Regulatory Open Forum

 View Only
Expand all | Collapse all

Identifying a predicate device for different anatomical sites

  • 1.  Identifying a predicate device for different anatomical sites

    Posted 16-Aug-2017 18:17
    Team,

    The device we are working on does not have a cleared, already marketed predicate.  To date, there are laser devices for the vagina that are non-OTC and, LED devices for treating acne.  Can we use a combination of devices as predicates? The vaginal rejuvenation device with LED (new device), OTC and some aspects of the OTC device for acne treatment using LED? I know this is a stretch, but how can I explain to my colleagues and management, that this will NOT be accepted?



    Thanks,
    Laura

    ------------------------------
    Laura HoShue
    Regulatory Compliance Specialist
    Las Vegas, Nevada
    USA
    ------------------------------


  • 2.  RE: Identifying a predicate device for different anatomical sites

    Posted 17-Aug-2017 10:16
    You've got about 3 different issues here, honestly.

    First - split predicates. Yes, they are possible. However, their typical use is in situations such as using one for the "indication for use" or "intended use" and another for the technology. However, you always have to, in addition , demonstrate that your use does not raise new clinical risks as compared to the predicate. I must admit I am struggling with how treating acne and trying to "tighten" vaginal tissue could possibly have similar risks. Plus, you should search into that acne treatment, as I suspect they had some type of clinical data supporting their use before getting clearance.

    Second - OTC. OTC doesn't necessarily rely on a predicate. There are plenty of products that have "gone" OTC simply by demonstrating their safety in the hands of consumers without physician instruction. This is often done by conducting usability or clinical studies. Once again, I tend to doubt that something this novel will be able to make that shift without some type of clear study - particularly if they are trying to go the route of making some of the claims you listed in a previous post (many of which I think FDA would reject out of hand).

    Please don't take this wrong (because I know you are trying hard to get them on the right path), but it sounds more and more like someone in this company wants to have one of these "shyster products" that gets sold on late night TV or something. The space in which they want to play is 1) very complex, 2)sits in a very conservative CDRH branch and 3) is replete with litigation if something goes wrong (feel free to google vaginal mesh, morcellators for fibroids, birth control devices etc if you aren't aware of that). None of this bodes well for a largely unproven technology that seems to want to skirt the FDA oversight process to a great degree.

    My advise to you would be to be very clear on the requirements to the company, and very clear on the device intent in your FDA filings, lest you spend way too much of the rest of your life giving depositions in the eventual legal proceedings.

    g-

    ------------------------------
    Ginger Glaser RAC
    Vice-President, Engineering
    MN
    ------------------------------



  • 3.  RE: Identifying a predicate device for different anatomical sites

    Posted 17-Aug-2017 11:39
    Ginger,


    Again, I could not even begin to understand the nature of the complexity of trying to file for this device without your help, as well as others and your very informational, constructive feedback.  I thank you again for the wealth of information.  You are quite precise in all that you have stated and in your assessment.  :)

    They are trying to not mention the LED as a feature, but wish to make cosmetic claims post "clearance" (if that happens), claims that are cosmetic in nature only, but if mentioned in the 510(k), mention LED as simply an illumination source (turns on/lights up when inside the vagina). So does it matter if the claims made post clearance are purely cosmetic even though we mention in the 510(k) that it is just there to illuminate when in use? They are trying hard to make several claims, refusing to do any clinical studies and want the product out there before the predicate which is only available in UK and Canada, and under FDA review to date. 

    The push-back I am getting is "Well, what does FDA care if our claims are purely cosmetic even when we mention that the lights are simply there to "light" up?" Claims like a more supple vagina, more attractive vagina, etc.  I have advised that claims of boosting collagen are not encouraged. 

    I am at my wit's end....  

    Thanks,
    Laura

    ------------------------------
    Laura HoShue
    Regulatory Compliance Specialist
    Las Vegas, Nevada
    USA
    ------------------------------



  • 4.  RE: Identifying a predicate device for different anatomical sites

    Posted 18-Aug-2017 06:01

    According to FDA, there is no such thing as a "cosmetic claim" for a device.

    A cosmetic product has to meet the following criteria:

    The Federal Food, Drug, and Cosmetic Act (FD&C Act) defines cosmetics by their intended use, as "articles intended to be rubbed, poured, sprinkled, or sprayed on, introduced into, or otherwise applied to the human body...for cleansing, beautifying, promoting attractiveness, or altering the appearance"

    In other words, you can make "cosmetic claims" for a cream, ointment, powder, liquid etc, but not a device.

    According to FDA, the definition of a device is:

    A medical device is defined within the Food Drug & Cosmetic Act as "...an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is: recognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them, intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or intended to affect the structure or any function of the body of man or other animals, and which does not achieve any of it's primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes."

