Guidance for Industry

Information Program on
Clinical Trials for Serious or
Life-Threatening Diseases and
Conditions

U.S. Department of Health and Human Services

Food and Drug Administration
Center for Drug Evaluation and Research (CDER)
Center for Biologics Evaluation and Research (CBER)

March 2002
Procedural
Guidance for Industry
Information Program on
Clinical Trials for Serious or
Life-Threatening Diseases and
Conditions
Additional copies are available from:
Office of Training and Communication
Division of Drug Information, HFD-240
Center for Drug Evaluation and Research
Food and Drug Administration
5600 Fishers Lane
Rockville, MD 20857
(Tel) 301-827-4573
http://www.fda.gov/cder/guidance/index.htm

or

Office of Communication, Training and

Manufacturers Assistance, HFM-40
Center for Biologics Evaluation and Research
Food and Drug Administration
1401 Rockville Pike, Rockville, MD 20852-1448
http://www.fda.gov/cber/guidelines.htm.
Fax: 1-888-CBERFAX or 301-827-3844
(Tel) Voice Information System at 800-835-4709 or 301-827-1800

U.S. Department of Health and Human Services

Food and Drug Administration
Center for Drug Evaluation and Research (CDER)
Center for Biologics Evaluation and Research (CBER)
March 2002
Procedural
 TABLE OF CONTENTS

I. INTRODUCTION................................................................................................................. 1
II. BACKGROUND ................................................................................................................... 1
III. STATUTORY REQUIREMENTS FOR IND SPONSORS .............................................. 2
A. What information must I submit to the Clinical Trials Data Bank? ......................................2
B. When should I begin submitting clinical trial information? ..................................................4
C. Can I submit my information at specified intervals rather than on a rolling basis? ..............4
D. What is a trial for a serious or life-threatening disease or condition?....................................4
E. What is a trial to test effectiveness?.......................................................................................5
F. Which trials must be included in the clinical trials data bank? .............................................5
G. Must I include information about foreign trial sites? ............................................................6
IV. IMPLEMENTATION ISSUES............................................................................................ 6
A. How do I submit information to the Clinical Trials Data Bank? ...........................................6
B. What information about trial sites must be included?...........................................................6
C. How long does it take for information to be made available on ClinicalTrials.gov? ...............7
D. How long do studies remain on ClinicalTrials.gov? ...............................................................7
E. Can information be transferred from a sponsor computer to the PRS? ................................7
F. Can intermediaries acting on behalf of a sponsor submit data? ............................................7
G. Can sponsors designate multiple individuals to be data providers?.......................................7
H. What happens to the information submitted to the Clinical Trials Data Bank? ....................7
I. Can I submit other information to the Clinical Trials Data Bank?........................................7
J. Should I continue submitting information to the ACTIS and PDQ databases? .....................8
K. Are there exemptions for submitting Clinical Trials Information? .......................................8
L. Is Institutional Review Board preapproval of the protocol listing required?.........................8
M. Will FDA monitor compliance?.............................................................................................9
 Guidance for Industry1
Information Program on Clinical Trials for Serious or Life-
Threatening Diseases and Conditions

This guidance represents the Food and Drug Administration's (FDA's) current thinking on this topic. It
does not create or confer any rights for or on any person and does not operate to bind FDA or the public.
An alternative approach may be used if such approach satisfies the requirements of the applicable statutes
and regulations.

I. INTRODUCTION

This guidance is intended to assist sponsors who will be submitting information to the Clinical
Trials Data Bank. The data bank was established as required under section 113 of the Food and
Drug Administration Modernization Act of 1997 (Modernization Act). This guidance combines
the statutory and procedural issues discussed in two previously published draft guidances on this
topic. It was finalized after considering comments received on the two draft guidances.

II. BACKGROUND

Section 113 of the Modernization Act creates a public resource for information on studies of
drugs, including biological drug products, to treat serious or life-threatening diseases and
conditions conducted under FDA's investigational new drug (IND) regulations (21 CFR part
312). Section 113 of the Modernization Act, enacted November 21, 1997, amends section 402 of
the Public Health Service Act (42 U.S.C. 282). It directs the Secretary of Health and Human
Services, acting through the Director of NIH, to establish, maintain, and operate a data bank of
information on clinical trials for drugs to treat serious or life-threatening diseases and conditions.

