1. An integrated approach to successful eClinical trials CCRA Seminar: Standards in Electronic Data Capture London 1 November 2005 Dr Bill Byrom Product Strategy Director, ClinPhone Group Ltd.

2. Presentation contents  Common application of IVR/IWR in today’s clinical trials  Why integrate EDC and IVR?  Integration overview  Case study: Procter & Gamble Pharmaceuticals  Demonstration movie  Conclusions

3. Common IVR / IWR application Typical application areas in today’s clinical trials

4. IVR/IWR application  Secure telephone / web access for the performance of various site-based, sponsor-based, or patient-based activities. –Randomization –Emergency Code Break –Medication Dispensing and Supply Chain Management –Electronic Patient-Reported Outcomes (ePRO) –Patient Pre-qualification and Recruitment

5. Recent Survey ClinPhone webinar April 2005 (n=300) a)Ensuring sites follow the randomization process correctly b)Preventing tampering of code break envelopes c)Providing 24h on-call code break staff d)Managing more complicated randomization e.g.. stratification e)Ensuring randomization methods are followed in open label studies f)Demonstrating internal staff are blinded to randomization schedule g)Other What is the largest issue or challenge you face with randomisation and blinding in today’s clinical trials?

6. Recent Survey ClinPhone webinar April 2005 (n=300) What is the largest issue or challenge you face with medication management in today’s clinical trials? a)Accurately forecasting the amount of drug required b)Managing the logistics of large multinational trials c)Managing drug expiration d)Limitations on supplies due to manufacturing e)Efficient use of medication in titration studies f)Other

7. Medication labelling/dispensing IVR / IWR approach  Unique Medication Numbering –Can be applied to ‘Kit’ of supplies –Can be applied to the Individual Dispensing Unit  Any unit can go to any patient (randomised to same treatment group)  Any unit can be used for any treatment period  Using the smallest dispensing unit gives the most flexibility  Pooling medication across studies possible

8. Medication dispensing and re-supply Notification: Arrival / Damaged packs Consignment request Consignment details Shipment Dispensing call Pack numbers Stock levels fall to trigger level Investigational site Drug distribution depot ClinPhone Inventory database AB

9. Why Integrate? The benefits of eClinical integration

10. eClinical solutions EDC IVR CDMS Safety System CTMS DSMS

11. Why Integrate?  Remove duplication of data and activities  Ensure all systems contain the most up-to-date information at all times  Simplify processes for the end-user  Enhanced data access –Facilitate reporting and consolidation of project management data through the solution of choice  Eliminate manual processes

12. Integration principles  The main objectives of any integrations: –Do each task once – remove resource duplication and the errors introduced by transcription –Do it in the place that makes sense – decide on the best overall process and configure systems to fit –Study specific

13. The breadth of integration Example 1: patient enrolment EDC IVR CDMS Safety System CTMS DSMS Patient Enrolment Data for randomisation (eg. stratification variables) Randomisation and Pack Number Randomisation Event Drug supply / re-supply request Drug Shipment Patient Identifiers, demography and visit frequency data Patient Data

14. The breadth of integration Example 2: IVR diary call EDC IVR CDMS Safety System CTMS DSMS Patient completes IVR Diary Diary Data Data validation Drug re-supply request Tracking Primary Efficacy data Safety alerts

15. Common overlap of data IVR CTMS EDC ePRO Randomization Dispensing Site contact details Screening data

16. Integration overview How real-time eClinical integration is achieved at ClinPhone

17. Application- specific message format Application- specific Message format Exporter Importer Transformer IVR / IWR database Application database F I R E W A L L Event XML message Database update F I R E W A L L FTP site FTP site Data interchange overview Application

18. IVR-CTMS Integration EDC IVR CDMS Safety System CTMS DSMS

19. Site de-activation Ethics approval Regulatory approval Patient tracking data Date first drug shipped Site details Delivery addresses Patient number ranges Integration touchpoints: CTMS Site initiation / qualification Site activation FSFV (screening) Randomisation Re-dispensing Withdrawal / completion LSLV Site / study close Study timeline IVR / IWRCTMS

20. IVR–EDC integration EDC IVR CDMS Safety System CTMS DSMS

21. Diary data Withdrawal Subject no. Initials / d.o.b. Stratification data Pack dispensed Integration Touchpoints: EDC Site initiation / qualification Site activation FPFV (screening) Randomization Re-dispensing Withdrawal / completion LPLV Site / study close Study timeline IVR / IWREDC Initial shipment?

22. Case study IVR-EDC integration Procter and Gamble Pharmaceuticals

23. P&GP’s Best Practices entry

24. Case study overview  Two almost identical study protocols –IDDM and NIDDM  Sites –USA only –17 sites  Patients –180 across both studies  IVR application (ClinPhone) –Real-time activities whilst with patient –Randomisation –Medication dispensing –Medication supply chain management –Patient reported outcomes data collection (am and pm diary)  EDC application (Phase Forward’s InForm)

25. Integration objective 1  Manage 6 common data points between systems –Patient demographic information –Date of birth –Initials –Gender –IVR generated data –Randomisation number –Randomisation date –Randomisation time

26. Integration objective 2  Remove duplication in end-user activities –Following randomisation call via IVR –Pass data to InForm –Enrol an new subject within InForm –Populate screening and randomisation eCRFs with IVR delivered data

27. Integration objective 3  Populate eCRFs with patient diary data in real-time –AM fasting blood glucose reading –PM sum of three daily dosing insulin volumes  Eliminate site data entry of paper diary data  Satisfy regulatory requirements for Investigators to take responsibility for diary data –Monitor diary compliance in real-time –Review and report diary data alongside other clinical data

28. P&GP key benefits realised  Site coordinators have less data entry to perform  The P&GP data management group do not have to check for discrepancies between common data points in the IVR and EDC systems  Queries from discrepancies are eliminated –Time and financial benefit for Sponsor and site staff  Patient diary compliance proactively monitored  Investigators have immediate access to diary data via EDC –Regulatory requirements –Improvements in patient care and monitoring  More efficient workflow –May improve database lock time

29. Demonstration movie EDC - IVR integration

30. Integration example  Screening data entered within EDC application  Randomization performed using IWR  Data received by EDC  Patient diary event sent from IVR / IWR to EDC Play movie

31. Summary and conclusions

32. The Future of Clinical Trials  A multitude of eClinical technologies are in use today –All are being used in some trials –Some are tightly integrated with others –Others still used in isolation  Integration can provide powerful Sponsor and site end- user benefits  eClinical Trials of the future? –Evolution … not Revolution –Increased adoption will lead to increased requirement to integrate –Highly integrated “seamless” solutions

33. Clinical Trial Management System Electronic Data Capture System Electronic Data Capture System Drug Supply Chain Management System CTMSIVR/web New study site details Site contact detail amendments Regulatory / ethics approval New patient enrolled / withdrawn/ completed Site medication inventories Patient tracking data EDCIVR/web New patient enrolled New study site Patient withdrawal Patient completion Randomization data Dose adjustment / calculation data Randomization number Medication pack number(s) IVR diary data DSMSIVR/web Dispatch notification Pack list and pack list updates Expiry date updates Shipment requests New study site / details New study site New patient enrolled IVR / web CTMS EDCDSMS Medication pack dispensed IVR central hub of real-time data

34. For more information www.clinphone.com info@clinphone.com