Practical implications of the new ICH Individual Case Safety Report (ICSR) standard. Alastair Fowkes

Transcription

1 Practical implications of the new ICH Individual Case Safety Report (ICSR) standard Alastair Fowkes

2 Acknowledgement This presentation is largely based on a comparison of the (R2) and (R3) versions of the ICH ICSR standard originally developed by Gaby Danan and Anja van Haren

3 In this presentation Introduction Element numbering Unknown Message Header changes Differences by E2B Section: - A.1 Identification of the Primary Source Section - A.2 Primary Source(s) of information - A.4 Literature Reference(s) - A.5 Study Identification - B.1 Patient characteristics - B.2 Reaction(s)/Events(s) - B.3 Lab tests - B.4 Drug information - B.5 Case narrative & further information A note on Backwards / Forwards compatibility

4 Introduction Key differences between new ISO ICSR standard and the ICH E2B(R2) guideline Examples of changes: Fields removed/updated (size increased, new codes) Some previously non-repeating fields have become repeatable New concepts are introduced, by: - adding new fields - using existing fields, but allow new values

5 Introduction Key differences between new ISO ICSR standard and the ICH E2B(R2) guideline Examples of changes: Fields removed/updated (size increased, new codes) Some previously non-repeating fields have become repeatable New concepts are introduced, by: - adding new fields - using existing fields, but allow new values

6 Element numbering This presentation uses the existing (R2) element numbers and (R3) element numbers as published in the Step 2 Implementation Guide v3.01 However At Step 4 the numbering will be revised To avoid confusion it is proposed that no number will exist in both (R2) and (R3) therefore the (R3) references in this presentation will change in the future

7 Unknown HL7 supports a variety of possibilities to indicate that information is not available (null flavours) Unknown may be a code (Action taken with drug) NI = no information MSK = information available but withheld OTH = value is available but is not included in the ICH code list UNK = unknown NA = not applicable ASKU = requested but not provided (by reporter) NASK = not asked Not all null flavours are available for every element

8 Message header changes HL7 messages will be sent as a batch Each batch has a header Each ICSR in the batch is its own message with its own message header (wrapper) M.1 ICH ICSR Batch Header 1 1 M.1.1 Type of Messages in Batch M.1.4 Batch Number M.1.5 Batch Sender Identifier M.1.6 Batch Receiver Identifier M.1.7 Date of Batch Transmission M.1 ICH ICSR Batch Header M.2 ICH ICSR Message Header 1 n M.2.r.4 Message Number M.2.r.5 Message Sender Identifier M.2.r.6 Message Receiver Identifier M.2.r.7 Date of Message Transmission

9 ICH E2B(R3) ENTITY RELATIONSHIP DIAGRAM ICH ICSR Diagram E2B(R3) The ICH ICSR A.5.1 Study Registration A.2.r Primary source(s) of information A.3 Sender of Case Safety Report A.4.r Literature reference(s) A.5 Study Identification A.1 Identification of the Case Safety Report A.1.8 Additional Documents A.1.11 Other Case IDs Previous Transmission A.1.12 Linked Reports B.1.2 Age Information B r Structure Information Medical History B.1.8.r Relevant Past Drug History B r Reported Cause(s) of Death B.5.1 Case Narrative B.5.3.r Sender s Diagnosis / Reclassification B.5.5 Case Summary & Reporter s Comments B.2.i Reaction(s) / Event(s) B.3.r Results of tests and procedures B.5 Case Narrative B.4.k Drug information B.4.k.10 Additional Information on Drug (coded) B.1 Patient characteristics B.4.k.1 Characterization of Drug Role B.4.k.2 Drug Identification B.1.9 In Case of Death B.1.10 Information Concerning Parent B.4.k.2.1 MPID or PhPID B.4.k.2.2 Medicinal Product Name Primary Source B r Autopsy-Determined Cause(s) of Death B r Structured Information (Parent) B r Relevant Past Drug History (Parent) B.4.k.11 Additional Information on Drug (free text) B.4.k.3 Holder & Authorisation/ Application Number B.4.k.4.r Dosage Information B.4.k.5 Cumulative Dose to the Reaction / Event B.4.k.6 Gestation Period at Time of Exposure B.4.k.2.3.r Substance(s) B.4.k.2.4 Country Where Drug Obtained B.4.k.2.5 Investigational Product Status Legend 1 to Many (1...n) Mandatory B.4.k.7.r Indication for Use in the Case B.4.k.8 Action Taken with Drug 1 to 1 Mandatory 1 to Many (0...n) Optional 1 to 1 (0...1) Optional B.4.k.9.i Drug Reaction / Event Matrix B.4.k.9.i.2.r Relatedness of Drug