    Years ago I had a non-US client who had had a run-in with FDA over a plastic mask with slot for magnets which were supposed to be placed at the same locations as acupuncture sites. The manufacturer claim was that the mask would cause a lifting effect - same as many cosmetics. He firmly believed that the cosmetic intent freed him from having to get the device cleared, but that little clause in the device definition about affecting the structure in the device definition put it firmly in the jurisdiction of CDRH. FDA insisted in seeing a cleared 510(k) before allowing it to be marketed. He was willing initially, but dropped it after seeing the cost of testing and clearance.

    There  are some ugly warning letters on the FDA website and I warn my clients who I think might be trying to take the low road that once a warning letter is on the internet (I call it the "Hall of Shame"), a google search of the name of the CEO will forever after turn up that letter. That is usually enough to deter them from marketing a product that isn't properly cleared.

    Good luck!



    ------------------------------
    Jean Bigoney PHD, RAC
    Managing Member
    Nu Device Consulting LLC
    Murphy NC
    United States
    ------------------------------



  • 5.  RE: Identifying a predicate device for different anatomical sites

    Posted 19-Aug-2017 09:54
    I have a lot to add to this conversation but not enough time to do it.  I can say the advice you've been given is solid.  Ginger Glaser is a pro and knows her stuff.  She is one of the top reggrers in the country that I have worked with in my career, and Jean's advice is very solid too.  Look on our website for our 510(k) series for the Alert on choosing a predicate to see the  discussion of split and multiple predicates. 

    FDA does allow cosmetic climbs for many medical devices.  In fact, the regime they've adopted for many predicate families is if you go to far and make a  more substantive treatment claims you no longer qualify as a 510(k) medical device.  The underlying assumption is you are a medical device. Fact is as Jean says if you try to avoid being a device by only making cosmetic claims, FDA will find a way to assert jurisdiction and authority over you. There are plenty of warning letters to attest to that fact and we've dealt with a bunch over the years.  

    Mark DuVal, J.D., FRAPS
    President & CEO
    DuVal & Associates, P.A.


    Sent from my Verizon, Samsung Galaxy smartphone





  • 6.  RE: Identifying a predicate device for different anatomical sites

    Posted 22-Aug-2017 12:16
    As always Mark, very solid and informative feedback. I am currently awaiting news from them on what the final decision is.  I have suggested the De Novo, Pre-sub and doing their own studies to substantiate their medical claims, all of which have been frowned upon.  Their decision I suspect is to proceed with the non-LED, non-heat "predicate" device.



    Laura

    ------------------------------
    Laura HoShue
    Regulatory Compliance Specialist
    Las Vegas, Nevada
    USA
    ------------------------------



  • 7.  RE: Identifying a predicate device for different anatomical sites

    Posted 22-Aug-2017 12:10
    Great feedback Jean, thank you!  We have been going back and forth about the claims they would like to make such as tightening, etc., post "clearance" and we have had some pretty heavy arguments.  They would like to make "cosmetic" claims on the LED after clearance and only mention it as an illumination source in the 510(k) with cosmetic benefits.  It has been quite the struggle, but I have advised that I will support them with the submission of the 510(k), but with the understanding that an NSE is highly likely.  

    Thanks again for all the wonderful feedback guys.  I have learned so much from dental implants to this.  


    Laura 


    ------------------------------
    Laura HoShue
    Regulatory Compliance Specialist
    Las Vegas, Nevada
    USA
    ------------------------------



  • 8.  RE: Identifying a predicate device for different anatomical sites

    Posted 17-Aug-2017 11:30

    Laura,

     

    The FDA has a guidance document on this topic, https://www.fda.gov/downloads/medicaldevices/deviceregulationandguidance/guidancedocuments/ucm284443.pdf . It can be difficult to use to predicates, but it can be successful if prepared properly. It is especially important to set you SE table up with the primary predicate and secondary.  Defining how your device is compared to each predicate  device and what aspect of the predicate is applicable is critical.

     

    Chrissy Marek

     

     

    Please be advised that this email may contain confidential information. If you are not the intended recipient, please notify us by email by replying to the sender and delete this message. The sender disclaims that the content of this email constitutes an offer to enter into, or the acceptance of, any agreement; provided that the foregoing does not invalidate the binding effect of any digital or other electronic reproduction of a manual signature that is included in any attachment.





  • 9.  RE: Identifying a predicate device for different anatomical sites

    Posted 17-Aug-2017 11:33
    Be careful when making decisions about Predicate Devices. FDA is looking for only one predicate device to be named in any premarket submission. Obviously Reference Devices are allowed, but multiple or split predicates are a thing of the past.

    Regards,

    John




  • 10.  RE: Identifying a predicate device for different anatomical sites

    Posted 17-Aug-2017 11:43
    Thank you John.  That's what I thought.  It can get quite complicated and complex using multiple predicates.  



