US Flashcards
What is a medical device?
An instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent or other similar or related article, including a component part or accessory
What milestone did the Safe Medical Devices Act establish in 1990?
- Extended adverse event reports to user facilities
- High risk device tracking requirements
- Defined SE
- 510(k) clearance required before marketing
- FDA authority over Combination Products
- Humanitarian Device Exemption
- FDA recall authority
The CDRH has the authority to regulate whom?
manufacturers, repackagers, relabelers, importers
Which device class requires General and Special controls?
Class II
Which device Class requires General controls?
Class I
Class II devices require what type of controls?
PMA
What are the 5 general controls of all device classes?
- Establishment Registration 21 CFR 807.20
- Device Listing
- Manufacturing in accordance with 21 CFR 820 GMP regulations
- Device Labeling in accordance with 21 CFR 801 and 809 regulations
- Submission of premarket notification (unless exempt)
Special controls contain what extra requirements?
- Labeling requirements
- Mandatory performance standards
- Specific Post market surveillance activities
21 CFR 814 describes what process
PMA of Class III devices
A device may be classified as Class III due to what?
A lack of information supporting the safety and effectiveness solely through general and special controls
Medical devices associated with blood collection and processing procedures, and some IVD if they employ biological technology to achieve their endpoint are subject to which FDA Center?
CBER
How many device “panels” exist for FDA device classifications?
16
What is HUD and what is its threshold?
Humanitarian Use Device
Affecting fewer than 4,000 individuals in the US
What is HDE and what is it exempt from?
Humanitarian Device Exemption
Exempt from PMA effectiveness requirements
A HUD may only be used under what circumstance?
In a facility with an established IRB to supervise the devices clinical use, only after approving the device for that clinical application
True or False? Class I and Class II devices are subject to the 510(k) clearance process?
True
Are all Class I devices exempt from 510(k) clearance?
No, roughly 800 have been made exempt
How many Class II devices are exempt from 510(k) clearance?
Roughly 60
Which section of the CFR defines 510(k) submission requirements?
21 CFR 807 Subpart E
Pre-amendment devices, reclassified Class I & II devices, and devices found to be SE to either of the above devices are all examples of what?
A legally marketed predicate device
What makes a device SE to a predicate
Same intended use and technological characteristics, or same intended use and different technological characteristics that do not raise new questions of safety and effectiveness and the device is at least as safe as the legally marketed device
If a device is determined to be NSE, what are the 4 options?
- Submit new 510(k)
- Request a Class I or Class II designation through the de novo process
- File a reclassification petition
- Submit a PMA
What is MDUFA and what did it implement?
Medical Device User Fee Amendments introduced performance goal for the FDA in exchange for User Fees
What is the FDA’s MDUFA III performance goal for 510(k) submissions?
Decision made within 90 days of active FDA review for >90% of all submissions
What are the 3 510(k) pathways?
Traditional, special, abbreviated
What is de novo classification?
The risk-based evaluation of automatic Class III Designation
What are the 2 options for requesting de novo classification?
- Within 30 days of receiving a NSE for a device not previously classified under the act
- Any sponsor with a device that does not have a predicate or equivalent device
What is IDE?
An Investigational Device Exemption
What does an IDE allow?
An investigational device to be used in a clinical study to collect safety and performance/effectiveness data to support a PMA or 510(k)
What is the least burdensome approach?
The least burdensome approach considers type of info, approaches to obtaining that info, and when during lifecycle that info is reasonably available
Do all clinical evaluations of investigational devices require an IDE?
Unless they are exempt, yes
How does an IDE differ from an IND?
An IDE requires the sponsor receive written approval within 30 days, whereas an IND may begin a new clinical trial 30 days after receipt with the FDA unless the FDA objects
What 5 things are required of devices which have not been cleared for market undergoing clinical evaluation?
- An approved IDE and IRB, if the study involves significant risk
- Informed consent from all patients
- Labeling for investigational use only
- Study monitoring
- Records and reports
Is it legal to ship an investigational new device?
Yes, only after it has received an approved IDE
What section of the QSR are IDE sponsors still required to follow?
Design Control
What is the MDUFMA
Medical Device User Fee and Modernization Act
When is an establishment required to be registered with the FDA?
When it is involved in the production and distribution of medical device for commercial distribution (sale or lease)
What is an “establishment” when discussing medical devices?
Any place of business under one management at one physical location at which a device is manufactured, assembled, or otherwise processed for commercial distribution
Who is the owner/operator?
The corporation, subsidiary, affiliated company, partnership or proprietor directly responsible for the registered establishments activities and who must register the establishment
What are FURLS?
The electronic submission of FDA’s Unified Registration and Listing System
Can an establishment register with the FDA if it has not been approved?
There is no approval of establishment registrations as they only serve to provide the FDA a list of registered products and device categories a manufacturer is operating within
What is the OCP and when was it established?
Office of Combination Products; 2002
What are the 3 types of combination products?
- drug-device
- drug-biologic
- device-biologic
How does a company determine which center is responsible for review of their combination product?
Requesting a formal designation from the FDA using a Request for Designation (RFD)
How long does the OCP have to make a determination during an RFD?
60 days
What are the means to which the FDA evaluates product safety and risks to US consumers?
Scientific review, standards, manufacturing and other inspections, advertising controls, conditional approvals, laboratory product testing, and postmarket pharmacovigilance
What is a “drug”?
A product used in the diagnosing, curing, mitigating, treating, or preventing a disease or affecting the structure or function of the body
What is a “biologic”?
A substance derived from or made with the the aid of living organisms or made of large macromolecules found in the body
Good Clinical Practices (GCP) is designed for what purpose?