10 Section A.1 ICH ICSR Diagram E2B(R3) The ICH ICSR A.5.1 Study Registration A.2.r Primary source(s) of information A.3 Sender of Case Safety Report A.4.r Literature reference(s) A.5 Study Identification A.1 Identification of the Case Safety Report A.1.8 Additional Documents A.1.11 Other Case IDs Previous Transmission A.1.12 Linked Reports B.1.2 Age Information B r Structure Information Medical History B.1.8.r Relevant Past Drug History B r Reported Cause(s) of Death B.5.1 Case Narrative B.5.3.r Sender s Diagnosis / Reclassification B.5.5 Case Summary & Reporter s Comments B.2.i Reaction(s) / Event(s) B.3.r Results of tests and procedures B.5 Case Narrative B.4.k Drug information B.4.k.10 Additional Information on Drug (coded) B.1 Patient characteristics B.4.k.1 Characterization of Drug Role B.4.k.2 Drug Identification B.1.9 In Case of Death B.1.10 Information Concerning Parent B.4.k.2.1 MPID or PhPID B.4.k.2.2 Medicinal Product Name Primary Source B r Autopsy-Determined Cause(s) of Death B r Structured Information (Parent) B r Relevant Past Drug History (Parent) B.4.k.11 Additional Information on Drug (free text) B.4.k.3 Holder & Authorisation/ Application Number B.4.k.4.r Dosage Information B.4.k.5 Cumulative Dose to the Reaction / Event B.4.k.6 Gestation Period at Time of Exposure B.4.k.2.3.r Substance(s) B.4.k.2.4 Country Where Drug Obtained B.4.k.2.5 Investigational Product Status Legend 1 to Many (1...n) Mandatory B.4.k.7.r Indication for Use in the Case B.4.k.8 Action Taken with Drug 1 to 1 Mandatory 1 to Many (0...n) Optional 1 to 1 (0...1) Optional B.4.k.9.i Drug Reaction / Event Matrix B.4.k.9.i.2.r Relatedness of Drug

11 Identification of the case safety report 1 1 A.1 Identification of the case safety report A.1 Identification of the case safety report A Sender s (Case) Safety Report Unique Identifier A.1.3 Date of this transmission A.1.4 Type of report A.1.6 Date report was first received from source A.1.7 Date of the most recent receipt information for this report A Are Additional Documents Available? A.1.9 Does this case fulfil the local criteria of an expedited report? A Worldwide unique case identification number A First sender of this case A.1.11 Other Case Identifiers in Previous Transmission A.1.13 Report nullification/amendment A Reason for nullification/amendment 0 n A.1.8 Additional Available Documents Held by Sender A r.1 Documents Held by Sender A r.2 Included Documents 0 n A.1.11 Other Case Identifiers in Previous Transmission A.1.11.r.1 Source(s) of the case identifier A.1.11.r.2 Case Identifier 0 n A.1.12 Identification Number of the Report Which is Linked to this Report A.1.12.r Identification Number of the Report Which is Linked to this Report

12 Fields deleted from Section A.1 Field deleted from A.1 but equivalent concept captured elsewhere (R2) A.1.1 identification of country of primary source (R3) A.2.r.1.3 Reporter s country code (R3) A.2.r.1.5 Primary source for regulatory purposes (new field!) Set to true for one (and only one) primary source

13 Fields deleted from Section A.1 Field deleted from A.1 but equivalent concept captured elsewhere (R2) A.1.2 Identification of the country where the reaction/event occurred (R3) B.2.i.8 moved to reaction/event level

14 Fields deleted from Section A.1 Field deleted from A.1 but equivalent concept captured elsewhere (R2) A Seriousness and serious criteria Moved to reaction/event level (R3) B.2.i.2.2

15 Fields deleted from Section A.1 Field deleted from A.1 but equivalent concept captured elsewhere (R2) A.1.14 Was the case medically confirmed if not initially reported from health professional? Moved to reaction/event level (R3) B.2.i.7

16 Repeatable: A Field A List of documents held by Sender becomes repeatable in R3: to allow each document to be listed individually field name updated to reflect this change: List of Documents held by Sender

17 Worldwide Case ID (R2) A or A (R3) A worldwide case id Plus A flag to indicate first sender: regulator or other

18 New concept: amendment New concept of amendment added by changing field (R2) A.1.13: (R2) 1 = Yes Report Nullification to Report Nullification/Amendment (R3) (R3) 1 = Nullification; 2 = Amendment change also reflected in field A where reason is provided: Reason for nullification/amendment

19 Use of amendment Use of field A.1.13 for Amendment: When after internal review some information has been modified or corrected Do not change A.1.7: Date of receipt of most recent information of this case

20 Attachments (R3) supports submission of attachment files within the ICSR message (e.g. PDF of copies of literature articles, copies of test results) Send full ICSR when attachment is submitted in follow up message: set field A.1.13 Report nullification/amendment to 2 (=amendment) provide reason (e.g. literature) in field A Document list in A r.1 Documents in A r.2 No need to send separate s File types supported will be specified regionally