The Clinical Trials Data Bank is intended to be a central resource, providing current information
on clinical trials to individuals with serious or life-threatening diseases or conditions, to other
members of the public, and to health care providers and researchers. Specifically, section 113 of
the Modernization Act requires that the Clinical Trials Data Bank contain (1) information about
Federally and privately funded clinical trials for experimental treatments (drug and biological

1
This guidance has been prepared by the Implementation Team for section 113 of the Food and Drug
Administration Modernization Act of 1997, including individuals from the Office of the Commissioner, the Center
for Drug Evaluation and Research (CDER), the Center for Biologics Evaluation and Research (CBER), and the
Center for Devices and Radiological Health (CDRH), at the Food and Drug Administration.

1
products) for patients with serious or life-threatening diseases or conditions, (2) a description of
the purpose of each experimental drug, (3) patient eligibility criteria, (4) a description of the
location of clinical trial sites, and (5) a point of contact for patients wanting to enroll in the trial.
Section 113 of the Modernization Act requires that information provided through the Clinical
Trials Data Bank be in a form that can be readily understood by the public. 42 U.S.C.
282(j)(3)(A).

The National Institutes of Health (NIH), through its National Library of Medicine (NLM) and
with input from the FDA and others, developed the Clinical Trials Data Bank. The first version
of the Clinical Trials Data Bank was made available to the public on February 29, 2000, on the
Internet. 2 At that time, the data bank included primarily NIH-sponsored trials.

On March 29, 2000, FDA made available in the Federal Register a draft guidance entitled
Information Program on Clinical Trials for Serious or Life-Threatening Diseases:
Establishment of a Data Bank.3 The draft guidance provided recommendations for industry on
the submission of protocol information to the Clinical Trials Data Bank. It included information
about the types of clinical trials for which submissions are required under section 113 of the
Modernization Act, as well as the content of those submissions.

FDA made available a second draft guidance entitled Information Program on Clinical Trials for
Serious or Life-Threatening Diseases: Implementation Plan, in the Federal Register on July 9,
2001.4 The second draft guidance addressed procedural issues, including how to submit required
and voluntary protocol information to the Clinical Trials Data Bank, as well as issues related to
submitting certification to the Secretary that disclosure of information for a particular protocol
would substantially interfere with the timely enrollment of subjects in the clinical investigation.
The second draft guidance also proposed a time frame for submitting the information. This final
guidance combines the two draft guidances into a single guidance.

III. REQUIREMENTS UNDER SECTION 113 OF THE MODERNIZATION ACT

FOR IND SPONSORS

A. What information must I submit to the Clinical Trials Data Bank?

Section 113 of the Modernization Act requires you to submit information to the data bank about
a clinical trial conducted under an investigational new drug (IND) application if it is for a drug to
treat a serious or life-threatening disease or condition and it is a trial to test effectiveness (42
U.S.C. 282(j)(3)(A)). If you wish, you can also provide information on non-effectiveness trials
or for drugs to treat conditions not considered serious or life-threatening.

Section 113 of the Modernization Act requires that you submit a description of the purpose of
each experimental drug, patient eligibility criteria for participation in the trial, a description of
the location of clinical trial sites, and a point of contact for those wanting to enroll in the trial.

2
See http://clinicaltrials.gov
3
See 65 FR 16620 and http://www.fda.gov/cder/guidance/3585dft.htm
4
See 66 FR 35798 and http://www.fda.gov/cder/guidance/4602dft.htm

2
Section 113 requires that the data bank provide this information in a form that can be readily
understood by members of the public (42 U.S.C. 282(j)(3)(A)).

To ensure that information available through the Clinical Trial Data Bank is in a form that is
readily understood, we have established four data elements, which are listed below. The data
elements are made up of the following data fields: (1) descriptive information, (2) recruitment
information, (3) location and contact information, and (4) administrative data. We have
established the Protocol Registration System (PRS), a Web-based data processing program, to
facilitate collection of this information for the data bank. The four data elements, which are
listed below, as well as definitions applicable to the PRS, can be viewed at
http://prsinfo.clinicaltrials.gov/.

1. Descriptive Information

Brief Title (in lay language)

Brief Summary (in lay language)
Study Design/Study Phase/Study Type
Condition or Disease
Intervention

2. Recruitment Information

Study Status Information including

• Overall Study Status (e.g., recruiting, no longer recruiting)
• Individual Site Status
Eligibility Criteria/Gender/Age

3. Location and Contact Information

Location of Trial
Contact information (includes an option to list a central contact person for all trial sites)

4. Administrative Data

Unique Protocol ID Number

Study Sponsor
Verification date

To verify the existence of an IND and to assist in administrative tracking, we ask that you also
include in your submission the IND number and serial number and designate whether the IND is
located in the Center for Drug Evaluation and Research (CDER) or the Center for Biologics
Evaluation and Research (CBER). This administrative information is in a separate data field and
will not be made public.

