a listed country, before release to the trial. A sponsor may perform verification of QP certification in a listed country themselves if they are the holder of a UK MIA(IMP). Alternatively, they may outsource this verification to a third party who holds a UK MIA(IMP). There will be a one-year transition period from January 1, 2021 to implement this guidance. IPs coming to Great Britain from Northern Ireland do not require this additional oversight. IPs coming directly to the UK from third countries that are not on the list of approved countries will continue to require import and QP certification in the UK by the MIA(IMP) holder as per the existing requirements. Per the G-SubtlAmndmt, for any change to IP manufacturing, importation, or certification relevant to the supply of IPs in an ongoing UK trial, a substantial amendment must be submitted to the MHRA. However, if the sponsor chooses to retain an existing UK release site for the ongoing UK trial but includes an additional EU/EEA site for trials in the EU/EEA only, then no substantial amendment to the MHRA will be required.

Please note: The UK is party to the Nagoya Protocol on Access and Benefit-sharing (GBR-5), which may have implications for studies of IPs developed using certain non-human genetic resources (e.g., plants, animals, and microbes). For more information, see GBR-48.

Overview

In accordance with the MHCTR, the MHCTR2006, and GBR-92, the sponsor or his/her designated representative is responsible for complying with the principles of good clinical practice (GCP) as specified in the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), and for providing investigators with an Investigator’s Brochure (IB). The IB must contain all of the relevant information on the investigational product(s) (IPs) (known as investigational medicinal products (IMPs) in the United Kingdom (UK)) obtained through the earlier research phases, including preclinical, toxicological, safety, efficacy, and adverse events data. The sponsor or his/her designated representative should also update the IB as significant new information becomes available.

Investigator's Brochure Content Requirements

As specified in GBR-113, the IB must provide coverage of the following areas:

• Physical, chemical, and pharmaceutical properties and formulation parameters
• Non-clinical studies (pharmacology, pharmacokinetics, toxicology, and metabolism profiles)
• Effects of IMPs in humans (pharmacology, pharmacokinetics, metabolism, and pharmacodynamics; safety and efficacy; regulatory and post marketing experiences)
• Summary of data and guidance for the investigator(s)
• Bibliography

See Section 7 of GBR-113 for detailed content guidelines.

As defined in GBR-113, the sponsor is also accountable for supplying the IMP, including the comparator(s) and placebo, if applicable. The MHCTR, the MHCTR2006, the G-GMP-GDP, GBR-15, and GBR-35 also specify that the sponsor or his/her designated representative must ensure that the products are manufactured in accordance with current Good Manufacturing Practice (GMP) guidelines. (See Investigational Products topic, Product Management subtopic for additional information on IP supply, storage, and handling requirements).

Certificate of Analysis

Per GBR-113, the sponsor must maintain a Certificate of Analysis to document the identity, purity, and strength of the IP(s) to be used in the clinical trial.

Overview

Labeling for investigational products (IPs) (known as investigational medicinal products (IMPs) in the United Kingdom (UK)) must comply with the requirements set forth in the MHCTR, the MHCTR2006, GBR-15, the EU Good Manufacturing Practice Directive (GBR-12), and the European Medicines Agency’s implementation of the Guideline for Good Clinical Practice E6 (R2) (GBR-113). Per GBR-12, labeling for IPs must ensure protection of the participant and traceability, to enable identification of the product and trial, and to facilitate proper use of the IP. As specified in GBR-15, for an IP to be used in a clinical trial, it must be properly labeled in the official language of the country where the trial is being conducted.

As set forth in GBR-15, the following labeling information must be included on the primary package label (or any intermediate packaging), and the outer packaging:

• Name, address and telephone number of the sponsor, contract research organization (CRO), or investigator
• Pharmaceutical dosage form, route of administration, quantity of dosage units, and in the case of open trials, the name/identifier and strength/concentration
• Batch and/or code number to identify the contents and packaging operation
• Trial reference code allowing identification of the trial, site, investigator, and sponsor (if not given elsewhere)
• Trial participant identification number/treatment number and where relevant, the visit number
• Investigator name (if not already included above)
• Instructions for use (reference may be made to a leaflet or other explanatory document intended for the trial participant or person administering the product)
• “For clinical trial use only” or similar wording indicating the IP is clinical trial material
• Storage conditions
• Expiration date (use by date, expiration date, or re-test date as applicable), in month/year format and in a manner that avoids any ambiguity
• “Keep Out of Reach of Children” except when the product is not going to be taken home by participants

As per the MHCTR, a sample of the labeling is required as part of the clinical trial application submission. (See Clinical Trial Lifecycle topic, Submission Content subtopic for detailed clinical trial application submission requirements). Furthermore, according to GBR-15, the IP must also be suitably packaged in a manner that will prevent contamination and unacceptable deterioration during transport and storage.

