The U.S. clinical research landscape is poised for a significant transformation as the Food and Drug Administration prepares to mandate single Institutional Review Board (sIRB) reviews for most multisite clinical trials by the end of 2024. This development follows the path set by the National Institutes of Health in 2018 and the Federal Policy for the Protection of Human Subjects in 2020, which established sIRB requirements for federally funded research.
Demonstrated Benefits of Centralized Review
The transition to sIRB has already shown remarkable efficiency gains in clinical trial operations. In a recent multisite influenza vaccine trial, the NIH documented substantial improvements in review timelines - mean time to approval decreased from 121 to 81 days under the sIRB model. Time to first enrollment also improved, dropping to 126 days compared to traditional local IRB averages of 169 days.
These accelerated timelines are particularly significant given the increasing complexity of modern clinical trials, which have seen a 6% rise in average trial endpoints since 2003. The streamlined approach not only reduces administrative burden but also ensures consistent study conduct and patient information across all trial sites.
Industry Perspective and Implementation
Dr. Christina Brennan, Senior Vice President of Clinical Research at Northwell Health, offers insights from extensive experience with the sIRB model: "I think the mandate is great – and it's a long time coming, giving sponsors the ability to know what's going on in their trial in real time and bringing efficiencies in study start-up and turnaround times."
Northwell Health, which manages approximately 1,000 active clinical trials annually with 500 clinical investigators, has successfully utilized the sIRB approach for over a decade. Their experience demonstrates that the model particularly benefits high-volume research institutions by allowing local IRBs to focus on investigator-initiated trials and academic activities.
Key Operational Advantages
The sIRB model's benefits extend throughout the entire trial lifecycle, particularly in managing protocol amendments and safety reporting. "Protocol amendments are very common, so one IRB facilitating everything for all the sites in the trial will help tremendously," explains Dr. Brennan. "When safety is being reported to the one IRB, then they have that knowledge in one location in real-time – and knowing is everything."
Strategic Implementation Guidelines
For successful implementation, sponsors should focus on three key areas:
- IRB Selection Standards
- Require AAHRPP accreditation
- Verify experience with multisite trials
- Ensure therapeutic area expertise
- Confirm experience with academic medical centers
- Workflow Alignment
- Establish direct communication between sites and sIRBs
- Review existing service contracts and reliance agreements
- Standardize informed consent language requirements
- Implement clear communication protocols
- Performance Monitoring
- Evaluate site performance using standardized metrics
- Track study start-up efficiency
- Monitor enrollment diversity
- Assess participant retention rates
The shift to sIRB represents a significant evolution in clinical research oversight, promising to accelerate the development of new treatments while maintaining rigorous safety and ethical standards. As Dr. Brennan notes, this change creates a "win-win" situation, benefiting researchers, sponsors, and most importantly, patients awaiting new therapeutic options.