3
B. When should I begin submitting clinical trial information?

Section 113 of the Modernization Act requires that sponsors submit information no later than 21
days after the trial is opened for enrollment5 (42 U.S.C. 282(j)(3)). Section 113 does not specify
when sponsors must submit information about clinical trials that are existing and ongoing. To
provide a transitional period for sponsors of clinical trials that are currently ongoing and
expected to continue enrolling patients for more than 45 days, we ask that you submit
information within 45 days after this guidance is made available through the Federal Register.
We encourage you to submit information through the PRS for inclusion in the data bank as soon
as possible.6

C. Can I submit my information at specified intervals rather than on a rolling basis?

As discussed above, you must submit information about new protocols open for enrollment
within 21 days after the trial is open for enrollment (42 U.S.C. 282(j)(3)), and we request that
you submit information about existing ongoing trials within 45 days after this guidance is
published. Supplemental information can be submitted at 30-day intervals. Such information
includes amendments to the protocol with respect to one of the data elements, or interruptions,
continuations, or completion of enrollment for a study. Protocol changes related to eligibility or
status information, such as routine opening and closing of trial sites, can be made at 30-day
intervals. FDA strongly encourages you to update information about trials that are unexpectedly
closed (e.g., clinical hold) within 10 days after the closing or sooner if possible.

To ensure that the information available through the data bank is timely and accurate, FDA also
encourages you to review, verify, and update all active protocol records on a semi-annual basis,
at a minimum.

D. What is a trial for a serious or life-threatening disease or condition?

FDA has defined serious and life-threatening diseases and conditions in previous documents.
Most recently, FDA discussed issues related to products intended to treat serious or life-
threatening diseases and conditions in the guidance for industry on Fast Track Drug
Development Programs — Designation, Development, and Application Review (November
1998).7 In that guidance, we stated that all conditions meeting the definition of life-threatening,
as set forth at 21 CFR 312.81(a), would also be serious conditions. The term life-threatening is
defined as (1) diseases or conditions where the likelihood of death is high unless the course of
the disease is interrupted and (2) diseases or conditions with potentially fatal outcomes, where
the endpoint of clinical trial analysis is survival (21 CFR 312.81(a)). All references in this
document to serious diseases or conditions include life-threatening diseases and conditions.

5
Section 113 says "not later than 21 days after the approval of the protocol." Because the Agency does not approve
protocols, we have interpreted this to mean within 21 days after the trial is open for enrollment.
6
See http://prsinfo.clinicaltrials.gov
7
CDER guidances are available at http://www.fda.gov/cder/guidance/index.htm

4
As FDA reiterated in the Fast Track Guidance, the seriousness of a disease is a matter of
judgment, but generally is based on such factors as survival, day-to-day functioning, and the
likelihood that the disease, if left untreated, will progress from a less severe condition to a more
serious one. For example, acquired immunodeficiency syndrome (AIDS), all other stages of
human immunodeficiency virus (HIV) infection, Alzheimer's disease, angina pectoris, heart
failure, cancer, and many other diseases are clearly serious in their full manifestations.
Furthermore, many chronic illnesses that are generally well managed by available therapy can
have serious outcomes. For example, inflammatory bowel disease, asthma, rheumatoid arthritis,
diabetes mellitus, systemic lupus erythematosus, depression, psychoses, and many other diseases
can be serious in some or all of their phases or for certain populations.

Any investigational drug that has received fast track designation would be considered a drug to
treat a serious disease or condition. 8 Information on effectiveness trials for drugs that have
received fast track designation would qualify for submission to the Clinical Trials Data Bank.

E. What is a trial to test effectiveness?

Not all trials carried out under 21 CFR part 312 are trials to test effectiveness. FDA considers all
phase 2, phase 3, and phase 4 trials with efficacy endpoints as trials to test effectiveness.9

F. Which trials are provided to the public through the Clinical Trials Data Bank?

Section 113 of the Modernization Act requires sponsors to submit information about clinical
trials of experimental treatments for serious diseases and conditions when conducted under the
IND regulations. 42 U.S.C. 282(j)(3)(A). Such information can be submitted at any time with
the consent of the protocol sponsor, and must be submitted within 21 days after a trial to test
effectiveness begins. In addition, section 113 of the Modernization Act states that information
on all treatment IND protocols and all Group C protocols10 must be included in the Clinical
Trials Data Bank.