Overview

In accordance with the MHCTR, the MHCTR2006, and GBR-92, the sponsor or his/her designated representative is responsible for complying with the principles of good clinical practice (GCP) as specified in the International Council for Harmonisation's Guideline for Good Clinical Practice E6(R2) (GBR-113), and for providing investigators with an Investigator’s Brochure (IB). The IB must contain all of the relevant information on the investigational product(s) (IPs) (known as investigational medicinal products (IMPs) in the United Kingdom (UK)) obtained through the earlier research phases, including preclinical, toxicological, safety, efficacy, and adverse event data. The sponsor should also update the IB as significant new information becomes available.

Investigational Product Supply, Storage, and Handling Requirements

As defined in the MHCTR, GBR-113, and GBR-35, the sponsor must supply the investigator(s)/institution(s) with the IP(s), including the comparator(s) and placebo, if applicable. The sponsor should not supply either party with the IP(s) until obtaining Medicines and Healthcare Products Regulatory Agency (MHRA) approval and a favorable opinion from a recognized ethics committee (EC).

The sponsor must ensure the following:

• IP product quality and stability over the period of use
• IP manufactured according to good manufacturing practice guidance (G-GMP-GDP and GBR-15)
• Proper coding, packaging and labeling of the IMP(s)
• IP use record including information on the quantity, loading, shipment, receipt, dispensing, handling, reclamation and destruction of the unused IP
• Acceptable storage temperatures, conditions, and times for the IP
• Written procedures including instructions for handling and storage of the IP, adequate and safe receipt, dispensing, retrieval of unused IP(s), and return of unused IP(s) to the sponsor
• Timely delivery of the IP(s)
• Establishment of management and filing systems for the IPs
• Sufficient quantities of the IP for the trial

As delineated in GBR-15, IPs should remain under the control of the sponsor until after completion of a two-step procedure: certification by the Qualified Person (QP) and release by the sponsor for use in a clinical trial. Both steps should be recorded and retained in the relevant trial files held by or on behalf of the sponsor. Shipping of IPs should be conducted according to instructions given by or on behalf of the sponsor in the shipping order. De-coding arrangements should be available to the appropriate responsible personnel before IPs are shipped to the investigator site. A detailed inventory of the shipments made by the manufacturer or importer should be maintained and include the addressees’ identification.

Refer to the MHCTR, GBR-113, and GBR-35 for detailed, sponsor-related IP requirements.

To help ensure the continuity of supply of medicines for clinical trials from January 1, 2021, the BrexitLtr-IPs indicates that the UK will unilaterally recognize certain European Union (EU) regulatory processes for a time-limited period. This recognition is known as “standstill.”

Record Requirements

As per GBR-35 and GBR-113, the sponsor should inform the investigator(s) and institution(s) in writing of the need for record retention and should notify the investigator(s) and institution(s) in writing when the trial-related pharmacy records are no longer needed. Additionally, the sponsor must ensure sufficient quantities of the IP(s) used in the trial to reconfirm specifications, should this become necessary, and should maintain records of batch sample analyses and characteristics.

As set forth in GBR-113, sponsor-specific essential documents should be retained until at least two (2) years after the last approval of a marketing application, until there are no pending or contemplated marketing applications, or at least two (2) years have elapsed since the formal discontinuation of the IP’s clinical development. The sponsor should inform the investigator(s) and the institution(s) in writing when trial-related records are no longer needed.

However, per the MHCTR2006, the sponsor and the chief investigator must ensure that the documents contained in the trial master file are retained for at least five (5) years following the trial’s completion. The documents must be readily available to the MHRA upon request, and be complete and legible. The sponsor should ensure that trial participant medical files are also retained for at least five (5) years after the trial’s conclusion.

Overview

The term “specimen” is not referenced within the United Kingdom (UK). However, the following terms are used relating to specimens:

• Relevant material: As per the UK-HTA, Code-E, GBR-73, and GBR-76, “relevant material” or “human tissue” is any material from a human body, other than gametes, that consists of, or includes, cells. This also includes blood (except where held for transplantation). Hair and nails from living persons are specifically excluded from this definition, as are gametes and embryos outside the body.
• Bodily material: GBR-64 defines “bodily material” as material from a human body that consists of, or includes, human cells. Unlike relevant material, this includes gametes, embryos outside the human body, and hair and nails from the body.
• Tissue: GBR-64 defines “tissue” as any human material (e.g., blood, biopsies, urine) and includes relevant and bodily material.