21 A.2 Primary Source(s) of information ICH ICSR Diagram E2B(R3) The ICH ICSR A.5.1 Study Registration A.2.r Primary source(s) of information A.3 Sender of Case Safety Report A.4.r Literature reference(s) A.5 Study Identification A.1 Identification of the Case Safety Report A.1.8 Additional Documents A.1.11 Other Case IDs Previous Transmission A.1.12 Linked Reports B.1.2 Age Information B r Structure Information Medical History B.1.8.r Relevant Past Drug History B r Reported Cause(s) of Death B.5.1 Case Narrative B.5.3.r Sender s Diagnosis / Reclassification B.5.5 Case Summary & Reporter s Comments B.2.i Reaction(s) / Event(s) B.3.r Results of tests and procedures B.5 Case Narrative B.4.k Drug information B.4.k.10 Additional Information on Drug (coded) B.1 Patient characteristics B.4.k.1 Characterization of Drug Role B.4.k.2 Drug Identification B.1.9 In Case of Death B.1.10 Information Concerning Parent B.4.k.2.1 MPID or PhPID B.4.k.2.2 Medicinal Product Name Primary Source B r Autopsy-Determined Cause(s) of Death B r Structured Information (Parent) B r Relevant Past Drug History (Parent) B.4.k.11 Additional Information on Drug (free text) B.4.k.3 Holder & Authorisation/ Application Number B.4.k.4.r Dosage Information B.4.k.5 Cumulative Dose to the Reaction / Event B.4.k.6 Gestation Period at Time of Exposure B.4.k.2.3.r Substance(s) B.4.k.2.4 Country Where Drug Obtained B.4.k.2.5 Investigational Product Status Legend 1 to Many (1...n) Mandatory B.4.k.7.r Indication for Use in the Case B.4.k.8 Action Taken with Drug 1 to 1 Mandatory 1 to Many (0...n) Optional 1 to 1 (0...1) Optional B.4.k.9.i Drug Reaction / Event Matrix B.4.k.9.i.2.r Relatedness of Drug

22 Primary source(s) of information 1 n A.2 Primary source(s) of information A.2.r.1 Primary Source A.2.r.1.1a Reporter s Title A.2.r.1.1b Reporter s Given Name A.2.r.1.1c Reporter s Middle Name A.2.r.1.1d Reporter s Family Name A.2.r.1.2a Reporter s Organisation A.2.r.1.2b Reporter s Department A.2.r.1.2c Reporter s Street Address A.2.r.1.2d Reporter s City A.2.r.1.2e Reporter s State or Province A.2.r.1.2f Reporter s Postcode A.2.r.1.2g Reporter s Telephone A.2.r.1.3 Reporter s Country Code A.2.r.1.4 Qualification A.2.r.1.5 Primary source for regulatory purposes

23 Fields deleted from A.2 Field deleted from A.2 but moved elsewhere (R2) A.2.2 literature reference (R3) A.4 new repeatable section A.4.r.1 literature reference A.4.r.2 included document allowed file types will be defined regionally

24 A.4 Literature references Repeatable: - to allow each reference to be listed individually User guidance updated: - to reflect that this field should not provide articles used for data analysis References must still be provided in Vancouver Style

25 Fields deleted from A.2 A.2.2 Study identification Study name, Sponsor study number, Study type Moved to new Section (A.5) Existing fields retained, new fields added But note that Study name is now 2000AN (previously 100AN)

26 A.5 Study Fields A.5.1 Study registration A.5.1.r.1 Study registration number Number assigned in a region / country A.5.1.r.2 Study registration country Country / region that assigned the number

27 Study example A.5.2 Study name (full name can be transmitted) A.5.3 Sponsor study number A.5.4 Study type Field First iteration Second iteration Study registration number GB-20179AB/ Study registration country GB EU Note that EU will be a permitted country code

28 New field: Primary source for regulatory purposes New field A.2.r.1.5 Primary source for regulatory purposes - the country of the person who first reports the facts to the sender - only one primary source should be flagged as true (yes) => Usually this field will be used for distribution rules for deciding to which national authority ICSR should be sent

29 Changes to (R2) A3 Holds Sender information as currently Existing Receiver information fields (R2) A.3.2 are removed

30 Section B.1 Patient Characteristics ICH ICSR Diagram E2B(R3) The ICH ICSR A.5.1 Study Registration A.2.r Primary source(s) of information A.3 Sender of Case Safety Report A.4.r Literature reference(s) A.5 Study Identification A.1 Identification of the Case Safety Report A.1.8 Additional Documents A.1.11 Other Case IDs Previous Transmission A.1.12 Linked Reports B.1.2 Age Information B r Structure Information Medical History B.1.8.r Relevant Past Drug History B r Reported Cause(s) of Death B.5.1 Case Narrative B.5.3.r Sender s Diagnosis / Reclassification B.5.5 Case Summary & Reporter s Comments B.2.i Reaction(s) / Event(s) B.3.r Results of tests and procedures B.5 Case Narrative B.4.k Drug information B.4.k.10 Additional Information on Drug (coded) B.1 Patient characteristics B.4.k.1 Characterization of Drug Role B.4.k.2 Drug Identification B.1.9 In Case of Death B.1.10 Information Concerning Parent B.4.k.2.1 MPID or PhPID B.4.k.2.2 Medicinal Product Name Primary Source B r Autopsy-Determined Cause(s) of Death B r Structured Information (Parent) B r Relevant Past Drug History (Parent) B.4.k.11 Additional Information on Drug (free text) B.4.k.3 Holder & Authorisation/ Application Number B.4.k.4.r Dosage Information B.4.k.5 Cumulative Dose to the Reaction / Event B.4.k.6 Gestation Period at Time of Exposure B.4.k.2.3.r Substance(s) B.4.k.2.4 Country Where Drug Obtained B.4.k.2.5 Investigational Product Status Legend 1 to Many (1...n) Mandatory B.4.k.7.r Indication for Use in the Case B.4.k.8 Action Taken with Drug 1 to 1 Mandatory 1 to Many (0...n) Optional 1 to 1 (0...1) Optional B.4.k.9.i Drug Reaction / Event Matrix B.4.k.9.i.2.r Relatedness of Drug

