遗传性耳聋相关基因突变检测试剂的注册现状及临床试验设计的关注点

随着遗传性耳聋相关基因的研究进展以及检测技术的发展,越来越多的新基因、新位点以及新技术应用到耳聋相关基因检测的体外诊断试剂领域。文章对已批准产品以及此类产品在注册申报中临床试验设计的关注点作简要阐述。     

无菌医疗器械包装验证主要物理性能的检测要点及不合格样品实例

无菌医疗器械在使用前均需要有包装作为无菌屏障进行保存或运输。包装是无菌医疗器械的重要组成部分,其质量直接影响内部医疗器械产品的质量。在无菌植入类医疗器械产品注册时,会要求厂家提供包装验证相关的资料,而合理全面的包装验证资料不仅能够保证产品顺利通过注册,而且可保证医疗器械产品的安全有效性。     

电解质分析仪产品安全有效性研究

根据《医疗器械注册与备案管理办法》《关于公布医疗器械注册申报资料要求和批准证明文件格式的公告》及相关指导原则、国家/行业标准的要求,结合注册申请人的注册申报资料,从注册审评的角度来对电解质分析仪产品的综述和非临床资料、说明书等安全有效性方面进行分析研究,希望对注册申请人注册申报该类产品有所帮助。     

如何开展医疗器械注册检验

<正>"注册证是进入市场的入场券"。在我国,第二、三类医疗器械要投入销售、使用,须先按照《医疗器械注册管理办法》或《体外诊断试剂注册管理办法》的相关规定向食药监部门申请产品注册,取得医疗器械注册批件,从而获得进入市场的资格。而第二、三类医疗器械产品的注册申请,需生产企业向食药监部门提交系列技术资料,包括注册检验报告、临床评价报告等。其中,注册检验是产品上市前评价的第一个主要环节。《医疗器械注册     

半自动化学发光免疫分析仪注册审评要点分析

基于医疗器械法规和配套指导性文件的更新，根据现行相关法规指南的要求，从注册审评的角度出发，对半自动化学发光免疫分析仪的综述资料、非临床资料、产品说明书等方面进行要点分析，以期为企业申请注册该类产品时提供参考。     

我国医疗器械注册制度与美国510K注册的比较

文章围绕着我国医疗器械产品注册为主线的监督管理制度设计中出现的一些问题．与美国FDA实行的医疗器械注册制度进行了比较。分析了在医疗器械注册中进行“实质性等同”审批的基础要素,提出了我国医疗器械注册的制度设计问题及亟待解决的一些基本要点。     

医疗器械注册产品标准编制要求和注意事项简

目的：规范医疗器械注册产品标准的编制要求,提高编制水平。方法：依据《国家医疗器械注册管理办法》、《医疗器械标准管理办法》、《注册产品标准编写规范》等法规探讨对注册产品标准的编制要求、执行现状和常见错误。结果与结论：注册产品标准的编制存在较多不规范之处,应加强医疗器械标准化管理工作,特别是对试验方法验证工作的管理。     

博鳌乐城先行区真实世界数据支持医疗器械上市前临床评价的应用探讨

海南博鳌乐城国际旅游先行区真实世界数据,具有支持医疗器械注册上市前临床评价的优势。该研究结合医疗器械临床评价相关要求,基于前期试点器械的实践经验,从审评角度对博鳌乐城真实世界数据在医疗器械上市前临床评价路径中的应用进行探讨,提出真实世界研究设计应考虑的要素及数据质量评价方式,以期为注册申请人合理使用真实世界数据助力申报器械注册上市提供参考。     

灸疗器具产品审评要点分析

灸疗器具类产品按照医疗器械分类目录，属于第二类无源医疗器械管理范围。文章从灸疗器具注册单元划分、产品名称、结构组成、原材料控制、技术要求、生物学特性研究、稳定性研究、临床评价资料、产品说明书和标签要求等方面对该产品的技术审评要点进行了梳理和归纳，为产品注册申请人和相关审评人员提供参考。     