GCP is an internationally accepted, scientific and ethical quality standard to ensure the design, conduct, performance, auditing, recordkeeping, analysis, and reporting of clinical trials involving human subjects
When a GCP compliance issue presents itself that has not been addressed by local GCP regulations and guidelines, what should you do?
RA professionals should consult internal and external resources, including their companies QA/RA departments, and/or local Ethics Committees (EC) or Institutional Review Boards (IRB)
Which clinical studies are subject to the ICH?
Drugs and biologics
What standards are medical devices subject to in regards to clinical trials?
ISO 14155:2011
GCPs of medical devices are unique from drugs and biologics in what major way?
They address component issuance, device malfunction, and use error documentation
Can a Class III device be approved through the 510(k) process?
Yes, but only certain class III device given that specific designation
What happens in the Preclinical phase of a clinical trial?
Testing is conducted on animals to determine toxicology, efficacy, and pharmacokinetic information
Which phase of a drug or biologic clinical trial evaluates the metabolism and pharmacological action?
Phase 1
Which phase of a drug or biologic clinical trial determines the safe dosage range and identifies side effects?
Phase 1
When is it okay to use real patients in a Phase 1 Clinical Trial study?
When the treatment may make healthy patients ill
What are the two potential sub-phases of a Phase 2 Clinical Trial study?
- Phase 2a: dosing requirements
- Phase 2b: efficacy evaluated
Which phase of a drug or biologic clinical trial is dosing given at therapeutic levels?
Phase 2
Which phase of a drug or biologic clinical trial compares the drug or biologic to commonly used treatments?
Phase 3
Which phase of a drug or biologic clinical trial confirms effectiveness?
Phase 3
What is the purpose of a Phase 3b study?
To allow a manufacturer to begin the marketing application while continuing to gather information on the drug or biologic and allows patients to continue to receive beneficial treatment until commercial availability
Which phase of a drug or biologic clinical trial evaluates postmarket activities and long term effects?
Phase 4
How many and what are the phases of a drug or biologic clinical trial?
5: Preclinical and Phase 1-4
Will the FDA accept a foreign clinical trial of a medical device?
Yes, if the clinical trial adhered to the Declarations of Helsinki ethical principles or the local governments own laws and regulations if they exceed those established in the Declaration of Helsinki
In addition to ISO 14155, what must US manufacturers conducting a clinical trial on a medical device must comply with?
All applicable sections of 21 CFR (Part 11, 50, 54, 486, 812)
Can a 510(k) require a clinical trial?
Yes
Do all PMA applications require clinical trials?
Yes
Which 2 section of the CDRH review premarket notifications (510(k))?
- Office of Device Evaluation (ODE)
- Office of In Vitro Diagnostics and Radiological Health (OIR)
What does Discovery and Concept phase of a medical device clinical trial entail?
Proof of concept and design and development (V&V)
When are preclinical trials and bench testing sufficient for establishing SE for a medical device?
When the device is an iterative improvement to technology already commercialized
What do Early Feasibility Studies focus on?
Prototype development
What phase of the medical device clinicl trial includes First-in-Human (FIH) studies?
Early Feasibility
What is the definition of an Early Feasibility study?
A limited clinical investigation of a device early in development, typically before the device design has been finalized, for a specific indication
Are Early Feasibility studies required?
No
What is the purpose of a Feasibility study?
To gain preliminary safety and effectiveness information and data on a finished or nearly finished medical device
What is the purpose of a Pivotal study?
To gain definitive safety and effectiveness evidence for a device within its specific intended use
When is a Pivotal study required?
Any time a clinical trial of a medical device is required
How many days does an IRB have to report a disagreement with the FDA on the nonsignificant risk determination of a medical device clinical trial?
5 days
In terms of ISO GCP, what is the difference between “protocol” and “clinical investigation plan (CIP”?
There is no difference
Is IRB approval required for changes to a clinical study prior to implementation at the testing cite?
Yes
How does the US GCP and ISO GCP differ in terms of clinical trial deviations?
The US GCP requires notice within 5 days of an emergency deviation
Informed consent is required under what circumstances?
Any clinical trial
How long does an investigator have to report an unanticipated adverse device effect (UADE) to the IRB and sponsor?
10 days
How long does the sponsor have to evaluate the UADE and report their findings to the FDA, IRB, and investigators?
10 days
What is a device deficiency?
Inadequacy of a medical device with respect to its identity, quality, durability, reliability, safety and performance.
Do device deficiencies need to be reported to the sponsor when there is no adverse event?
Yes, if it could have led to an adverse event
How can a device deficiency be classified?
use error, malfunction, or inadequate labeling
Which CDRH division is responsible for the development and execution of inspections as well as the review and classification of resultant establishment registration reports for IDE, PMA, PDP, HDE, 510(k), and IRBs?
Division of Bioresearch Monitoring (DBM or BIMO)
Title 21 CR 820 provides detailed requirements for medical devices manufactured under what?
cGMP, also known as QSR
What is the QbD approach?
Quality by Design, meaning a products quality cannot be ensured by testing alone
What does cGMP require to be established?
A Quality Management System (QMS)
What are the 4 Quality System Documentation elements and what is their process flow?
- Quality Manual
- Policies and SOP
- Work Instructions and Process Documents
- Quality System Records
What does it mean for a document to be controlled?
It must be reviewed, approved, and contain a revision history prior to implementation
What is the purpose of change control?
To formally document and review any changes made to a product, including manufacturing, raw material, inspection criteria, etc. prior to implementation
Where must design control activities be recorded?
Design History File
What is the core responsibility of the design and development plan?
To specify the development process, compliance with design control, and assignment of responsibilities for each activity