31 B.1 - Patient Characteristics B B.1 - Patient Characteristics B.1.1 Patient (name or initials) B.1.1.1a Patient Medical Record Number(s) and the Source(s) of the Record Number (GP Medical Record Number) B.1.1.1b Patient Medical Record Number(s) and the Source(s) of the Record Number (Specialist Record Number) B.1.1.1c Patient Medical Record Number(s) and the Source(s) of the Record Number (Hospital Record Number) B.1.1.1d Patient Medical Record Number(s) and the Source(s) of the Record Number (Investigation Number) B.1.3 Body Weight (kg) B.1.4 Height (cm) B.1.5 Sex B.1.6 Last Menstrual Period Date B Text for Relevant Medical History and Concurrent Conditions (not including reaction / event) B Concomitant Therapies B Date of Death B Was Autopsy Done? B.1.2 Age Information 0 1 B Date of Birth B.1.2.2a Age at Time of Onset of Reaction / Event (value) B.1.2.2b Age at Time of Onset of Reaction / Event (unit) B a Gestation Period When Reaction / Event Was Observed in the Foetus (value) B b Gestation Period When Reaction / Event Was Observed in the Foetus (unit) B Patient Age Group (as per reporter) B r Structured Information on Relevant Medical History 0 n B r.a.1 MedDRA Version for Medical History B r.a.2 Structured Medical History Information (disease / surgical procedure / etc.) B r.c Start Date B r.d Continuing B r.f End Date B r.g Comments B r.h Family History B.1.8.r Relevant Past Drug History 0 n B.1.8.r.a0 Name of Drug as Reported B.1.8.r.a1 Medicinal Product Identifier (MPID) B.1.8.r.a2 MPID Version Date / Number B.1.8.r.a3 Pharmaceutical Product Identifier (PhPID) B.1.8.r.a4 PhPID Version Date / Number B.1.8.r.c Start Date B.1.8.r.e End Date B.1.8.r.f.1 MedDRA Version for Indication B.1.8.r.f.2 Indication B.1.8.r.g.1 MedDRA Version for Reaction B.1.8.r.g.2 Reaction B r Reported Cause(s) of Death 0 n B r.a MedDRA Version for Reported Cause(s) of Death B r.b1 Reported Cause(s) of Death (MedDRA code) B r.b2 Reported Cause(s) of Death (free text) Continued on Next Page

32 B.1 - Patient Characteristics Continued from Previous Page B.1 0 n B r Autopsy-determined Cause(s) of Death B r.a MedDRA Version for Autopsy-determined Cause(s) of Death B r.b1 Autopsy-determined Cause(s) of Death (MedDRA code) B r.b2 Autopsy-determined Cause(s) of Death (free text) 0 1 B.1.10 For a Parent-Child / Fetus Report, Information Concerning the Parent B Parent Identification B Last Menstrual Period Date of Parent B Body Weight (kg) of Parent B Height (cm) of Parent B Sex of Parent B Parent Age Information 0 1 B Date of Birth of Parent B Age of Parent B a Age of Parent (age value) B b Age of Parent (age unit) B Relevant Medical History and Concurrent Conditions of Parent 0 1 B Text for Relevant Medical History and Concurrent Conditions of Parent B r Structured Information Parent 0 n B r.a.1 MedDRA Version for Parent Medical History B r.a.2 Structured Information (disease / surgical procedure/ etc.) B r.c Start Date B r.d Continuing B r.f End Date B r.g Comments B Relevant Past Drug History of Parent 0 n B r.a0 Name of Drug as Reported B r.a1 Medicinal Product Identifier (MPID) B r.a2 MPID Version Date / Number B r.a3 Pharmaceutical Product Identifier (PhPID) B r.a4 PhPID Version Date / Number B r.c Start Date B r.e End Date B r.f.1 MedDRA Version for Indication B r.f.2 Indication B r.g.1 MedDRA Version for Reaction B r.g.2 Reactions (if any and known)

33 B Patient Age Group New code added (R2) 1= Neonate 2 = Infant 3 = Child 4 = Adolescent 5 = Adult 6 = Elderly (R3) 0 = Fetus 1 = Neonate 2 = Infant 3 = Child 4 = Adolescent 5 = Adult 6 = Elderly

34 B Concomitant Therapies New field B.1.7.3: Concomitant therapies Flag to indicate presence or absence of concomitant therapies such as: - radiotherapy - drug class not otherwise specified (anything that can not be structured in drug section) Permitted value = true Omit element if not appliable Information should be provided in narrative section

35 IDMP: Sections B.1.8 & B Sections B.1.8 (patient drug history) and B (parent drug history) include new elements to support IDMP identifiers: Transmit either Medicinal Product Identifier (MPID) or Pharmaceutical Product Identifier (PhPID)

