Long-Term Follow-Up for Gene Therapies: Toolkit Release

Webinar

Presented on: November 4, 2025

Long-term follow-up (LTFU) studies of gene therapy recipients are crucial for understanding the overall benefit-risk profile of these innovative products. However, LTFU studies are challenging to design, conduct, and execute, and pose significant burdens on both patients and sponsors.

In September 2024, the MRCT Center launched an LTFU Working Group. The committee comprises patients, as well as representatives from patient advocacy organizations, industry sponsors, academic medical centers, clinical research organizations, and human oversight protection organizations, each bringing diverse perspectives and complementary scientific, medical, regulatory, and ethical expertise.

On November 4, 2025, the MRCT Center released the Toolkit for Supporting the Design, Conduct, and Reporting of Long-Term Follow-Up Studies as a draft for public comment. The Toolkit provides practical guidance regarding best practices for LTFU studies for both investigational and approved gene therapies. It aims to balance the generation of critical long-term safety and efficacy data with the need to reduce burdens placed on participants, caregivers, sponsors, and investigators.

This webinar introduced the Toolkit’s 𝘀𝘁𝗿𝘂𝗰𝘁𝘂𝗿𝗲 𝗮𝗻𝗱 𝗰𝗼𝗻𝘁𝗲𝗻𝘁𝘀, including:
🔹 𝗚𝘂𝗶𝗱𝗶𝗻𝗴 𝗣𝗿𝗶𝗻𝗰𝗶𝗽𝗹𝗲𝘀
🔹 𝗖𝗼𝗻𝘀𝗶𝗱𝗲𝗿𝗮𝘁𝗶𝗼𝗻𝘀 𝗮𝗻𝗱 𝗥𝗲𝗰𝗼𝗺𝗺𝗲𝗻𝗱𝗮𝘁𝗶𝗼𝗻𝘀
🔹 𝗟𝗼𝗼𝗸𝗶𝗻𝗴 𝗙𝗼𝗿𝘄𝗮𝗿𝗱

It also highlighted additional practical resources:
🔹 𝗞𝗲𝘆 𝗱𝗲𝘀𝗶𝗴𝗻 𝗲𝗹𝗲𝗺𝗲𝗻𝘁𝘀 of LTFU studies for FDA-approved gene therapies
🔹 𝗜𝗻𝘁𝗲𝗿𝗻𝗮𝘁𝗶𝗼𝗻𝗮𝗹 𝗿𝗲𝗴𝘂𝗹𝗮𝘁𝗼𝗿𝘆 𝗴𝘂𝗶𝗱𝗮𝗻𝗰𝗲
🔹 𝗚𝗹𝗼𝘀𝘀𝗮𝗿𝗶𝗲𝘀 𝗮𝗻𝗱 𝗯𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱 𝗶𝗻𝗳𝗼𝗿𝗺𝗮𝘁𝗶𝗼𝗻 on types of LTFU studies

𝗠𝗼𝗱𝗲𝗿𝗮𝘁𝗼𝗿:
Carolyn Riley Chapman, PhD MS – Lead Investigator, Brigham and Women’s Hospital; Member of the Faculty, Harvard Medical School

𝗣𝗮𝗻𝗲𝗹𝗶𝘀𝘁𝘀:
Durhane Wong-Rieger, PhD – President and CEO, Canadian Organization for Rare Disorders
Barbara Isquith Arone, MS – Vice President, Medical Affairs Category Lead, IQVIA
Patrick Cullinan, PhD – Head of Medical Writing and Transparency, Adverum Biotechnologies



https://www.fda.gov/regulatory-information/search-fda-guidance-documents/postapproval-methods-capture-safety-and-efficacy-data-cell-and-gene-therapy-products

Toolkit for Supporting the Design, Conduct, and Reporting of Long-Term Follow-Up Studies for Gene Therapies

Toolkit

Released on: November 4, 2025

Long-term follow-up (LTFU) studies of gene therapy recipients are crucial for understanding the overall benefit-risk profile of these innovative products. However, LTFU studies are challenging to design, conduct, and execute, and pose significant burdens on both patients and sponsors.

