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Risk-adapted approaches to the management of clinical trials: guidance from the Department of Health (DH)/Medical Research Council (MRC)/Medicines and Healthcare Products Regulatory Agency (MHRA) Clinical Trials Working Group


In response to a request from the Department of Health in 2009 to identify and suggest remedial actions to major obstacles to non-commercial clinical trials research in the UK, the MRC and MHRA formed a group to address risk-proportionality in trial management and monitoring. Their remit was to:

  • Develop a process to facilitate the agreement of key stakeholders on the level of risk associated with a clinical trial of an investigational medicinal product (CTIMP)
  • Identify how risk-adapted approaches for CTIMPs can be achieved within the current regulatory framework
  • Develop guidance on risk assessment and the risk-proportionate management of clinical trials.


The resulting guidance focuses on the risks inherent in a trial protocol which impact on participant safety and rights, and the reliability of the results.

A two-part assessment is suggested. First, a simple IMP risk categorisation based on marketing status and standard medical care, and second, an assessment of the trial design, population and procedures to identify specific areas of vulnerability.

Both the risk category and safety monitoring plan resulting from the vulnerability assessment can be submitted to the MHRA with the Clinical Trial Authorisation application to ensure there is shared understanding on this key aspect of a trial.


The guidance is available here: