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Iwamoto S, Cavanaugh K, Malone M, Lottes A, Thatcher R, Kumar K, Rowland S, Fearnot N, Uchida T, Iwaishi C, Senshu K, Konishi R, Ikeda K, Suzuki Y, Ikeno F, Tamura A, Ho M, Ohashi M, Katayama H, Krucoff MW. Global Medical Device Clinical Trials Involving Both the United States and Japan: Key Considerations for Development, Regulatory Approval, and Conduct. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:67-74. [PMID: 36870799 DOI: 10.1016/j.carrev.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/16/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
As medical device development becomes increasingly global, the opportunities and potential advantages offered by international clinical trial and regulatory approval strategies are also growing. In particular, medical device clinical trials involving sites in both the United States and Japan and intended to support marketing in both countries may warrant particular consideration, given the similarities in their regulatory systems, patients and clinical practice patterns, and market sizes. Since 2003, the US-Japan Harmonization By Doing (HBD) initiative has been focused on identifying and addressing clinical and regulatory barriers to medical devices access in both countries via collaboration between governmental, academic, and industry stakeholders. Through the efforts of HBD participants, US-Japanese clinical trials have been conducted and the resulting data have supported regulatory approval for marketing in both countries. Based on these experiences, this paper outlines some of the key factors to consider when developing a global clinical trial involving US and Japanese participation. These considerations include the mechanisms for consultation with regulatory authorities on clinical trial strategies, the regulatory framework for clinical trial notification and approval, recruitment and conduct of clinical sites, and lessons learned from specific US-Japanese clinical trial experiences. The goal of this paper is to promote global access to promising medical technologies by assisting potential clinical trial sponsors in understanding when an international strategy may be appropriate and successful.
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Affiliation(s)
- Shin Iwamoto
- Office of Medical Devices Policy, Policy Planning Division for Pharmaceutical Industry Promotion and Medical Information Management, Health Policy Bureau, Ministry of Health, Labour, and Welfare, Chiyoda-ku, Tokyo 100-8916, Japan.
| | - Kenneth Cavanaugh
- Office of Health Technology II: Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Misti Malone
- Office of Health Technology II: Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Aaron Lottes
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47906, USA.
| | - Robert Thatcher
- Diaxamed, 200C Patewood Dr. Suite 4125, Greenville, SC 29615, USA.
| | - Katherine Kumar
- 4C Medical Technologies, Inc., 6655 Wedgwood Rd N., Suite 160, Maple Grove, MN 55311, USA.
| | - Steve Rowland
- OrbusNeich Medical Trading Inc., 5363 NW 35th Avenue, Fort Lauderdale, FL 33309, USA.
| | - Neal Fearnot
- Cook Advanced Technologies, 1400 Cumberland Avenue, West Lafayette, IN 47906, USA.
| | - Takahiro Uchida
- JOMDD, Inc., Nihonbashi-Honcho #601, Chuo-Ku, Tokyo 103-0023, Japan
| | - Chie Iwaishi
- Edwards Lifesciences, One Edwards Way, Irvine, CA 92614, USA.
| | | | - Ryo Konishi
- Terumo Corporation, Shinjuku-ku, Tokyo 163-1450, Japan.
| | - Koji Ikeda
- Department of Development Promotion, Clinical Research, Innovation and Education Center, Tohoku University Hospital (CRIETO), Sendai, Miyagi 980-8574, Japan.
| | - Yuka Suzuki
- Department of International Affairs, Clinical Research, Innovation and Education Center, Tohoku University Hospital (CRIETO), Sendai, Miyagi 980-8574, Japan.
| | - Fumiaki Ikeno
- Stanford Byers Center for Biodesign, Stanford University, Stanford, CA 94305, USA.
| | - Atsushi Tamura
- Clinical Research Center in Hiroshima, Hiroshima University Hospital, Minami-ku, Hiroshima 734-8551, Japan.
| | - Mami Ho
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency (PMDA), Chiyoda-ku, Tokyo 100-0013, Japan.
| | - Moe Ohashi
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency (PMDA), Chiyoda-ku, Tokyo 100-0013, Japan.
| | - Hiroshi Katayama
- Research Management Division, Clinical Research Support Office, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan.
| | - Mitchell W Krucoff
- Duke University Medical Center/Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27715, USA.