Although it is not specifically discussed in section 113 of the Modernization Act, there are
situations in which there may be a significant number of patients with the disease or condition
for which the drug is being developed who are not adequately treated by existing therapy, who

8
That a drug is intended to treat a serious or life-threatening disease or condition, however, does not mean that it
fills an unmet medical need and qualifies for fast track designation under section 506 of the Food Drug and
CosmeticAct (21 U.S.C. 356).
9
Listing a trial in the Clinical Trials Data Bank is not a guarantee that the trial design is considered adequate to
support approval of a drug, nor does it reflect any judgment on the conduct, analysis, or outcome of the study.
10
"Group C protocols" refers to investigational drugs designated by FDA for the treatment of specific cancers.
These drugs have reproducible efficacy in one or more specific tumor types. Such a drug has altered or is likely to
alter the pattern of treatment of disease and can be safely administered by properly trained physicians without
specialized supportive care facilities. See National Cancer Institute Handbook for Investigators, Appendix XV,
"Policy for Group C Drug Distribution,"
http://ctep.info.nih.gov/HandbookText/Appendix_XV.htm#Proc_Mgmt_GrpC_Prot.

5
do not meet the eligibility criteria for enrollment, or who are otherwise unable to participate in a
controlled clinical study. In these situations, sponsors may have initiated one or more expanded
access protocols that include such patients. In such cases, FDA strongly recommends that
sponsors also consider submitting information to the Clinical Trials Data Bank about the
availability of any expanded access protocol for treatment use in addition to required
submissions.

For protocols not specifically mentioned above, sponsors should review each protocol submitted
to an IND to determine if the protocol is for a serious disease or condition and if it is a trial to
test effectiveness. If the protocol meets these criteria, the sponsor must submit information about
the trial to the Clinical Trials Data Bank, unless the sponsor provides detailed certification to
FDA that such a disclosure would substantially interfere with the timely enrollment of subjects in
the investigation (42 U.S.C. 282(j)(3) and (j)(4)). Sponsors with questions on whether protocols
meet the criteria for submission to the Clinical Trials Data Bank are encouraged to contact the
appropriate review division for additional guidance.

G. Must I include information about foreign trial sites?

Yes, you must include information about foreign trials when those trials are conducted under an
IND submitted to FDA and the trial meets the criteria for submission to the Clinical Trials Data
Bank. Section 113 of the Modernization Act requires sponsors to submit information about
specified clinical trials that are "under regulations promulgated pursuant to section 505(i) of the
Federal Food, Drug, and Cosmetic Act," which are FDA's IND regulations (42 U.S.C. 282(j)(3)).
Sponsors may voluntarily conduct a foreign trial under the IND regulations. Sponsors are not
required to submit information to the Clinical Trials Data Bank when a foreign trial is not
conducted under an IND.

IV. IMPLEMENTATION ISSUES

A. How do I submit information to the Clinical Trials Data Bank?

To facilitate the submission process, we have established the Web-based PRS at

ClinicalTrials.gov. The system allows for entry of required and voluntary information about
clinical trials. You or your designee can initiate submission of clinical trial information to
ClinicalTrials.gov by completing a registration form at http://prsinfo.clinicaltrials.gov/.

After you have entered the data, the PRS generates a receipt for use by sponsors. An electronic
copy of the receipt will be sent to the FDA.

B. What information about trial sites must be included?

Section 113 of the Modernization Act requires sponsors to submit a description of the location of
trial sites and a point of contact. To ensure an adequate description, we recommend that you
provide for each individual trial site the full name of the organization, city, state, postal code, and

6
country where the protocol is being conducted; and a central contact name and phone number.
You can also provide the names and phone numbers of individual site contacts.

C. How long does it take for information to be made available on ClinicalTrials.gov?

Studies will be made available to the public through ClinicalTrials.gov within two to five days
after submission by the sponsor.

D. How long will information about studies remain available through

ClinicalTrials.gov?

NLM intends to maintain the Data Bank as a long-term registry of clinical trials. Therefore, in
addition to information about open trials, information about closed trials will also be available
through ClinicalTrials.gov, even after accrual and analysis are completed and the product is
approved.

E. Can information be transferred from a sponsor computer to the PRS?

Yes. Information can be transferred according to the format specified by the PRS. The PRS has
a mechanism for uploading and downloading XML-formatted protocol records. Instructions for
transferring information are provided at http://prsinfo.clinicaltrials.gov/

F. Can intermediaries acting on behalf of a sponsor submit data?

Yes. For example, in some cases a sponsor might want to contract with an information
management company to serve as an intermediary in preparing data for inclusion in
ClinicalTrials.gov. The information management company, when authorized by the sponsor,
could act on behalf of the sponsor for this purpose.