    Laura

    ------------------------------
    Laura HoShue
    Regulatory Compliance Specialist
    Las Vegas, Nevada
    USA
    ------------------------------



  • 11.  RE: Identifying a predicate device for different anatomical sites

    Posted 18-Aug-2017 07:43
    I agree that FDA would PREFER single predicates, but they still do take multiples on occasion (we used multiples just recently for something). You just have to be really clear on why it fits.

    g-

    ------------------------------
    Ginger Glaser RAC
    Vice-President, Engineering
    MN
    ------------------------------



  • 12.  RE: Identifying a predicate device for different anatomical sites

    Posted 19-Aug-2017 11:03

    As I understand it, FDA no longer accepts "split predicates," which it defines as one or more predicates for the technology and one or more predicates for intended use. In other words, predicates that "split" technology and intended use. FDA still accepts multiple predicates "in certain circumstances." From the guidance:

    1. Multiple Predicates

    A manufacturer may use multiple predicate devices to help demonstrate substantial equivalence in certain circumstances. Manufacturers sometimes choose to do this when combining features from two or more predicate devices with the same intended use into a single new device, when seeking to market a device with more than one intended use, or when seeking more than one indication for use under the same intended use, as described in the examples below.



    ------------------------------
    Julie Omohundro, ex-RAC (US, GS), still an MBA
    Principal Consultant
    Class Three, LLC
    Durham, North Carolina, USA
    919-544-3366 (T)
    434-964-1614 (C)
    julie@class3devices.com
    ------------------------------



  • 13.  RE: Identifying a predicate device for different anatomical sites

    Posted 19-Aug-2017 11:06
    ​...the use of a "split predicate" is inconsistent with the 510(k) regulatory standard. "Split predicate" refers to a situation in which a manufacturer is attempting to "split" the 510(k) decision making process by demonstrating that a new device has the same intended use as one marketed device while comparing the new device's technological characteristics with a second marketed device that has a different intended use.

    Of course, it's "just a guidance"...

    ------------------------------
    Julie Omohundro, ex-RAC (US, GS), still an MBA
    Principal Consultant
    Class Three, LLC
    Durham, North Carolina, USA
    919-544-3366 (T)
    434-964-1614 (C)
    julie@class3devices.com
    ------------------------------



  • 14.  RE: Identifying a predicate device for different anatomical sites

    Posted 20-Aug-2017 13:23

    Yes, split predicates-drawing an intended use from one device and the technological characteristics-is no longer allowed by FDA.  They prohibited that practice long ago.  But we have successfully argued for multiple predicates many times.  It is not easy and we have had to dig hard to find compelling reasons/arguments for FDA drawing from previous predicates and their own guidance document examples.  FDA clearly would not like to use multiple predicates if they don't have to.  But they do allow them and reference devices are very limited in their use the way FDA considers them.  We used to argue for technological "precedents" (my term, not FDA's) and say "FDA you have this vast repository of institutional knowledge in front of you, please use it to review this characteristic of my device."  And this argument usually worked. 

     

    The concept of reference device was supposed to borrow from that line of thinking, but it has become pigeon-holed (wrongfully so in my opinion) to be used only after decision Point 4 on the decision-tree, i.e. "Do the different technological characteristics of the devices raise different questions of safety and effectiveness?"  It now is only used after one has established the technological characteristics are the same and then you can use it to "Review the proposed scientific methods for evaluating new/different characteristics' effects on safety and effectiveness."  So it is limited to borrowing testing methods, not to expand the idea that FDA has been there, done that, with a given technological characteristic and has confidence in it, now it is being used elsewhere so let's profitably leverage that knowledge.  As I said, we used to get FDA to do that.   

     

     

    DuVal-signature version

     

    Mark DuVal, J.D., FRAPS

    President & CEO, DuVal & Associates, P.A.

    Suite 1820, Medical Arts Building, 825 Nicollet Mall

    Minneapolis, MN 55402

    Office:  612.338.7170 Cell:  612-325-9074 - Fax:  612.455.0665

    duval@duvalfdalaw.com 

    www.duvalfdalaw.com

     

    facebook icontwitter iconlinkedin icon

     






  • 15.  RE: Identifying a predicate device for different anatomical sites

    Posted 22-Aug-2017 12:36
    Thank you Mark, again very insightful.  I will steer away from using multiple predicates as there is nothing even cleared or marketed with the LED for that site.


    Thanks again for the wealth of information.  I am sure I will use it in time to come.


    Regards,
    Laura

    ------------------------------
    Laura HoShue
    Regulatory Compliance Specialist
    Las Vegas, Nevada
    USA
    ------------------------------



  • 16.  RE: Identifying a predicate device for different anatomical sites

    Posted 22-Aug-2017 12:30
    Right Julie.  The problem for me in using either split/multiple predicates is that while the current predicate and novel device have the same intended use(s), their technological characteristics aren't the same.  To date there are no predicates out there that I could use of LED in that anatomical site. There is no data to support it's safe use in that site, but tons by the use of laser.  It is indeed quite a messy project, especially since they are unwilling to do any studies.