36 B.2 Reaction(s)/Event(s) ICH ICSR Diagram E2B(R3) The ICH ICSR A.5.1 Study Registration A.2.r Primary source(s) of information A.3 Sender of Case Safety Report A.4.r Literature reference(s) A.5 Study Identification A.1 Identification of the Case Safety Report A.1.8 Additional Documents A.1.11 Other Case IDs Previous Transmission A.1.12 Linked Reports B.1.2 Age Information B r Structure Information Medical History B.1.8.r Relevant Past Drug History B r Reported Cause(s) of Death B.5.1 Case Narrative B.5.3.r Sender s Diagnosis / Reclassification B.5.5 Case Summary & Reporter s Comments B.2.i Reaction(s) / Event(s) B.3.r Results of tests and procedures B.5 Case Narrative B.4.k Drug information B.4.k.10 Additional Information on Drug (coded) B.1 Patient characteristics B.4.k.1 Characterization of Drug Role B.4.k.2 Drug Identification B.1.9 In Case of Death B.1.10 Information Concerning Parent B.4.k.2.1 MPID or PhPID B.4.k.2.2 Medicinal Product Name Primary Source B r Autopsy-Determined Cause(s) of Death B r Structured Information (Parent) B r Relevant Past Drug History (Parent) B.4.k.11 Additional Information on Drug (free text) B.4.k.3 Holder & Authorisation/ Application Number B.4.k.4.r Dosage Information B.4.k.5 Cumulative Dose to the Reaction / Event B.4.k.6 Gestation Period at Time of Exposure B.4.k.2.3.r Substance(s) B.4.k.2.4 Country Where Drug Obtained B.4.k.2.5 Investigational Product Status Legend 1 to Many (1...n) Mandatory B.4.k.7.r Indication for Use in the Case B.4.k.8 Action Taken with Drug 1 to 1 Mandatory 1 to Many (0...n) Optional 1 to 1 (0...1) Optional B.4.k.9.i Drug Reaction / Event Matrix B.4.k.9.i.2.r Relatedness of Drug

37 Reaction(s) / Event(s) 1 n B.2 - Reaction(s)/Event(s) B.2.i - Reaction(s)/Event(s) B.2.i.0.a Reaction / Event as Reported by the Primary Source in Native Language B.2.i.0.b Reaction / Event as Reported by the Primary Source for Translation B.2.i.1.a MedDRA Version for Reaction / Event B.2.i.1.b Reaction / Event in MedDRA Terminology B.2.i.2.1 Term Highlighted by the Reporter B.2.i.2.2 Seriousness Criteria at Event Level B.2.i.3 Date of Start of Reaction / Event B.2.i.4 Date of End of Reaction / Event B.2.i.5a Duration of Reaction / Event B.2.i.5b Duration of Reaction / Event (duration unit) B.2.i.6 Outcome of Reaction / Event at the Time of Last Observation B.2.i.7 Medical Confirmation by Healthcare Professional B.2.i.8 Identification of the Country Where the Reaction / Event Occurred

38 Key differences for Reaction(s) / Event(s) Section Separate fields for original language and English translation of reporter s description of event Concepts now captured at Reaction(s)/Event(s) level: - Reason(s) for Seriousness - <termhighlighted> remains - Medical confirmation by health professional - Country ID where reaction/event occurred

39 Event as reported and translation B.2.i.0.a1 Reaction / Event as Reported by the Primary Source in Native Language B.2.i.0.a2 Reaction / Event as Reported by the Primary Source Language B.2.i.0b Use ISO RA, alpha-3 Reaction / Event as Reported by the Primary Source for Translation English translation to facilitate international transmission

40 B.2.i.2.2 Seriousness at event level Select all appropriate for each event / reaction: - results in death - life threathening - caused / prolonged hospitalisation - disabling / incapacitating - congenital anomaly / birth defect - other medically important condition

41 B.2.i.7 Medical confirmation by Healthcare Professional If an event is reported by a non healthcare professional (e.g. lawyer, consumer) this field can be used to indicate whether the occurrence of the event is confirmed by a healthcare professional If the event is reported by a healthcare professional this field is not transmitted

42 B.2.i.7 Medical confirmation by Healthcare Professional (example) Patient reports: Dizziness Heavy chest pain Heart attack Follow-up by health professional Patient did not have a heart attack Patient has been diagnosed with angina Values for B.2.i.7 Dizziness False Heavy chest pain False Heart attack False Angina True

43 B.2.i.8 Identification of the Country Where the Reaction / Event Occurred Should be the country where the event occurred For example patient living in A experiences event while travelling in B; event is reported by a healthcare professional in C A.2.r.1.3 = C B.2.i.8 = B

44 Start end - duration A previous draft of the standard proposed allowing no more than two of start date, end date and duration to be transmitted This was based on a perceived restriction in HL7 There is a technical solution to this: all three elements can be transmitted thus removing the need for receiving systems to calculate the nontransmitted part