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Simonato M, Vemulapalli S, Ben-Yehuda O, Krucoff M. Reply. JACC Cardiovasc Interv 2022; 15:1387-1388. [DOI: 10.1016/j.jcin.2022.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 10/17/2022]
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3
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Simonato M, Vemulapalli S, Ben-Yehuda O, Wu C, Wood L, Popma J, Feldman T, Krohn C, Hardy KM, Guibone K, Christensen B, Alu MC, Chen S, Ng VG, Chau KH, Shahim B, Vincent F, MacMahon J, James S, Mack M, Leon MB, Thourani VH, Carroll J, Krucoff M. Minimum Core Data Elements for Evaluation of TAVR: A Scientific Statement by PASSION CV, HVC, and TVT Registry. JACC Cardiovasc Interv 2022; 15:685-697. [PMID: 35367168 DOI: 10.1016/j.jcin.2022.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/03/2021] [Accepted: 01/10/2022] [Indexed: 01/07/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is the standard of care for severe, symptomatic aortic stenosis. Real-world TAVR data collection contributes to benefit/risk assessment and safety evidence for the U.S. Food and Drug Administration, quality evaluation for the Centers for Medicare and Medicaid Services and hospitals, as well as clinical research and real-world implementation through appropriate use criteria. The essential minimum core dataset for these purposes has not previously been defined but is necessary to promote efficient, reusable real-world data collection supporting quality, regulatory, and clinical applications. The authors performed a systematic review of the published research for high-impact TAVR studies and U.S. multicenter, multidevice registries. Two expert task forces, one from the Predictable and Sustainable Implementation of National Cardiovascular Registries/Heart Valve Collaboratory and another from The Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry convened separately and then met to reconcile a final list of essential data elements. From 276 unique data elements considered, unanimous consensus agreement was achieved on 132 "core" data elements, with the most common reasons for exclusion from the minimum core dataset being burden or difficulty in accurate assessment (36.9%), duplicative information (33.3%), and low likelihood of affecting outcomes (10.7%). After a systematic review and extensive discussions, a multilateral group of academicians, industry representatives, and regulators established 132 interoperable, reusable essential core data elements essential to supporting more efficient, consistent, and informative TAVR device evidence for regulatory submissions, safety surveillance, best practice, and hospital quality assessments.
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Affiliation(s)
| | | | - Ori Ben-Yehuda
- University of California-San Diego, San Diego, California, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Changfu Wu
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Larry Wood
- Edwards Lifesciences, Irvine, California, USA
| | | | - Ted Feldman
- Edwards Lifesciences, Irvine, California, USA
| | - Carole Krohn
- The Society of Thoracic Surgeons, Chicago, Illinois, USA
| | | | - Kimberly Guibone
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York, USA
| | - Shmuel Chen
- Columbia University Irving School of Medicine, New York, New York, USA
| | - Vivian G Ng
- Columbia University Irving School of Medicine, New York, New York, USA
| | - Katherine H Chau
- Columbia University Irving School of Medicine, New York, New York, USA
| | - Bahira Shahim
- Cardiovascular Research Foundation, New York, New York, USA
| | | | - John MacMahon
- Mitre Medical Corporation, Morgan Hill, California, USA
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Michael Mack
- Baylor Scott and White Health, Dallas, Texas, USA
| | - Martin B Leon
- Columbia University Irving School of Medicine, New York, New York, USA
| | | | - John Carroll
- University of Colorado School of Medicine, Denver, Colorado, USA
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4
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Simonato M, Vemulapalli S, Ben-Yehuda O, Wu C, Wood L, Popma J, Feldman T, Krohn C, Hardy KM, Guibone K, Christensen B, Alu MC, Chen S, Ng VG, Chau KH, Shahim B, Vincent F, MacMahon J, James S, Mack M, Leon MB, Thourani VH, Carroll J, Krucoff M. Minimum Core Data Elements for Evaluation of TAVR: A Scientific Statement by PASSION CV, HVC, and TVT Registry. Ann Thorac Surg 2022; 113:1730-1742. [PMID: 35367049 DOI: 10.1016/j.athoracsur.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/10/2022] [Indexed: 11/20/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is the standard of care for severe, symptomatic aortic stenosis. Real-world TAVR data collection contributes to benefit/risk assessment and safety evidence for the U.S. Food and Drug Administration, quality evaluation for the Centers for Medicare and Medicaid Services and hospitals, as well as clinical research and real-world implementation through appropriate use criteria. The essential minimum core dataset for these purposes has not previously been defined but is necessary to promote efficient, reusable real-world data collection supporting quality, regulatory, and clinical applications. The authors performed a systematic review of the published research for high-impact TAVR studies and U.S. multicenter, multidevice registries. Two expert task forces, one from the Predictable and Sustainable Implementation of National Cardiovascular Registries/Heart Valve Collaboratory and another from The Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry convened separately and then met to reconcile a final list of essential data elements. From 276 unique data elements considered, unanimous consensus agreement was achieved on 132 "core" data elements, with the most common reasons for exclusion from the minimum core dataset being burden or difficulty in accurate assessment (36.9%), duplicative information (33.3%), and low likelihood of affecting outcomes (10.7%). After a systematic review and extensive discussions, a multilateral group of academicians, industry representatives, and regulators established 132 interoperable, reusable essential core data elements essential to supporting more efficient, consistent, and informative TAVR device evidence for regulatory submissions, safety surveillance, best practice, and hospital quality assessments.