1996年7～12月国外医疗器械产品在华注册情况（一）

随着改革开放，国外高科技医疗器械产品在我国的销售量日渐增多。我刊将陆续刊载国外医疗器械产品在我国注册情况．供购买决策时参考。     

On statistical analysis for placebo-challenging designs in clinical trials

In clinical trials, appropriate designs are often chosen to address scientific/medical questions of particular interest to the investigator. For a chosen statistical design, however, standard statistical procedures may not be applicable owing to the nature of the design. In this paper we examine statistical methods for analysis of data collected from a placebo-challenging design which is often considered for assessment of the efficacy of drug products for indication of erectile dysfunction. An example concerning a clinical trial conducted with 120 male patients with erectile dysfunction is used to illustrate the derived statistical methods. Some recommendations to the randomization procedure for the study design of this kind are also made.     

我国医疗器械注册审批中临床试验管理研究

我国医疗器械注册审批中,因临床试验而影响注册审批速度。通过与欧美医疗器械临床试验比较,总结我国医疗器械在临床试验中存在的一些问题并以具体实例加以分析,提出解决我国临床试验问题的相关建议。     

从技术审评角度谈医疗器械临床试验

从医疗器械技术审评的角度对医疗器械临床试验常见问题进行探讨,期望能为注册申请人开展临床试验以及技术审评人员对临床试验资料进行技术审评提供一定借鉴。     

内蒙古某三甲医院临床试验医疗器械使用安全现状分析

目的 了解临床试验医疗器械使用安全现状,分析其影响因素,提出建议,为提高临床试验医疗器械管理水平提供参考。方法 收集内蒙古某三甲医院2018年1月1日-2021年12月31日上报的31项医疗器械临床试验项目中与患者安全相关的186份研究报告,对相关数据进行描述性分析。结果 不良事件报告占28.5%,严重不良事件报告占47.8%,器械缺陷报告占0.6%,方案偏离报告占23.1%;患者主要年龄段为>50岁～70岁(57.0%);心内科项目数量占比(51.6%)和报告数量占比(50.5%)均最大;患者安全事件与试验器械有关的报告有52份(28.0%);有合并症和并发症的患者有119人(63.9%)。结论 临床试验医疗器械使用安全与器械本身、研究者能力、方案执行程度、患者自身等因素有关。应加强临床试验项目质量管理医疗器械规范化管理、使用安全管理以及患者自身管理。     

真实世界研究在医疗器械临床评价中的应用

该文通过阐明真实世界研究(RWS)的相关概念,以及分析RWS与随机对照试验(RCT)的区别及联系、医疗器械临床评价的发展趋势,并结合RWS在医疗器械临床评价中的发展与应用,剖析将真实世界数据(RWD)应用于医疗器械临床评价中的各类情形,同时结合实际指出RWS在开展过程中存在的问题,探讨如何利用RWS在医疗器械临床评价中...     

Mise sur le marché européen des dispositifs médicaux innovants à haut risque : l’efficacité clinique et la sécurité sont-elles garanties ?

BackgroundInnovative high-risk medical devices, such as new types of heart valves or hip prostheses, become available on the European market more rapidly than in USA. This is due to the European legislation allowing early marketing of innovative high-risk medical devices before high-quality clinical evidence is obtained from randomized controlled trials.MethodsWe studied the premarket clinical evaluation of innovative high-risk medical devices in Europe compared with the USA. We also discussed patient safety and the transparency of information. The literature and regulatory documents were checked. Representatives from industry, competent authorities, notified bodies, ethics committees, and health technology assessment agencies were consulted.ResultsIn contrast to the US, there is no requirement in Europe to demonstrate the clinical efficacy of high-risk devices in the premarket phase. For the patient, this implies earlier access to innovative technology, but at the risk of potential safety issues. At this moment, European requirements for clinical studies are lower for medical devices than for drugs, and data from premarket clinical trials are scarce or remain unpublished. The European Medical Device Directives are currently being reworked.ConclusionsFor innovative high-risk devices, and while awaiting a reworked Medical Device Directive, patient risk should be minimized by limiting the market introduction of novel high-risk devices with minimal clinical data to physicians with the necessary training and expertise. The new European legislation should require the premarket demonstration of clinical efficacy and safety, using a randomized controlled trial if possible, and a transparent clinical review, preferably centralized.     

