The U.S. Food and Drug Administration has released a comprehensive white paper detailing its regulatory framework for selective safety data collection (SSDC) in late-stage clinical trials, offering pharmaceutical companies a pathway to streamline safety monitoring for drugs with well-established safety profiles.
The document from the FDA's Center for Clinical Trial Innovation provides an overview of the agency's approach to collecting safety data throughout clinical development, specifically addressing scenarios where continued collection of routine safety information may not yield clinically meaningful insights.
Framework Definition and Scope
Selective Safety Data Collection refers to "a planned reduction in the collection of certain types of data in a clinical investigation for drugs with a well-characterized safety profile and for which the continued collection of common, non-serious adverse events or routine laboratory assessments is unlikely to provide additional knowledge of clinical importance," according to the FDA's definition.
The approach targets late-stage pre-marketing and post-approval trials for drugs where safety profiles regarding commonly occurring adverse events are well understood and documented. Eligible trial types include studies for approved drugs seeking new indications in similar populations, label expansion trials for additional endpoints in the same patient population, and safety trials investigating specific safety concerns.
Regulatory Evolution and Implementation
The SSDC framework has evolved significantly over the past two decades. The FDA first discussed data reduction possibilities for cancer drugs in 2001, followed by formal guidance in February 2016 titled "Determining the Extent of Safety Data Collection Needed in Late-Stage Premarket and Postapproval Clinical Investigations."
International harmonization occurred through the International Council for Harmonisation (ICH), which formed the E19 Expert Work Group in 2017. The ICH E19 guidance was finalized in September 2022 as "A Selective Approach to Safety Data Collection in Specific Late-Stage Pre-Approval or Post-Approval Clinical Trials," with FDA implementation following in December 2022.
Clinical Implementation Examples
The white paper provides detailed case studies demonstrating successful SSDC implementation across therapeutic areas. The Pragmatica-Lung Study (NCT05633602) compared overall survival in previously treated non-small cell lung cancer patients, limiting safety collection to grade 3+ severity adverse events and fatalities only, based on the well-established safety profiles of pembrolizumab and ramucirumab.
The VICTORION-2-PREVENT study (NCT05030428) achieved dramatic reductions in monitoring requirements, reducing visit frequency from monthly-quarterly standard to every 6 months. The study streamlined assessments by requiring vital signs only at screening versus all visits, eliminating scheduled ECGs, and conducting laboratory assessments at screening only rather than at all visits.
EMPA-KIDNEY and EMPACT-MI studies further demonstrated the approach's versatility. EMPACT-MI implemented the most streamlined approach with only one visit at 2 weeks post-randomization, followed by remote follow-ups every 6 months, while limiting adverse event collection to serious adverse events, adverse events of special interest, and those leading to treatment discontinuation.
Safety Guardrails and Limitations
The framework maintains critical safety requirements despite data reduction. The approach does not eliminate data necessary for participant safety, does not reduce comprehensive baseline assessments, and requires continued collection of serious adverse events and adverse events resulting in study drug discontinuation. Local and regional safety reporting requirements remain unchanged.
Stakeholder Benefits
The white paper outlines benefits across multiple stakeholders. For study participants, the approach reduces participation burden through fewer blood draws, laboratory tests, and visits, potentially leading to higher enrollment and retention rates. Investigators benefit from simpler protocols and better focus on relevant study objectives, while sponsors experience lower costs and clearer incentives for conducting adequate and well-controlled studies.
Despite international regulatory harmonization and compelling real-world success stories spanning oncology to cardiovascular medicine, the white paper notes that adoption of SSDC remains surprisingly limited, representing untapped potential for pharmaceutical development efficiency.
