CLINICAL DATA MANAGEMENT Presented by: Ayasha Parveen M.Pharm 1st year Clinical Research DPSRU

CONTENTS Introduction Tools for clinical data management Regulations, guidelines, and standards in clinical data management The clinical data management process Roles and responsibilities in clinical data management Example of CDM process

INTRODUCTION Clinical data management is a process of collection, cleaning, and management of subject data in compliance with regulatory standard. The primary objective of CDM processes is to provide high-quality data by keeping the number of errors and missing data as low as possible and gather maximum data for analysis. To meet this object, best practices are adopted to ensure that data are complete, reliable, and processed correctly. This has been facilitated by the use of software application that maintain an audit trail and provide easy identification and resolution of data discrepancies.

TOOLS FOR CDM Many software tools are available for data management, and these are called clinical data management system (CDMS). In multicentric trials, a CDMS has become essential to handle the huge amount of data. Most of the CDMS used in pharmaceutical companies are commercial, but a few open source tools are available as well. Commonly used CDM tools are; ORACLE CLINICAL CLINTRIAL MACRO RAVE eClinical Suite

CONTINUED… In term of functionality, these software tools are more or less similar and there is no significant advantage of one system over the other. These software tools are expensive an need sophisticated information technology infrastructure to function.

REGULATION, GUIDELINES, AND STANDARDS IN CDM CDM has guidelines and standards that must be followed. Since the pharmaceutical industry relies on the electronically captured data for the evaluation of medicines, there is a need to follow good practices in CDM and maintained standards in electronic data capture. These electronic records have to comply with a code of federal regulations (CFR), 21 CFR part 11. This regulation is applicable to records in electronic format that are created, modified, archived, retrieved, or transmitted. This demands the use of validated system to ensure accuracy, reliability, and consistency of data with the use of secure, computer-generated, time-stamped audit trails to independently record the data and time of operator entries and actions that create, modify, or delete electronics records.

THE CDM PROCESS The CDM process is designed to deliver an error-free, valid, and statistically sound database. To meet this objective, the CDM process starts early, even before the finalization of the study protocol. REVIEW AND FINALIZATION OF STUDY DOCUMENTS; In this the protocol is reviewed for clarity and consistency with a perspective for designing data base. During this the CDM personnel identify the data items to be collected and the frequency of collection with respect to the visit schedule.

CONTINUED… A case report form (CRF) is designed by the CDM team, as this is the first step in translating the protocol-specific activities into data being generated. The CDM activities include; Data collection CRF tracking CRF annotation Database design Data entry Medical coding Data validation Discrepancy management Database lock

CONTINUED… DATA COLLECTION data collection is done using the CRF that may exist in the form of a paper or an electronic version. The paper CRFs are filled up by the investigator according to the completion guidelines. In the e-CRF-based CDM, the investigator or a designee will be logging into the CDM system and entering the data directly at the site. In e-CRF method, chances of errors are less, and the resolution of discrepancies happens faster. Since pharmaceutical companies try to reduce the time taken for drug development processes by enhancing the speed of processes involved, many pharmaceutical companies are opting for e-CRF options (also called remote data entry).

CONTINUED… CRF TRACKING The entries made in the CRF will be monitored by the clinical research associate (CRA) for completeness and filled up CRFs are retrieved and handed over to the CDM team. The CDM team will track the retrieved CRFs and maintain their record. CRFs are tracked for missing pages and illegible data manually to assure that the data are not lost. In case of missing or illegible data, a clarification is obtained from the investigator and the issue is resolved.

CONTINUED… DATABASE DESIGNING :- Database are the clinical software applications, which are built to facilitate the CDM tasks to carry out multiple studies. Generally, these tools have built-in compliance with regulatory requirements and are easy to use. “System Validation” is conducted to ensure data security, during which system specification, user requirements, and regulatory compliance are evaluated before implementation.

CONTINUED… DATA ENTRY :- Data entry takes place according to the guidelines prepared along with the data management practices (DMP). This is applicable only in the case of paper CRF retrieved from the sites. Usually, double data entry is performed wherein the data is entered by two operators separately. The second pass entry (entry made by second person) helps in verification and reconciliation by identifying the transcription errors and discrepancies caused by illegible data. Earlier studies have shown that double data entry ensures better consistency with paper CRF as denoted by a lesser error rate.

CONTINUED… MEDICAL CODING :- Medical coding helps in identifying and properly classifying the medical terminologies associated with the clinical trial. (eg, adverse events (AE) reported in clinical trial. Medical dictionary for regulatory activities (MedDRA) is used for the coding of adverse events as well as other illnesses and world health organization— drug dictionary enhanced (WHO-DDE) is used for coding the medication.

CONTINUED… DATA VALIDATION :- Data validation is the process of testing the validity of data in accordance with the protocol specification. Edit check programs are written to identify the discrepancies in the entered data, which are embedded in the database, to ensure data validity. DISCREPANCY MANAGEMENT This is also called query resolution. Discrepancy management includes reviewing discrepancies, investigation the reason, and resolving them with documentary proof or declaring them as irresolvable.

CONTINUED… DATABASE LOCKING :- After a proper quality check and assurance, the final data validation is run. If there is no discrepancies, the SAS (statistically analysis software) datasets are finalized in consultation with the statistician. All data management activities should have been completed prior to database lock. Once the approval for locking is obtained from all stakeholders, the database is locked and clean data is extracted for statistical analysis.

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Example;

ROLES AND RESPONSIBITIES IN CDM In a CDM team, different roles and responsibilities are attributed to the team members. The list of roles given below can be considered as minimum requirements for a CDM team. Data manager Database programmer/designer Medical coder Clinical data coordinator Quality control associate Data entry associate

CONTINUED… The data manager is responsible for supervising the entire CDM process. The data manager prepares the data management plan (DMP), approves the CDM procedures and all internal documents related to CDM activities. Controlling and allocating the database access to team members is also the responsibility of the data manager. The data entry personnel will be tracking the receipt of CRF pages and performs the data entry into the database.

REFERENCES “Basic Principles of Clinical Research and Methodology” by Dr. S. K. Gupta. https://en.wikipedia.org/wiki/Clinical_data_management “ The Clinical Data Management Process” by Aron Shapiro and Dale Usner, Business of Retina( Clinical Trials for the Retina Specialist) Google Images

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