Clinical trials in the new millennium

Since the introduction of the randomized clinical trial (RCT) over 50 years ago, this method has become the corner stone for evaluating new pharmacologic or biologic agents with many disease areas benefiting. There are numerous examples demonstrating beneficial interventions as well as others either not beneficial or harmful. Statistical methodology for clinical trials has grown rapidly. Advances in information technology for data collection have allowed trials to be conducted around the world. Academia, industry and government have worked in partnership to conduct RCTs. Despite these many RCT achievements, the most interesting and challenging era of clinical trials lies ahead of us. With the human genome now sequenced, we face a new set of challenges to transform vast amounts of data into useful information. The post-genomics era will better identify the disease mechanism and thus help design better treatments, and be more selective in screening patients, yielding more efficient clinical trials. For some areas of medicine, such as medical devices, standards of acceptance and regulatory approval are changing. Other areas, such as medical procedures and alternative medicines, are generally not well evaluated and could benefit greatly from a wider use of RCT methodology. As the ICH guidelines facilitate and encourage international clinical trials, the scientific and ethical dimension of conducting trials in Third World countries are raised. For example, Western society's best standard of care may not be available or affordable to these countries as the control Western investigators should not exploit patients in the Third World. Those and many other challenges face us in the decade ahead. It is truly an exciting time with new opportunities for the RCT to contribute to medicine and health care or prevention.     

Die 12. Novelle des Arzneimittelgesetzes in Deutschland

The European Union's so called Clinical Trials Directive 2001/20/EC was implemented in national law in Germany in August 2004, leading to the 12th amendment of the German Drug Law (Arzneimittelgesetz). The directive is intended to harmonize the clinical trial's regulatory environment across the European Union and to improve protection of human subjects. It lays down the principles and guidelines of Good Clinical Practice (GCP). As the regulation applies to all clinical trials on medicinal products for human use, and as only non-interventional studies are excluded, academic, investigator-initiated clinical trials will also have to comply with the EU clinical trials directive implemented in the German Drug Law. In an investigator-initiated trial in which the investigator takes the responsibility of a sponsor, the investigator-sponsor must take total legal and financial responsibility for the clinical trial. Since publicly funded clinical trials make a large contribution to improved care, concern has been expressed that non-commercial research projects will be reduced and the vital medical research conducted at academic institutions curtailed. Nonetheless GCP ensures a valid study design, qualified data management, analysis and monitoring of the trial and thereby promotes more valid data and protection of study participants. The trials are more likely to lead to reliable results leading to new therapies, strategies or a better understanding of diseases. What is needed, therefore, is an increase in public funding and the establishment of clinical trial units/organizations associated with the universities or hospitals where independent researchers have the possibility to obtain theoretical advice and practical help, professional training and support. In the end, the directive may serve as a stimulus to build a better national research environment and to promote public funding, and may lead to fewer but more valid clinical trials.     

Randomized clinical trials in surgery.

When it is well conducted, a randomized clinical trial provides the strongest evidence available for evaluating the comparative effectiveness of the interventions tested. Over the last two generations, we have learned much about various devices for strengthening them and about methods of avoiding pitfalls in their design, execution, analysis, and reporting. In a trial, we seek evidence for a causal link between treatments and observed outcomes. Because the controlled trial depends on an argument based on exclusion (i.e., no other causes or differences affected the experimental groups), we strengthen its inference by taking steps to exclude any such differences. This article discusses a number of issues that deserve consideration: problems and generalizability, devices for strengthening trials, issues of power and sample size, the relationship between study design and reported gains, when to undertake a trial, the role of collaborative trials, and ways to make trials more feasible in clinical settings.     

医疗器械安全质量管理问题探讨

目的分析医疗器械上市前临床试用或验证中的缺陷,探讨医疗器械上市后的安全质量管理评价。方法采取定性分析与定量分析相结合的方法,分析医疗器械上市前临床试用中的缺陷以及医疗器械安全质量管理的途径。结果医疗器械安全质量通过医疗器械不良事件报告、医疗器械召回和医疗器械追踪得以实现。结论医疗器械进入市场后的不良事件报告、召回制度和追踪制度,是医疗器械进入市场后对其安全性、有效性和质量管理的重要环节。