Overview

As set forth in the UK-HTA, the HTRegs, and GBR-9, the Human Tissue Authority (HTA) regulates the storage and use of specimens (known as “relevant materials” or “human tissue” in the United Kingdom (UK)) from the living, and the removal, storage, use, and licensing of relevant materials/human tissue from the deceased for specified health-related purposes in the UK. The UK-HTA refers to specified purposes as “scheduled purposes.” Per GBR-9, the HTA and the Health Research Authority (HRA) have agreed to collaborative arrangements in a Memorandum of Understanding.

Note that per GBR-9 and GBR-105, an HTA license is not needed for storage of specimens for certain research projects that have been approved by an ethics committee (EC). HTA and the UK Health Departments’ Research Ethics Service (RES) (GBR-62) have agreed that an EC can give generic ethical approval for a research tissue bank’s arrangements for collection, storage, and release of specimens, provided the specimens in the bank are stored on HTA-licensed premises. This approval can extend to specific projects receiving non-identifiable tissue from the bank. The specimens do not then need to be stored on HTA-licensed premises, nor do they need project-specific ethical approval. However, a license is required for specimens stored for which there is no ethical approval (e.g., in large biobanks).

Per the UK-HTA, the G-QAHumTissue, and Code-E, the scope of the UK-HTA provisions specifically cover England, Northern Ireland, and Wales. The UK-HTA licensing requirements do not apply in Scotland, with the exception of those provisions relating to the use of DNA. Scotland complies with the Scotland-AnatAct and the Scotland-HTA for the removal, retention, use, licensing, and import of human organs, tissue, and tissue samples specifically removed post mortem, and subsequently used for research. Per GBR-52, the Scotland-HTA does not regulate the use of tissue from the living for research.

Relevant Materials/Human Tissue

As specified in the UK-HTA, the HTA has jurisdiction regarding the import and export of relevant materials/human tissue, and complies with the Code of Practice on import and export set forth in Code-E. According to the UK-HTA, Code-E, and GBR-52, the import and export of relevant material/human tissue is not in itself a licensable activity under the UK-HTA. However, once the material is imported, storage of this material may be licensable if it is deemed to be for a specified or scheduled purpose.

If relevant material/human tissue is being imported or exported for an application, the HTRegs specify that this must be carried out under the authority of a license or third party agreement with an establishment licensed by the HTA to store material for human application. Per G-Tissues-Brexit, because the UK has left the European Union (EU) single market and customs union, there may be regulatory changes to an import/export license to continue to receive tissues and cells for human application from the EU, or send tissues and cells intended for human application to the EU. For detail and forthcoming updates, see the G-Tissues-Brexit. For more information about Brexit, see the Regulatory Authority topic, Scope of Assessment subtopic.

Code-E requires imported material to be procured, used, handled, stored, transported, and disposed of in accordance with the donor’s consent. In addition, due regard should be given to safety considerations, and with the dignity and respect accorded to human bodies, body parts, and tissue as delineated in Code-E. Any individual or organization wishing to import human bodies, body parts, and tissue into England, Wales or Northern Ireland must comply with the guidelines set forth in Code-E.

Exported material should also be procured, used, handled, stored, transported and disposed of, in accordance with the donor’s consent, with due regard for safety considerations, and with the dignity and respect accorded to human bodies, body parts, and tissue as stated in Code-E. This includes providing donors with adequate information upon taking consent, that their samples may be transported as exported samples for use abroad. It is the responsibility of the recipient country to ensure that, prior to export, the material is handled appropriately and that the required country standards have been met.

In addition, the G-QualityBlood lists the quality and safety standards when importing or exporting blood into or from the European Union (EU)/European Economic Area (EEA). In addition, after the Brexit transition period from January 1, 2021, this guidance states that there is no change to blood quality and safety practices. The UK is maintaining the existing quality and safety standards for the collection, testing, processing, storage, and distribution of human blood and blood components. The Medicines and Healthcare Products Regulatory Agency (MHRA) should be consulted before importing or exporting blood or blood components. See the G-QualityBlood for relevant EU quality and safety directives.