In September 2024, the MRCT Center launched an LTFU Working Group. The committee comprises patients, as well as representatives from patient advocacy organizations, industry sponsors, academic medical centers, clinical research organizations, and human oversight protection organizations, each bringing diverse perspectives and complementary scientific, medical, regulatory, and ethical expertise.

On November 4, 2025, the MRCT Center released the Toolkit for Supporting the Design, Conduct, and Reporting of Long-Term Follow-Up Studies, as a draft for public comment. The Toolkit provides practical guidance regarding best practices for LTFU studies for both investigational and approved gene therapies. It aims to balance the generation of critical long-term safety and efficacy data with the need to reduce burdens placed on participants, caregivers, sponsors, and investigators.

The Toolkit enables easy navigation to various sections and subsections via multiple clickable, interactive toolbars. The sections are as follows, with the core elements in bold font:

  • Introduction and Background
  • Types of LTFU studies for GTs
  • Flowcharts
  • Guiding Principles
  • Considerations and Recommendations for the Design, Conduct, and Reporting of LTFU Studies for GTs
  • Looking Forward
  • Key Design Elements of LTFU Studies for FDA-approved GTs
  • Regulatory Guidance Relating to LTFU of GTs
  • Compiled Glossary of Scientific LTFU-Related Terminology
  • Easy-to-Understand (Accessible) LTFU-Related Definitions from the MRCT Center’s Clinical Research Glossary
  • Appendices
    • List of Acronyms and Abbreviations Used
    • References Cited

We welcome your suggestions and feedback on this Toolkit, which has been released as a draft for public comment. Please email us at mrct@bwh.harvard.edu with your comments and/or questions.



Navigation Highlights

The Toolkit incorporates several interactive features designed to support intuitive navigation and ease of use:

  • Clickable Table of Contents for rapid access to major sections and subsections.
  • Right-hand vertical navigation bar on every page, enabling quick movement between tools within the document.
  • Interactive table of LTFU study types, mirrored by color-coded tabs that remain clickable throughout the associated pages.
  • Secondary navigation bar at the top of each page within the Considerations & Recommendations section. This feature highlights your location within the nine subsections, allows you to jump directly between subsections by clicking the dots, and includes a grey diamond icon that returns you to the full list of subsections.

Applied Health Literacy: Using Teach-Back in Conversations about Clinical Research

Webinar

Presented on: October 30, 2025

On October 30, the MRCT Center hosted a webinar on Applied Health Literacy: Using Teach-Back in Conversations About Clinical Research. The session focused on how the Teach-Back method can improve participant understanding, support safe and equitable clinical research, and strengthen communication throughout the research process. The recording, slides, and a list of resources discussed during the session are provided below.

Overview

The webinar reviewed the essential elements of the Teach-Back method and discussed how study teams can simplify complex information, confirm understanding, and foster dialogue with participants and caregivers during recruitment, informed consent, and ongoing study engagement. Presenters emphasized the role of Teach-Back in enhancing clarity, reducing burden, and supporting participant-centered, high-quality research.

Speakers

  • Mary Ann Abrams, MD, MPH – Physician and Health Literacy Expert, Nationwide Children’s Hospital; Assistant Professor of Pediatrics, The Ohio State University College of Medicine
  • Stephanie Shepherd, MBOE, BSN, RN – Clinical Educator, Nationwide Children’s Hospital
  • Marian Ryan, PhD, MA, MPH – Chief Policy & Research Officer, Institute for Healthcare Advancement (IHA)

Moderator

  • Sylvia Baedorf Kassis, MPH – Program Director, MRCT Center

What the Session Covered

  • How Teach-Back supports participant comprehension, autonomy, and safety
  • Approaches to explaining complex study information in accessible, plain language
  • Strategies for confirming understanding in an ethical, respectful, and culturally responsive manner
  • Practical examples of how to integrate Teach-Back across recruitment, informed consent, and study follow-up processes

