Clinical trials in human medicines
The European Medicines Agency (EMA) relies on the results of clinical trials carried out by pharmaceutical companies to reach its opinions on the authorisation of medicines. Although the authorisation of clinical trials occurs at national level, EMA plays a key role in ensuring the standards of good clinical practice (GCP) are applied across the European Economic Area (EEA) in cooperation with the Member States. It also manages a database of clinical trials carried out in the European Union (EU).
Clinical trial management during the COVID-19 pandemic
This covers how to deal with the extraordinary situations that the pandemic presents and specific advice on clinical trials for potential COVID-19 treatments.
Guidance is also available on the actions that sponsors of affacted clinical trials should take to help ensure the integrity of their studies and the interpretation of the study results while safeguarding the safety of trial participants as a first priority:
Clinical trials are studies intended to discover or verify the effects of one or more investigational medicines.
Regardless of where they are conducted, all clinical trials included in applications for marketing authorisation for human medicines in the EEA must have been carried out in accordance with the requirements set out in Annex 1 of Directive 2001/83/EC. This means that:
- clinical trials conducted in the EEA have to comply with EU clinical trial legislation (Directive 2001/20/EC);
- clinical trials conducted outside the EEA have to comply with ethical principles equivalent to those set out in the EEA, including adhering to international good clinical practice and the Declaration of Helsinki.
In the EEA, approximately 4,000 clinical trials are authorised each year. This equals approximately 8,000 clinical-trial applications, with each trial involving two Member States on average.
Approximately 61% of clinical trials are sponsored by the pharmaceutical industry and 39% by non-commercial sponsors, mainly academia.
EMA's Committee for Medicinal Products for Human Use (CHMP) is responsible for conducting the assessment of a human medicine for which an EU-wide marketing authorisation is sought. As part of its scientific evaluation work, the CHMP reviews the clinical trial data included in the application.
Clinical trial data is included in clinical-study reports that form a large part of the application dossiers submitted by pharmaceutical companies applying for a marketing authorisation via the Agency.
Assessments are based on purely scientific criteria and determine whether or not the medicines concerned meet the necessary quality, safety and efficacy requirements in accordance with EU legislation, particularly Directive 2001/83/EC.
EMA is responsible for the development, maintenance and coordination of the European Union Drug Regulating Authorities Clinical Trials (EudraCT) database.
A subset of this data is made available through the European Union Clinical Trials Register, which the Agency manages on behalf of EU Member States. Users are able to view:
- the description of phase-II to phase-IV adult clinical trials where the investigator sites are in the EEA;
- the description of any clinical trials in children with investigator sites in the EU and any trials that form part of a PIP including those where the investigator sites are outside the EU.
A European Commission guideline and in its technical guidance determine the content and level of detail of these summary results. A typical set of summary results provides information on the objectives of a given study, explains how it was designed and gives its main results and conclusions.
In July 2019, EMA published a letter co-signed by the European Commission and the Heads of Medicines Agencies (HMA) reminding all sponsors of clinical trials conducted in the EU of their obligation to make the summary results of concluded trials publicly available in the EudraCT database:
- Joint letter by the European Commission, EMA and HMA to stakeholders regarding the requirements to provide results for authorised clinical trials in EudraCT
From October 2020, sponsors can post the results in the EudraCT database from clinical trials that ended prematurely, whether they were approved but never started or started but terminated early. Sponsors should provide the reasons and any partial results, if available. For more information, see the EudraCT database website.
The Agency has a separate policy on the publication of clinical reports submitted by pharmaceutical companies to support their regulatory applications for human medicines. For more information, see Clinical data publication.
Clinical trials conducted outside the EU but submitted in an application for marketing authorisation in the EU have to follow the principles which are equivalent to the provisions of the Directive 2001/20/EC.
In 2012, the Agency published the final version of this paper:
- Reflection paper on ethical and GCP aspects of clinical trials of medicinal products for human use conducted outside of the EU / EEA and submitted in marketing-authorisation applications to the EU regulatory authorities .
This paper aims to strengthen existing processes to provide assurance that clinical trials meet the required ethical and GCP standards, no matter where in the world they have been conducted.
On 16 April 2014 the European Commission adopted the new Clinical Trial Regulation (EU No 536/2014), repealing Directive 2001/20/EC.
Although the Clinical Trial Regulation was adopted and entered into force in 2014, the timing of its application depends on confirmation of full functionality of Clinical Trials Information System (CTIS) through an independent audit.
The Regulation becomes applicable six months after the European Commission publishes notice of this confirmation.
For more information, see Clinical Trial Regulation.
- acts as forum for discussion to agree on common principles and processes to be applied throughout the European medicines regulatory network;
- promotes harmonisation of clinical trial assessment decisions and administrative processes by national competent authorities;
- operates the voluntary harmonisation procedure for assessment of clinical-trial applications involving several Member States.