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Affiliation(s)
| | | | - Ori Ben-Yehuda
- University of California-San Diego, San Diego, California; Cardiovascular Research Foundation, New York, New York
| | - Changfu Wu
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Larry Wood
- Edwards Lifesciences, Irvine, California
| | | | | | - Carole Krohn
- The Society of Thoracic Surgeons, Chicago, Illinois
| | | | | | | | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York
| | - Shmuel Chen
- Columbia University Irving School of Medicine, New York, New York
| | - Vivian G Ng
- Columbia University Irving School of Medicine, New York, New York
| | - Katherine H Chau
- Columbia University Irving School of Medicine, New York, New York
| | - Bahira Shahim
- Cardiovascular Research Foundation, New York, New York
| | | | | | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala, Sweden
| | | | - Martin B Leon
- Columbia University Irving School of Medicine, New York, New York
| | | | - John Carroll
- University of Colorado School of Medicine, Denver, Colorado
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Iwamoto S, Ohashi M, Shirato H, Ho M, Malone M, Cavanaugh K. Japan-USA orbital atherectomy for calcific coronary lesions: COAST study, a Harmonization by Doing proof-of-concept: The Japanese and US regulatory perspective. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:118-119. [PMID: 34483075 DOI: 10.1016/j.carrev.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
Regulatory approval processes for medical devices in Japan and the United States of America (US) often require similar clinical trials to establish safety and effectiveness. The Harmonization by Doing (HBD) program provides a collaborative environment for communication between regulators, academics and industry, facilitating the design and conduct of US/Japanese clinical trials supporting approval in both countries.
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Affiliation(s)
- Shin Iwamoto
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; U.S. & Japan Medical Device Harmonization by Doing (HBD) Group, USA.
| | - Moe Ohashi
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; U.S. & Japan Medical Device Harmonization by Doing (HBD) Group, USA.
| | - Haruki Shirato
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; U.S. & Japan Medical Device Harmonization by Doing (HBD) Group, USA.
| | - Mami Ho
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan; U.S. & Japan Medical Device Harmonization by Doing (HBD) Group, USA.
| | - Misti Malone
- U.S. Food and Drug Administration, Silver Spring, MD, USA; U.S. & Japan Medical Device Harmonization by Doing (HBD) Group, USA.
| | - Kenneth Cavanaugh
- U.S. Food and Drug Administration, Silver Spring, MD, USA; U.S. & Japan Medical Device Harmonization by Doing (HBD) Group, USA.
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6
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Martinsen BJ, Kumar K, Saito S, Sharma SK, Ikeno F, Fearnot NE, Shlofmitz RA, Thatcher R, Krucoff MW. Japan-USA orbital atherectomy for calcific coronary lesions: COAST study, Hharmonization by Doing proof-of-concept. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:112-117. [PMID: 34607786 DOI: 10.1016/j.carrev.2021.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
Effective treatment strategies and medical devices continue to be needed in Japan and the United States of America (US) to mitigate the growing burden of cardiovascular disease and coronary heart disease. Unfortunately, there can be a delay in gaining cardiovascular device approval in Japan after a device has already been approved and is in use in the US. The Harmonization by Doing (HBD) program; however, can eliminate this delay and reduce the cost of completing a clinical trial in Japan. The HBD proof-of-concept study, COAST, resulted in approval of the Diamondback 360® Coronary Orbital Atherectomy System Micro Crown simultaneously in Japan and the US on the same day. Subsequently, the Diamondback 360® Coronary OAS Classic Crown also received approval in Japan. The COAST study provides further evidence that global clinical trials via HBD for medical devices are practical and advantageous.