Additional Resources

MRCT Center Health Literacy Website


Health Literacy Resources for IRBs
Health Literacy Best Practices
https://health.gov/our-work/national-health-initiatives/healthy-people/healthy-people-2030/health-literacy-healthy-people-2030
https://nces.ed.gov/naal/health.asp
https://www.ahrq.gov/sites/default/files/wysiwyg/health-literacy/dhhs-2008-issue-brief.pdf
http://justplainclear.com/en
http://www.plainlanguage.gov/whatisPL/definitions/eagleson.cfm
https://Teachbacktraining.org
https://www.Teachbacktraining.org/OrganizationalHealthLiteracyGuidebook2
https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html



A Scoping Review of Challenges in Pediatric Health Technology Assessments with a Focus on Pharmaceutical Interventions

Publication

Presented on: October 16, 2025

Published in: International Journal of Technology Assessment in Health Care

Abstract: In this scoping review detailing the challenges of assessing new technologies for use in children, authors Nora Hutchinson, Lauren Otterman, Elisa Koppelman, Barbara E. Bierer, and colleagues highlight the substantial difficulties in incorporating children within the population-wide health technology assessment (HTA) system, as well as the uncertainty accompanying pediatric HTAs due to data constraints, lack of guidance and/or variation in guidance, between HTA bodies.

Hutchinson N, Otterman L, Bain PA, Koppelman E, Bierer BE. A Scoping Review of Challenges in Pediatric Health Technology Assessments with a Focus on Pharmaceutical Interventions. International Journal of Technology Assessment in Health Care. Published online 2025:1-34. doi:10.1017/S0266462325103188

Characteristics of long-term follow-up studies for gene therapies registered on ClinicalTrials.gov

Publication

Presented on: October 22, 2025

Published in: Gene Therapy

October 22: In the article “Characteristics of long-term follow-up studies for gene therapies registered on ClinicalTrials.gov,” published in Gene Therapy, co-authors Carolyn Chapman, Emina Berbic, Ava Glazier, and Barbara Bierer report a descriptive study of key characteristics of LTFU gene therapy study protocols registered in ClinicalTrials.gov. The analysis enabled a better understanding of how registered LTFU studies are currently designed and stimulated ideas for improvement. Most notably, the results suggest a lack of harmonization in how safety outcomes are monitored and reported across LTFU studies. Standardization and/or harmonization of data and outcome reporting may increase the scientific value of these studies.

Chapman, C.R., Glazier, A., Berbić, E. et al. Characteristics of long-term follow-up studies for gene therapies registered on ClinicalTrials.gov. Gene Ther (2025). https://doi.org/10.1038/s41434-025-00571-4

AI Digital Twins and Synthetic Data: Application to Clinical Trials

Webinar

Presented on: September 30, 2025

This webinar focused on how to responsibly integrate AI into the design, conduct, and oversight of clinical research, introducing two rapidly evolving applications:

  • Digital twins – simulated models of individual patients designed to predict disease trajectories and treatment responses, with the potential to enhance statistical power, optimize design, and reduce the number of participants assigned to control arms.
  • Synthetic data – artificially generated datasets that mirror the statistical properties of verified clinical data, with potential use in trial design, conduct, analysis, and regulatory submissions.

Panelist: Daniele Bertolini, Machine Learning Scientist at Unlearn.ai.

Moderator: Barbara Bierer, Faculty Director at the MRCT Center

A Framework for AI Adoption and Oversight in Clinical Research


E21 Inclusion of Pregnant and Lactating Women in Clinical Trials

Public Comment

Comments provided on: September 18, 2025

Comments provided to: U.S. Food and Drug Administration; FDA-2025-D-1797

Description: The Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard (MRCT Center) submitted public comments on the draft ICH E21 guidance regarding the inclusion of pregnant and breastfeeding women in clinical trials. The MRCT Center strongly supports the ethical inclusion of these historically understudied populations and emphasized the need for ethical and rigorous, well-designed research guided by participant and individual protections.