45 B.3 Lab data ICH ICSR Diagram E2B(R3) The ICH ICSR A.5.1 Study Registration A.2.r Primary source(s) of information A.3 Sender of Case Safety Report A.4.r Literature reference(s) A.5 Study Identification A.1 Identification of the Case Safety Report A.1.8 Additional Documents A.1.11 Other Case IDs Previous Transmission A.1.12 Linked Reports B.1.2 Age Information B r Structure Information Medical History B.1.8.r Relevant Past Drug History B r Reported Cause(s) of Death B.5.1 Case Narrative B.5.3.r Sender s Diagnosis / Reclassification B.5.5 Case Summary & Reporter s Comments B.2.i Reaction(s) / Event(s) B.3.r Results of tests and procedures B.5 Case Narrative B.4.k Drug information B.4.k.10 Additional Information on Drug (coded) B.1 Patient characteristics B.4.k.1 Characterization of Drug Role B.4.k.2 Drug Identification B.1.9 In Case of Death B.1.10 Information Concerning Parent B.4.k.2.1 MPID or PhPID B.4.k.2.2 Medicinal Product Name Primary Source B r Autopsy-Determined Cause(s) of Death B r Structured Information (Parent) B r Relevant Past Drug History (Parent) B.4.k.11 Additional Information on Drug (free text) B.4.k.3 Holder & Authorisation/ Application Number B.4.k.4.r Dosage Information B.4.k.5 Cumulative Dose to the Reaction / Event B.4.k.6 Gestation Period at Time of Exposure B.4.k.2.3.r Substance(s) B.4.k.2.4 Country Where Drug Obtained B.4.k.2.5 Investigational Product Status Legend 1 to Many (1...n) Mandatory B.4.k.7.r Indication for Use in the Case B.4.k.8 Action Taken with Drug 1 to 1 Mandatory 1 to Many (0...n) Optional 1 to 1 (0...1) Optional B.4.k.9.i Drug Reaction / Event Matrix B.4.k.9.i.2.r Relatedness of Drug

46 Lab tests B.3 Results of Tests and Procedures Relevant to the Investigation of the Patient 0 n B.3.r Results of Tests and Procedures Relevant to the Investigation of the Patient B.3.r.b Test Date B.3.r.c.1 Test Name (free text) B.3.r.c.2 Test Name (MedDRA code) B.3.r.c.3 Test Name (MedDRA Version) B.3.r.d1 Test Result (Code) B.3.r.d2 Test Result (Value / Qualifier) B.3.r.e Unit B.3.r.f Result Unstructured Data (free text) B.3.r.1 Normal Low Value B.3.r.2 Normal High Value B.3.r.3 Comments (free text) B.3.r.4 More Information Available

47 B.3 Lab data (R2) B.3.2 free text results field deleted In (R3) new 2000 character field provided per test for transmission of unstructured results data

48 B.4 Drugs ICH ICSR Diagram E2B(R3) The ICH ICSR A.5.1 Study Registration A.2.r Primary source(s) of information A.3 Sender of Case Safety Report A.4.r Literature reference(s) A.5 Study Identification A.1 Identification of the Case Safety Report A.1.8 Additional Documents A.1.11 Other Case IDs Previous Transmission A.1.12 Linked Reports B.1.2 Age Information B r Structure Information Medical History B.1.8.r Relevant Past Drug History B r Reported Cause(s) of Death B.5.1 Case Narrative B.5.3.r Sender s Diagnosis / Reclassification B.5.5 Case Summary & Reporter s Comments B.2.i Reaction(s) / Event(s) B.3.r Results of tests and procedures B.5 Case Narrative B.4.k Drug information B.4.k.10 Additional Information on Drug (coded) B.1 Patient characteristics B.4.k.1 Characterization of Drug Role B.4.k.2 Drug Identification B.1.9 In Case of Death B.1.10 Information Concerning Parent B.4.k.2.1 MPID or PhPID B.4.k.2.2 Medicinal Product Name Primary Source B r Autopsy-Determined Cause(s) of Death B r Structured Information (Parent) B r Relevant Past Drug History (Parent) B.4.k.11 Additional Information on Drug (free text) B.4.k.3 Holder & Authorisation/ Application Number B.4.k.4.r Dosage Information B.4.k.5 Cumulative Dose to the Reaction / Event B.4.k.6 Gestation Period at Time of Exposure B.4.k.2.3.r Substance(s) B.4.k.2.4 Country Where Drug Obtained B.4.k.2.5 Investigational Product Status Legend 1 to Many (1...n) Mandatory B.4.k.7.r Indication for Use in the Case B.4.k.8 Action Taken with Drug 1 to 1 Mandatory 1 to Many (0...n) Optional 1 to 1 (0...1) Optional B.4.k.9.i Drug Reaction / Event Matrix B.4.k.9.i.2.r Relatedness of Drug

