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  • 1.  Clinical trials of combination products-EU requirements

    This message was posted by a user wishing to remain anonymous
    Posted 13-Jul-2021 17:08
    This message was posted by a user wishing to remain anonymous

    Hi Everyone, 

    Would welcome feedback from people with experience in clinical trials involving combination products in the EU (eg. products like insulin pens). 

    The primary mechanism of action of our product is achieved by the medicinal product rather than the device. Based on this, we are submitting a clinical trial under the current clinical trial Directive. 

    During the trial, we intend to introduce a new pen system to replace the syringes and needles. The new pen system is a non-integral drug-device combination product that includes BWFI cartridges and a single-use reconstitution device to be used together with the multidose vials of our IMP. Commercially available needles for the pen injector and a reusable injection pen are used for the administration of the reconstituted drug.

    The medicinal product, the reconstitution device and the BWFI cartridge will be packaged together in the same pack. However, the reusable pen injector will be packaged separately. 

    The injection pen and the reconstitution device are both class IIb, non-invasive devices; however, both device components are not currently commercialized in Europe and therefore do not have a CE mark.


    Uncertainties:
    • Is it possible to introduce a new injection pen system during the clinical trial via a substantial amendment to the study protocol, IMPD and IB?
    • Would Member State competent authorities expect a separate clinical investigation of the device components to have been completed prior to including them in the proposed clinical trial?
    • It is my understanding that the requirement for a CE mark for a device is strictly for commercial purposes and therefore the device/device components in the context of a clinical trial do not require a CE mark. Is this interpretation correct?

    Would welcome any feedback from folks with medical device expertise. 

    Thank you in advance


  • 2.  RE: Clinical trials of combination products-EU requirements

    Posted 14-Jul-2021 05:02
    Dear Colleague,

    I guess the main point is the following, does the medicinal component have marketing authorisation (MA) in the EU in any presentation?

    In case it has, the clinical investigation (CI) will target therapeutic equivalency (dosing accuracy, usability, safety). In this case I would consider the planned investigation to be a clinical investigation of an authorised medicinal product administered by new medical device, in line with MDR 2017/745. The CI targets the approval of a variation of an authoriosed medicinal product's new presentation. 

    In case the medicinal component does not have MA in the EU, this investigation would be a pharmaceutical clinical investigation targeting the marketing authorisation approval of a new medicinal product applied by a certain medical device.

    regards


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    Peter Mikó M.D
    ArtPharm Ltd.
    Gyermely
    Hungary
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  • 3.  RE: Clinical trials of combination products-EU requirements

    This message was posted by a user wishing to remain anonymous
    Posted 14-Jul-2021 08:49
    This message was posted by a user wishing to remain anonymous

    Thank you for your feedback and comments. The medicinal product does not have a MA within the EU for any indication. However, the medicinal product does have FDA approval in another indication. 

    In our case (from the EU perspective), we would fit the second scenario described above "a pharmaceutical clinical investigation targeting the marketing authorisation approval of a new medicinal product applied by a certain medical device".

    Are we incorrect to be proposing a clinical trial under the clinical trial Directive in the EU?


  • 4.  RE: Clinical trials of combination products-EU requirements

    Posted 14-Jul-2021 12:01
    Dear Colleague, I think, yes. Take into consideration the attached documents. In my view, it is important to be ready for the evaluation of the injection pen and the reconstitution device according to the MDR's Art. 117. I guess, the lack of CE-mark for non-integrated medical devices might be acceptable for the EMA/NCAs, but you need to prove, that the devices cannot be used for injection of other pharmaceuticals. Consider usability. I would appreciate, if you let me know your opinion about the usefulness of my advices, when you receive the approval for the clinical investigations. 

    regards

     

    ------------------------------
    Peter Mikó M.D
    ArtPharm Ltd.
    Gyermely
    Hungary
    ------------------------------



  • 5.  RE: Clinical trials of combination products-EU requirements

    Posted 14-Jul-2021 15:58
    I am sorry, I made a mistake. The answer for the question "Are we incorrect to be proposing a clinical trial under the clinical trial Directive in the EU?" I have forgotten to add this. Check this information Clinical trials - Regulation EU No 536/2014 | Public Health (europa.eu)  and Presentation - Key features and objectives of Regulation EU No 536 /014 - What is new, what has changed? (Laura Pioppo) (europa.eu)

    regards


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    Peter Mikó M.D
    ArtPharm Ltd.
    Gyermely
    Hungary
    ------------------------------



  • 6.  RE: Clinical trials of combination products-EU requirements

    Posted 14-Jul-2021 16:34
    Edited by Cheng Chen 14-Jul-2021 16:35
    If the principle intended action of the combination product is achieved by the medicine, the entire product is regulated as a medicinal under Directive 2001/83/EC or Regulation (EC) No 726/2004. Medical devices that are co-packaged or obtained separately must be CE marked in accordance with the medical device legislation.

    I think some NCA will likely ask for the certificate for the device to be used in the drug/biologics clinical trials, if the device is not CE-marked, then it will be considered as a experimental/invesitgational product, therefore, its use in human research needs to be filed to the authorities.


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    Cheng Chen
    Nowa Wola
    Poland
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