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Affiliation(s)
- Brad J Martinsen
- Department of Clinical and Scientific Affairs, Cardiovascular Systems, Inc., St. Paul, MN, USA; U.S. & Japan Medical Device Harmonization by Doing (HBD) Group Member.
| | - Katherine Kumar
- U.S. & Japan Medical Device Harmonization by Doing (HBD) Group Member.
| | - Shigeru Saito
- Division of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan.
| | - Samin K Sharma
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Fumiaki Ikeno
- U.S. & Japan Medical Device Harmonization by Doing (HBD) Group Member; Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Neal E Fearnot
- U.S. & Japan Medical Device Harmonization by Doing (HBD) Group Member.
| | | | - Robert Thatcher
- U.S. & Japan Medical Device Harmonization by Doing (HBD) Group Member.
| | - Mitchell W Krucoff
- U.S. & Japan Medical Device Harmonization by Doing (HBD) Group Member; Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA.
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Miyoshi T, Kato A, Yasukochi S, Takahashi S, Ho M, Yamamoto H, Inuzuka R, Kim SH, Sakamoto K, Kobayashi T. Pediatric Medical Devices - Survey of Pediatric Cardiologists and Cardiovascular Surgeons in Japan. Circ Rep 2021; 3:153-160. [PMID: 33738348 PMCID: PMC7956883 DOI: 10.1253/circrep.cr-20-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: In Japan, the choice of pediatric medical devices is limited because of 2 "device lag" problems: Japan lags behind the USA and Europe in device development, and development of pediatric devices lags behind that of adult devices. We aimed to identify the problems with and impediments to pediatric medical device development as recognized by pediatric physicians in Japan. Methods and Results: A voluntary survey of pediatric medical devices for all council members of the Japanese Society of Pediatric Cardiology and Cardiac Surgery was conducted in 2019. The response rate was 47.1% (154/327). The respondents were 115 pediatric cardiologists (74.7%) and 39 cardiovascular surgeons (25.3%). Approximately 90% believed that difficulties in development existed. Approximately 70% were dissatisfied with the pediatric medical devices currently available in Japan, which was a result of the unavailability of medical devices approved overseas, few types and sizes, and off-label use. Factors that hindered the development of pediatric medical devices included anatomical issues specific to children with congenital heart disease, as well as system issues such as lack of corporate profitability, development cost, and amount of time for development. Conclusions: Pediatric cardiologists and cardiovascular surgeons regard "device lag" and "off-label use" in Japan as important hindrances to the delivery of better medical care for pediatric patients with congenital heart disease.
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Affiliation(s)
- Takekazu Miyoshi
- Division of Project Management, Department of Clinical Research Promotion, Clinical Research Center, National Center for Child Health and Development Tokyo Japan
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center Suita Japan
| | | | | | - Mami Ho
- Pharmaceuticals and Medical Devices Agency Tokyo Japan
| | - Haruko Yamamoto
- Department of Advanced Medical Technology Development, National Cerebral and Cardiovascular Center Suita Japan
| | - Ryo Inuzuka
- Department of Pediatrics, the University of Tokyo Hospital Tokyo Japan
| | - Sung-Hae Kim
- Department of Cardiology, Shizuoka Children's Hospital Shizuoka Japan
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Shizuoka Children's Hospital Shizuoka Japan
| | - Tohru Kobayashi
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development Tokyo Japan
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Takahashi S, Iwasaki K, Shirato H, Ho M, Umezu M. Comparison of supportive regulatory measures for pediatric medical device development in Japan and the United States. J Artif Organs 2020; 24:90-101. [PMID: 33079285 PMCID: PMC7889561 DOI: 10.1007/s10047-020-01216-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
Further development of medical devices for children is required in Japan, but the development of such devices is delayed compared to that of medical devices for adults. Herein, we investigated policies for advancing the development of pediatric medical devices in Japan and the United States. Considering the achievements of each policy, we proposed a strategy to promote further development of pediatric medical devices in Japan. We investigated policies for supporting the development of pediatric medical devices and approved cases in Japan and the United States by searching contents of websites of regulatory bodies and other related administrations, and scientific papers. We found the main six policies in Japan and nine main policies in the United States for the development of pediatric medical devices. In the United States, various measures have initiated mainly in the 2000s, while in Japan, the main measures have been in place since 2013. Similarities were found in both countries, such as subsidies for application fees and research and development expenses, exemption of requirements for regulatory approval, and priority review and consultation by the regulatory body. Our study revealed that there are similarities in initiatives by both countries. To promote further development of pediatric medical devices in the future, improvements to expediting the review process to approval by the regulatory body, global development, and implementation of alternative measures to ensure the efficacy and safety of the device instead of large-scale clinical trials should be anticipated through cooperation among industry, government, and academia.