49 B.4 Drug(s) Information 1 n B.4.k Drug(s) Information B.4.k.1 Characterization of Drug Role B.4.k.2.1.1a Medicinal Product Identifier (MPID) B.4.k.2.1.1b MPID Version Date / Number B.4.k.2.1.2a Pharmaceutical Product Identifier (PhPID) B.4.k.2.1.2b PhPID Version Date / Number B.4.k.2.2 Medicinal Product Name as Reported by the Primary Source B.4.k.2.4 Identification of the Country Where the Drug Was Obtained B.4.k.2.5 Investigational Product Blinded B.4.k.3.1 Authorisation / Application Number B.4.k.3.2 Country of Authorisation / Application B.4.k.3.3 Name of Holder / Applicant B.4.k.5.1 Cumulative Dose to First Reaction (number) B.4.k.5.2 Cumulative Dose to First Reaction (unit) B.4.k.6a Gestation Period at Time of Exposure (number) B.4.k.6b Gestation Period at Time of Exposure (unit) B.4.k.8 Action(s) Taken with Drug B.4.k.11 Additional Information on Drug (free text) B.4.k.2.3.r Substance / Specified Substance Identifier and Strength 0 n B.4.k.2.3.r.1 Substance/ Specified Substance Name B.4.k.2.3.r.2a Substance/Specified Substance TermID B.4.k.2.3.r.2b Substance/Specified Substance TermID Version Date / Number B.4.k.2.3.r.3 Strength B.4.k.2.3.r.4 Strength Unit B.4.k.4.r Dosage Information 0 n B.4.k.4.r.1 Dose (number) B.4.k.4.r.2 Dose (unit) B.4.k.4.r.4 Number of Units in the Interval B.4.k.4.r.5 Definition of the Time Interval Unit B.4.k.4.r.6 Date and Time of Start of Drug B.4.k.4.r.7 Date and Time of Last Administration B.4.k.4.r.8a Duration of Drug Administration (number) B.4.k.4.r.8b Duration of Drug Administration (unit) B.4.k.4.r.9 Batch / Lot Number B.4.k.4.r.10 Dosage Text 0 n B.4.k.4.r.11 Pharmaceutical Dose Form B.4.k.4.r.11.1 Pharmaceutical Dose Form (free text) B.4.k.4.r.11.2a Pharmaceutical Dose Form TermID B.4.k.4.r.11.2b Pharmaceutical Dose Form TermID Version Date / Number B.4.k.4.r.12 Route of Administration 0 n B.4.k.4.r.12.1 Route of Administration (free text) B.4.k.4.r.12.2a Route of Administration TermID B.4.k.4.r.12.2b Route of Administration TermID Version Date / Number B.4.k.4.r.13 Parent Route of Administration (in case of a parent child / foetus report) 0 n B.4.k.4.r.13.1 Parent Route of Administration (free text) B.4.k.4.r.13.2a Parent Route of Administration TermID B.4.k.4.r.13.2b Parent Route of Administration TermID Version Date / Number Continued on Next Page

50 B.4 Drug(s) Information Continued from Previous Page B.4.k.7.r Indication for Use in Case 1 n B.4.k.7.r.1 Indication as Reported by the Primary Source B.4.k.7.r.2a Indication in MedDRA Terminology (version) B.4.k.7.r.2b Indication in MedDRA Terminology (LLT code) B.4.k.9 Drug-reaction(s) / Event(s) Matrix 0 n B.4.k.9.i.1 Reaction(s) / Event(s) Assessed B.4.k.9.i.3.1a Time Interval between Beginning of Drug Administration and Start of Reaction / Event (number) B.4.k.9.i.3.1b Time Interval between Beginning of Drug Administration and Start of Reaction / Event (unit) B.4.k.9.i.3.2a Time Interval Between Last Dose of Drug and Start of Reaction / Event (number) B.4.k.9.i.3.2b Time Interval Between Last Dose of Drug and Start of Reaction / Event (unit) B.4.k.9.i.4 Did Reaction Recur on Re-administration? B.4.k.9.i.2.r Assessment of Relatedness of Drug to Reaction(s) / Event(s) 0 n B.4.k.9.i.2.r.1 Source of Assessment B.4.k.9.i.2.r.2 Method of Assessment B.4.k.9.i.2.r.3 Result of Assessment B.4.k.10 Coded Drug Information 0 n B.4.k.10.r Additional information on drug (Coded)

51 Key differences for Drug Section Full integration with ISO IDMP (ICH M5) New characterisation of drug role (drug not administered) Drug identification Investigational product status (blinded) Repeatable field for indication Structuring of dosage information Reporting of special situations (e.g. counterfeit medicines, product defects, medication errors)

52 B.4.k.1 Characterisation of drug role New value added: Drug not administered (R2) (R3) Suspect 1 1 Concomitant 2 2 Interacting 3 3 Drug not administered N/A 4 drug not administered can be used in two situations: 1. clinical trial 2. medication error

53 B.4.k.1 Characterisation of drug role Examples 1. clinical trial: the event occurred prior to administration of study drug, eg during screening period Information on cause to be provided in narrative (B.5) 2. medication error: if patient did not receive the actual prescribed drug but another one: - one drug section with prescribed drug (field B.4.k.1 = 4) - one drug section with dispensed drug (field B.4.k.1 = 1)

54 B.4.k.2 Drug identification IDMP elements: the most specific identifier, being either the Medicinal Product Identifier (MPID, B.4.k.2.1.1) or the Pharmaceutical Product Identifier(s) (PhPID, B.4.k.2.1.2) should be provided. If an MPID or PhPID(s) for the reported medicinal product is not available, these fields should be left blank. Until M5 is available, these fields will be left blank The product name used by the reporter should always be provided in B.4.k.2.2

55 B.4.k.2 Drug identification If an MPID (B.4.k.2.1.1) or PhPID (B.4.k.2.1.2) is provided then there is no need to provide information such as Strength or Term IDs for Pharmaceutical dose form and substance name etc.