Overview

In accordance with the UK-HTA, Code-A, GBR-35, GBR-34, and GBR-9, prior to collecting, storing, or using a research participant’s specimens (known as relevant material/human tissue in the United Kingdom (UK)), consent from the participant and/or his/her legal representative(s) and ethics committee (EC) approval must be obtained. The scope of the UK-HTA provisions specifically cover England, Northern Ireland, and Wales. The UK-HTA licensing requirements do not apply in Scotland, with the exception of those provisions relating to the use of DNA. Scotland complies with the Scotland-AnatAct and the Scotland-HTA for the removal, retention, use, licensing, and import of human organs, tissue, and tissue samples specifically removed post mortem, and subsequently used for research.

Per G-ConsentPIS, the Participant Information Sheet (PIS) supports the consent process to help ensure participants have been adequately informed. In addition, the PIS forms part of the transparency information that must be provided to participants under the data protection legislation for the use and processing of personal data. As delineated in the UK-GDPR and UK-DPAct, personal data includes genetic data and biological samples. G-GDPR indicates that for the purposes of the UK-GDPR, the legal basis for processing data for health and social care research should not be consent. This means that requirements in UK-GDPR relating to consent do not apply to health and care research, and therefore, do not change the consent requirements to participate in a clinical trial and remove human tissue samples. For more information about the sponsor and investigator’s responsibilities to comply with the data protection requirements (e.g., transparency, safeguards, and data rights), see the Sponsorship topic.

Human Genetic Research Consent Requirements

As set forth in the UK-HTA, GBR-9, and GBR-37, the UK-HTA considers it a UK-wide offense to have relevant material/human tissue with the intention of conducting a DNA analysis or using the results of this analysis without “qualifying consent” from a participant and/or his/her legal representative(s), unless the information is being used for an “excepted purpose.” The UK-HTA states that “qualifying consent” is consent required in relation to the analysis of DNA manufactured by the human body. An “excepted purpose” is defined as the following:

• Medical diagnosis/treatment
• Coroner purposes
• Crime prevention/detection
• Prosecution
• National security
• Court/tribunal order
• An existing holding to be used for research

In addition to participant consent, EC approval is required for the analysis of DNA in material from the living, where the research is not within the terms of consent for research from the person whose body manufactured the DNA. Please refer to the UK-HTA, GBR-9, GBR-37, and GBR-75 for detailed DNA analysis consent requirements.

Human Tissue/Relevant Material Consent Requirements

In accordance with the UK-HTA, Code-A, GBR-35, GBR-34, and GBR-9, prior to removing, storing, or using any living or deceased person’s organs, tissues, or cells for the purpose of research in connection with disorders in, or the functioning of the human body, investigators must obtain “appropriate consent” from the trial participants and/or their legal representative(s) as well as EC approval. The UK-HTA and Code-A define “appropriate consent” in terms of the person who may give consent. This person may be either the trial participant, his/her legal representative (referred to as “nominated representative” in the UK-HTA), or, in the absence of either of these, the consent of a person in a “qualifying relationship” with the participant immediately before he/she dies.

As indicated in the UK-HTA and Code-A, in the case of a living child donor, “appropriate consent” must be obtained from the child’s legal representative(s). If the child has died, the written consent must be obtained prior to the child’s death in the presence of at least one (1) witness, or, it must be signed at the direction of the child concerned, in his/her presence, and in the presence of at least one (1) witness.

As indicated in the UK-HTA and Code-A, in the case of an adult donor, 18 years or older, his/her consent must be obtained prior to removing any materials from his/her body. If the adult has died, his/her written consent is only valid when it is signed by the person prior to his/her death in the presence of at least one (1) witness at his/her direction, or it is contained in the person’s will. An adult donor may also appoint one (1) or more people (“nominated representative(s)”) to consent on his/her behalf in the event of his/her death. This consent may be obtained orally or in writing. If the deceased donor has neither provided consent nor an appointed or nominated representative, appropriate consent may be given by someone in a “qualifying relationship” with the donor immediately prior to his/her death. Refer to the UK-HTA and Code-A to obtain a complete list of relatives in hierarchical order who may qualify to provide this consent.

In the case of obtaining materials from an adult donor who lacks the capacity to consent, and neither a decision to consent or not consent is in force, the UK-HTA, the MCA2005, GBR-9, and GBR-37 state that approval by an EC is required. In addition, a living person’s organs, tissues, or cells may be stored and used without consent if the investigator is unable to identify the individual and it is being used for an EC-approved research project. Please refer to the UK-HTA and Code-A for detailed consent requirements.

See the Informed Consent topic, Required Elements and Participant Rights subtopics for additional information on informed consent.