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Term of the Day

Natural history study

A natural history study is a preplanned observational study intended to track the course of a disease over time, identifying demographic, genetic, environmental and other variables that correlate with its development and outcomes in the absence of intervention, or under standard of care. Designs may be retrospective (chart review of existing records) or prospective (longitudinal follow-up of a cohort or registry).

Natural history data is particularly important in rare and paediatric diseases, where randomised placebo-controlled trials may be infeasible or unethical. The FDA (guidance on rare disease natural history studies, 2019) and the EMA accept well-designed natural history studies to define endpoints and biomarkers, identify patient subgroups, estimate sample sizes and, in some cases, serve as external or historical control arms for single-arm trials supporting orphan products.

Because they are non-interventional, natural history studies fall outside the CTR and are governed by national law (for example France's MR-003 or MR-004 reference methodologies) and by the GDPR. They typically involve secondary use of medical records, long-term follow-up, genetic data and small populations in which anonymisation is rarely achievable, so pseudonymisation, a DPIA and a robust research legal basis under Art. 9(2)(j) are essential. Registries maintained by patient organisations or academic consortia raise additional questions of joint controllership and data access governance.

S

Sponsor

A sponsor means an individual, company, institution or organisation which takes responsibility for the initiation, for the management and for setting up the financing of the clinical trial (Art. 2(2)(14) EU Clinical Trials Regulation 536/2014). A trial may have several co-sponsors who allocate responsibilities by written contract (Art. 72). Where the sponsor is not established in the EU or EEA, it must appoint a legal representative established in the Union who is responsible for ensuring compliance with the Regulation and is the addressee of all communications (Art. 74); some Member States instead accept a contact person.

The sponsor's obligations run through the whole Regulation: submitting the application in CTIS, selecting qualified investigators and suitable sites, ensuring GCP compliance through monitoring and audits, manufacturing and supplying the IMP, safety recording and reporting, notifying serious breaches, maintaining the trial master file for 25 years, publishing results, and arranging insurance or indemnification. Tasks may be delegated to a CRO but responsibility is not transferred (Art. 71).

Under the GDPR the sponsor is the controller for the trial dataset because it determines the purposes and essential means through the protocol; the EDPB Opinion 3/2019 sets out the legal bases it may rely on. A non-EU sponsor recruiting EU participants must also appoint an Art. 27 Data Protection Representative, which is a distinct role from the CTR legal representative although one organisation can hold both. The sponsor conducts the DPIA, concludes processor agreements with vendors, puts transfer safeguards in place, and ensures the informed consent form carries the required GDPR information. iliomad acts as DPO and DPR for sponsors worldwide; see clinical trials compliance services and data protection for biotech and pharma sponsors.

Does outsourcing trial activities to a CRO transfer all sponsor responsibility?

No. Delegating activities does not remove the sponsor’s overall responsibility for its trial activities. The agreement should clearly identify the work being transferred, and the sponsor should retain appropriate oversight. Define reporting, escalation and access to records so responsibility is supported by an operational process rather than contract wording alone.