The clinical research landscape is poised for a significant transformation with the FDA's impending regulation mandating the use of a single, centralized institutional review board (sIRB) for multisite trials. Expected by May 2025, this mandate marks a departure from the traditional decentralized model, potentially streamlining study timelines and offering sponsors greater control over the IRB selection process.
Streamlining Trial Timelines and Reducing Redundancies
The sIRB mandate is expected to transfer the authority to select the IRB from individual sites to the sponsors, who will likely have the final say in choosing the IRB-of-record. This shift aims to reduce administrative burdens and eliminate the disparate feedback often received from multiple local IRBs, which can extend study timelines. According to the NIH, in one multisite trial of an influenza vaccine, the sIRB model demonstrated substantially faster approval times, averaging 81 days compared to 121 days with local IRBs. Time to first enrollment was also reduced (126 vs. 149 days).
Opportunity to Reassess Trial Site Partners
Beyond streamlining the IRB process, the sIRB mandate presents sponsors with a valuable opportunity to reassess their trial site partners. With increased leverage, sponsors can now analyze site performance based on standardized indicators such as study startup time, enrollment diversity, and participant retention rates, rather than relying solely on reputation or less quantifiable criteria.
Aaron Sanford, senior director, study start up at Linical, a global CRO for full-service drug development, noted, "Organizations naturally tend to work with the same, familiar trial sites that they have had historically positive experiences with over time. However, working with the ‘same old same old’ could cause companies to inadvertently miss out on opportunities to improve trial operational performance, patient recruitment success and speed, patient population representation (diversity), and efficiency."
Key Characteristics of Efficient Trial Sites
Advarra's benchmarking data highlights several characteristics of the most efficient and effective sites from an sIRB review perspective. These include:
- Disentangling local institution administrative reviews from IRB review.
- Simple processes for local review/approvals before sIRB submission.
- Acceptance of the study-level template language for informed consent forms.
- Streamlined communication between local administration and the sIRB.
- Integration of local systems with the sIRB's technology.
Conversely, less efficient sites often conduct "shadow IRB reviews," pause the sIRB review process for internal administrative activities, have lengthy budget and contract negotiations, require IRB reliance agreements per study, and submit institution-specific consent language without prior sponsor approval.
Turning Change into Opportunity
James Riddle, senior vice president of global review operations at Advarra, emphasizes that the sIRB mandate will create newfound transparency in institutional processes. By separating traditional IRB review processes from site activation processes, sponsors can more accurately evaluate each on their own. While the transition to an sIRB model may present challenges, it ultimately offers a significant opportunity to improve clinical trial efficiency across the enterprise portfolio.