Continued Access to Investigational Products: Guiding Equitable and Fair Decisions

Webinar

Date: September 12, 2025

This webinar explores the MRCT Center’s work addressing the challenges of post-trial, continued access to investigational products. Post-trial access is a shared responsibility that should be planned before a trial begins. Even with careful planning, complex situations may arise, requiring sponsors to balance competing priorities and the needs of diverse stakeholders.

The MRCT Center’s Post-Trial Continued Access Task Force has developed principles, frameworks, and recommendations to guide equitable and fair decision-making about the continued provision of investigational medicines or the maintenance of significant-risk investigational devices after a trial ends.

The session includes a case study examining a scenario in which a trial’s primary endpoint is not met, but a subpopulation benefits, illustrating the difficult decisions sponsors and investigators must navigate in determining whether—and how—to provide post-trial, continued access.

Speakers:

  • Karla G. Childers, BA, MSJ, MSBE – Vice President, Bioethics, Policy & Partnerships, Johnson & Johnson
  • Brandy Ellis – Lived Experience Advocate
  • Ben Rotz, RPh – Associate Vice President, Global Medical Policy, Strategy, and Operations, Eli Lilly & Company

Moderated by:
Sarah White, MPH, Executive Director, MRCT Center

The roadmap to integrate diversity, equity, and inclusion in hematology clinical trials: an American Society of Hematology initiative

Publication

Published on: February 12, 2025

Published in: Blood Advances

In a Blood Advances article titled The roadmap to integrate diversity, equity, and inclusion in hematology clinical trials: an American Society of Hematology initiative,” Barbara E. Bierer and co-authors outline a comprehensive strategy to address barriers to diversity, equity, and inclusion (DEI) in clinical research for classical hematologic diseases. These trials face unique challenges, including small sample sizes, methodological limitations, and underrepresentation of diverse populations. Through surveys and five international focus groups with patients, advocates, academia, regulators, industry, and research organizations, the team identified eight priority areas: (1) harmonizing demographic terminology, (2) engaging lived experience experts, (3) mitigating implicit bias, (4) strengthening the role of ethics committees and institutional review boards in upholding justice, (5) broadening eligibility criteria, (6) leveraging decentralized trial designs, (7) improving access to trial information, and (8) increasing engagement of community physicians. Implementing solutions in these areas will foster accessible, inclusive trials and generate representative data to improve research quality, regulatory decision-making, and patient care.

Alice Kuaban, Alysha K. Croker, Jeffrey Keefer, Leonard A. Valentino, Barbara E. Bierer, Stephen Boateng, Donna DiMichele, Patrick Fogarty, C. Michael Gibson, Anna M. Hood, Lloryn Hubbard, Antonella Isgrò, Karin Knobe, Leslie Lake, Iman Martin, Michel Reid, Jonathan C. Roberts, Wendy Tomlinson, Lanre Tunji-Ajayi, Harriette G.C. Van Spall, Caroline Voltz-Girolt, Allison P. Wheeler, Alan E. Mast, Stephanie Seremetis; The roadmap to integrate diversity, equity, and inclusion in hematology clinical trials: an American Society of Hematology initiative. Blood Adv 2025; 9 (4): 687–695. doi: https://doi.org/10.1182/bloodadvances.2024013945

Disparate data retention standards in biomedical research

Publication

Published on: August 6, 2025

Published in: Accountability in Research

In an Accountability in Research article titled “Disparate data retention standards in biomedical research”, Barbara Bierer and Carolyn Lye, Minal Caron, Lauren Walsh, and Mark Barnes discuss disparate data retention standards for biomedical research. The article summarizes the divergent data retention standards set forth by federal agencies, grant programs, and research institutions, as well as other applicable requirements under law, contract, and policy.  The authors also discuss the importance of data retention in the context of research professionalism, data sharing efforts, intellectual property issues, and research integrity challenges, and provide recommendations for both institutions and applicable federal agencies to streamline and clarify data retention standards.

Lye, C. T., Caron, M. M., Walsh, L., Bierer, B. E., & Barnes, M. (2025). Disparate data retention standards in biomedical research. Accountability in Research, 1–28. https://doi.org/10.1080/08989621.2025.2543884