G. Can sponsors designate multiple individuals to be data providers?

Yes. When sponsors register to become a PRS data provider, they will be given information,
including instructions, for creating additional users for their accounts. A sponsor can control
access to the account by designating users and administrators for the account.

H. What happens to the information submitted to the Clinical Trials Data Bank?

Except for the IND number, serial number, and FDA center designation, all information
submitted through the PRS is made available to the public at http://clinicaltrials.gov.

I. Can I submit other information to the Clinical Trials Data Bank?

Yes. PRS is designed to permit you to submit more detailed information about a protocol.
Additional data fields (e.g., projected enrollment) and their definitions are included in the PRS.
You also can submit protocol information about other clinical trials under IND, including trials
for a disease or condition that is not serious or any trial that is not designed to test effectiveness.

7
Finally, you can submit information about results of a trial. This information, which, according
to the structure of the Clinical Trials Data Bank, must come from the published literature, should
be linked by including the unique MEDLINE identifier for citations of publications.

You can use the link section provided to allow pointers to Web pages directly relevant to the
protocol. If you link to other Web pages from your entries, you should ensure that the links do
not misbrand your products, for example, by promoting the products before the product or an
indication is approved. (See 21 U.S.C. 321(n), 331(a)(b)(c)(d), 352(a)(n)
http://www.fda.gov/opacom/laws/fdcact/fdcact1.htm.) When inputting links to other web pages,
the database will instruct you that the links should be directly relevant to the protocol, and that
you should not link to sites whose primary goal is to advertise or sell commercial products or
services.

J. Should I continue submitting information to the ACTIS and PDQ databases?

No. All information for AIDS and cancer protocols that meet the requirements of section 113 of
the Modernization Act must now be submitted to ClinicalTrials.gov through the PRS. Data from
the current AIDS Clinical Trials Information System (ACTIS) and Physician’s Data Query
(PDQ) databases are included in ClinicalTrials.gov. Information from the Rare Diseases and
National Institute of Aging Databases is also included in ClinicalTrials.gov.

K. Are there exemptions for submitting clinical trials information?

Information about an investigation will not be included in the data bank if you provide a detailed
certification to the Secretary of Health and Human Services that disclosure of such information
would substantially interfere with timely enrollment of subjects in the clinical trial and the
Secretary does not disagree. If there is disagreement, the Secretary will provide a detailed
written determination that such disclosure would not substantially interfere with such enrollment
(42 U.S.C. 282(j)(4)).

FDA has not identified specific instances when disclosure of information would substantially
interfere with enrollment of subjects in a clinical investigation. We solicited comments on this
topic for the purpose of including a listing of acceptable reasons for certification in the final
guidance. We received no comments. Therefore, if you identify a specific instance when
disclosure of information would interfere with enrollment of subjects in a clinical investigation,
FDA will consider your request on a case-by-case-basis.

All requests for exemption should be forwarded to Director, Office of Special Health Issues,
Office of Communications and Constituent Relations, Office of the Commissioner, HF-12, 5600
Fishers Lane Rockville, MD 20857, or by email at [email protected], or by fax at 301-443-
4555.

L. Is Institutional Review Board preapproval of the protocol listing required?

No. Section 113 of the Modernization Act does not require prior IRB approval when submitting
this information to the Clinical Trials Data Bank. Current FDA guidance recommends that IRB

8
review of listings need not occur when, as here, the system format limits the information
provided to basic information, such as title, purpose of the study, protocol
summary, basic eligibility criteria, study site locations, and how to contact the site for further
information. 11

M. Will FDA monitor compliance?

A copy of the protocol listing in ClinicalTrials.gov will be sent to the FDA. FDA’s Office of
Special Health Issues intends to initiate a one-year pilot educational program in 2002 that will
include a component to evaluate compliance. The primary objective of the pilot program is to
educate sponsors about the existence of the guidance document and the availability of the online
PRS data entry tool. The secondary objective of the pilot program is to evaluate the success of
the educational initiative. The pilot, which will measure the number of protocols (voluntary and
required) made available through the ClinicalTrials.gov database, will provide FDA with
compliance information.

11
The 1998 update of Information Sheets: Guidance for Institutional Review Boards and Clinical Investigators
provides guidance on IRB review and approval of listings of clinical trials on the Internet. See
http://www.fda.gov/oc/ohrt/irbs/toc4.html#recruiting.