56 (R3) B.4.k.2.5 Investigational Product Blinded Flag to reflect that medication is blinded May be used in clinical trial reports if there is a need to exchange blinded reports Value allowed = true : omit element if not relevant

57 Dosage information Dosage information becomes repeatable within drug Change of presentation (following HL7 principles): R2 field R2 value R3 value B.4.k B.4.k.5.2 mg mg B.4.k element removed B.4.k B.4.k.5.5 day hours

58 Indication (R2) B.4.k.11 (r3) B.4.k.7 Repeatable elements for: Original text B.4.k.7.r.1 MedDRA LLT code B.4.k.7.r.2 Optional, but if not known then the MedDRA code "Drug use for unknown indication ( ) should be used

59 B.4.k.9 Drug reaction / event matrix Now supports time to onset of reaction / event from first dose / last dose for all drug event combinations

60 (R3) B.4.k.10.r.1 Additional information on drug (coded) New field B.4.k.10.r.1 additional information on drug (coded) Provides a set of codes to provide specific additional information in a coded form Repeatable

61 (R3) B.4.k.10.r.1 Additional information Values proposed in (R3): on drug (coded) - counterfeit - overdose - drug taken by the father - drug taken beyond expiry date - batch and lot tested and found within specifications - batch and lot tested and found not within specifications - medication error - misuse - abuse - occupational exposure - off label use

62 (R3) B.4.k.11 Additional information on drug (free text) Corresponds to (R2) field B.4.k.19 Allows free text comments to be added (2000 characters)

63 B.5 Narrative ICH ICSR Diagram E2B(R3) The ICH ICSR A.5.1 Study Registration A.2.r Primary source(s) of information A.3 Sender of Case Safety Report A.4.r Literature reference(s) A.5 Study Identification A.1 Identification of the Case Safety Report A.1.8 Additional Documents A.1.11 Other Case IDs Previous Transmission A.1.12 Linked Reports B.1.2 Age Information B r Structure Information Medical History B.1.8.r Relevant Past Drug History B r Reported Cause(s) of Death B.5.1 Case Narrative B.5.3.r Sender s Diagnosis / Reclassification B.5.5 Case Summary & Reporter s Comments B.2.i Reaction(s) / Event(s) B.3.r Results of tests and procedures B.5 Case Narrative B.4.k Drug information B.4.k.10 Additional Information on Drug (coded) B.1 Patient characteristics B.4.k.1 Characterization of Drug Role B.4.k.2 Drug Identification B.1.9 In Case of Death B.1.10 Information Concerning Parent B.4.k.2.1 MPID or PhPID B.4.k.2.2 Medicinal Product Name Primary Source B r Autopsy-Determined Cause(s) of Death B r Structured Information (Parent) B r Relevant Past Drug History (Parent) B.4.k.11 Additional Information on Drug (free text) B.4.k.3 Holder & Authorisation/ Application Number B.4.k.4.r Dosage Information B.4.k.5 Cumulative Dose to the Reaction / Event B.4.k.6 Gestation Period at Time of Exposure B.4.k.2.3.r Substance(s) B.4.k.2.4 Country Where Drug Obtained B.4.k.2.5 Investigational Product Status Legend 1 to Many (1...n) Mandatory B.4.k.7.r Indication for Use in the Case B.4.k.8 Action Taken with Drug 1 to 1 Mandatory 1 to Many (0...n) Optional 1 to 1 (0...1) Optional B.4.k.9.i Drug Reaction / Event Matrix B.4.k.9.i.2.r Relatedness of Drug

64 B5 Narrative Case Summary and Other Information 1 1 B5 Narrative Case Summary and Other Information B Case Narrative Including Clinical Course, Therapeutic Measures, Outcome and Additional Relevant Information B.5.2 Reporter s comments B.5.4 Sender s comments B.5.3 Sender s Diagnosis 0 n B.5.3.r.1 MedDRA Version for Sender's Diagnosis / Syndrome and / or Reclassification of Reaction / Event B.5.3.r.2 - Sender's Diagnosis / Syndrome and / or Reclassification of Reaction / Event 0 n B.5.5 Case Summary and Reporter s Comments in Native Language B.5.5.r.1 Case Summary and Reporter s Comments Text B.5.5.r.2 Case summary and reporter s comments language

65 B.5.5.r Case Summary & Reporter s comments in native language B.5.5.r Case Summary & Reporter s comments in native language B.5.5.r.1 Case summary and Reporter s Comments Text (repeat as necessary) B.5.5.r.1 Case summary and Reporter s Comments Language (repeat as necessary) Transmit narrative and Sender s comments in other language than English as required in some countries and regions - Use English language in B.5.1 (Case narrative), B.5.2 (Reporter s comments) and B.5.4 (Sender s comments)

66 Backwards / forwards compatibility (BFC) Backwards => (R3) -> (R2) Forwards => (R2) -> (R3) ICH BFC guidance assumes that the receiver will perform the necessary conversions

67 BFC 1 For instance: upgraded system receives an (R2) message (R3) compliant system needs to be able to convert / accommodate (R2) file current system receives an (R3) message (R2) compliant system needs to be able to convert / accommodate (R3) file

68 BFC 2 Conversion rules are aimed at maintaining data integrity In some scenarios this involves putting (R3) data into (R2) text fields For instance if (R3) B.4.k.2.5 = true then INVESTIGATIONAL should be added to (R2) field B.4.k.19 if performing a backwards conversion

69 BFC 3 Dates: (R3) supports lower precision than (R2) in some fields: LMP (patient) Date of birth (parent) LMP (parent) Minimum precision in (R3) is CCYY

70 Closing remarks Obvious technical changes such as the move to HL7 and incorporation of IDMP should not obscure the impact of many structural changes particularly those relating to moving current case level fields to drug or event level

71 Thank you