    Thanks so much as always.


    Laura

    ------------------------------
    Laura HoShue
    Regulatory Compliance Specialist
    Las Vegas, Nevada
    USA
    ------------------------------



  • 17.  RE: Identifying a predicate device for different anatomical sites

    Posted 17-Aug-2017 11:42
    Thank you Chrissy.  But can that be done even when this is a novel device for that anatomical site? There are no studies on the use of LED in the vagina area.  I am not sure how to go about doing this. 


    Thanks,
    Laura

    ------------------------------
    Laura HoShue
    Regulatory Compliance Specialist
    Las Vegas, Nevada
    USA
    ------------------------------



  • 18.  RE: Identifying a predicate device for different anatomical sites

    Posted 21-Aug-2017 21:04
    ​Laura, simply put, I seriously doubt it, and I think you have one big mess on your hands.  To add to Ginger's wise advice, I would also keep my resume up to date and my eyes open...

    ------------------------------
    Julie Omohundro, ex-RAC (US, GS), still an MBA
    Principal Consultant
    Class Three, LLC
    Durham, North Carolina, USA
    919-544-3366 (T)
    434-964-1614 (C)
    julie@class3devices.com
    ------------------------------



  • 19.  RE: Identifying a predicate device for different anatomical sites

    Posted 22-Aug-2017 10:24
    My experience adding a new anatomical site to an existing Class II product was that FDA required clinical evidence of safe use in the new anatomical site.  They weren't as concerned about effectiveness for our product in the new site because effectiveness was well established across multiple other anatomical sites and multiple other very similar product lines.  Our strategy worked because the predicate we used for the 510(k) was the same device used in our clinical literature review (no new clinical data needed), and it was our company's device.  So there were lots of things in our favor, which it does not sound like is the case for you project.

    ------------------------------
    John Van Hoven
    Colorado, United States
    ------------------------------



  • 20.  RE: Identifying a predicate device for different anatomical sites

    Posted 22-Aug-2017 12:02
    Thank you John. The predicate they are proposing to use is the same anatomical site, except with new technological features: LED light and heat.  I am guessing that if we were to use a predicate device that is laser based, instead of LED, we would still have to show through studies that LED is safe, even though it is less harsh than laser. 

    I am trying to figure out ways to get this thing going.  


    Thanks,
    Laura

    ------------------------------
    Laura HoShue
    Regulatory Compliance Specialist
    Las Vegas, Nevada
    USA
    ------------------------------



  • 21.  RE: Identifying a predicate device for different anatomical sites

    Posted 23-Aug-2017 10:31
    If your company is willing to spend a little money, I'd suggest contacting one of the well-established Regulatory-Legal firms (some of whom have members that post on this list) who have quite a bit of experience putting together these approaches. First, they will have great experience with some strategies that are proven to work, and second, they will probably tell you if there is or isn't a chance of it happening.

    Just knowing the direction you are going can be really helpful. I tend to use them to "double-check" big strategy decisions myself.

    g-

    ------------------------------
    Ginger Glaser RAC
    Vice-President, Engineering
    MN
    ------------------------------



  • 22.  RE: Identifying a predicate device for different anatomical sites

    Posted 24-Aug-2017 16:09
    Thank you Ginger for that bit of advice.  This is what I think I will advise them to do, and that is IF they are willing to spend the money.  At this point, not so much considering that they want to go the most "cost-efficient" route of submitting a 510(k) for a non-SE device, rather than the clinical study route for the novel device.


    Fingers crossed.


    Laura

    ------------------------------
    Laura HoShue
    Regulatory Compliance Specialist
    Las Vegas, Nevada
    USA
    ------------------------------



  • 23.  RE: Identifying a predicate device for different anatomical sites

    Posted 23-Aug-2017 13:14
    Well then, bless their hearts.  A device that is effective in one or more anatomical sites won't necessarily  be effective at another anatomical site, for pretty much the same reasons it won't necessarily be safe at another anatomical site.

    ------------------------------
    Julie Omohundro, ex-RAC (US, GS), still an MBA
    Principal Consultant
    Class Three, LLC
    Durham, North Carolina, USA
    919-544-3366 (T)
    434-964-1614 (C)
    julie@class3devices.com
    ------------------------------



  • 24.  RE: Identifying a predicate device for different anatomical sites

    Posted 22-Aug-2017 12:37
    Thanks Julie.  Agreed.  LOL.

    ------------------------------
    Laura HoShue
    Regulatory Compliance Specialist
    Las Vegas, Nevada
    USA
    ------------------------------