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Affiliation(s)
- Sara Takahashi
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan.
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency, Shin-Kasumigaseki Building, 3-3-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-0013, Japan.
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan.
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan.
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan.
| | - Haruki Shirato
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency, Shin-Kasumigaseki Building, 3-3-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Mami Ho
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency, Shin-Kasumigaseki Building, 3-3-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Mitsuo Umezu
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan
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Redfors B, Sharma SK, Saito S, Kini AS, Lee AC, Moses JW, Ali ZA, Feldman RL, Bhatheja R, Stone GW. Novel Micro Crown Orbital Atherectomy for Severe Lesion Calcification: Coronary Orbital Atherectomy System Study (COAST). Circ Cardiovasc Interv 2020; 13:e008993. [PMID: 32757661 PMCID: PMC7434218 DOI: 10.1161/circinterventions.120.008993] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Supplemental Digital Content is available in the text. Percutaneous coronary intervention of severely calcified lesions carries a high risk of adverse events despite the use of contemporary devices. The Classic Crown Orbital Atherectomy System (OAS) was safe and effective for severely calcified lesion preparation in the ORBIT II study (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) but was not optimized for tight lesions. COAST (Coronary Orbital Atherectomy System Study) evaluated the safety and efficacy of calcified lesion preparation before stent implantation with the Diamondback 360 Micro Crown Coronary OAS, designed for use in tighter lesions.
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Affiliation(s)
- Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., J.W.M., Z.A.A., G.W.S.).,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, NY (B.R., J.W.M., Z.A.A.).,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.)
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., A.S.K., G.W.S.)
| | - Shigeru Saito
- Shonan Kamakura General Hospital, Kamakura, Japan (S.S.)
| | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., A.S.K., G.W.S.)
| | - Arthur C Lee
- The Cardiac and Vascular Institute, Gainesville, FL (A.C.L.)
| | - Jeffrey W Moses
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., J.W.M., Z.A.A., G.W.S.).,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, NY (B.R., J.W.M., Z.A.A.).,St Francis Hospital, Roslyn, NY (J.W.M., Z.A.A.)
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., J.W.M., Z.A.A., G.W.S.).,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, NY (B.R., J.W.M., Z.A.A.).,St Francis Hospital, Roslyn, NY (J.W.M., Z.A.A.)
| | | | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., J.W.M., Z.A.A., G.W.S.).,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., A.S.K., G.W.S.).,AdventHealth, Orlando, FL (R.B.)
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Takahashi S, Ibrahim N, Yasukochi S, Ringel R, Ing F, Tomita H, Sugiyama H, Yamagishi M, Forbes TJ, Kim SH, Ho M, Gillette N, Nakamura Y, Mineta K, Fearnot N, Dineen D, Vang E, Haskin R, Becker LAM, Sekiguchi K, Sakamoto K, Ruiz CE. Partnership Between Japan and the United States for Early Development of Pediatric Medical Devices - Harmonization By Doing for Children. Circ J 2020; 84:786-791. [PMID: 32238666 DOI: 10.1253/circj.cj-19-1092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Harmonization By Doing (HBD) program was established in 2003 as a partnership among stakeholders of academia, industry and regulatory agencies in Japan and the United States, with a primary focus on streamlining processes of global medical device development for cardiovascular medical devices. While HBD has traditionally focused on development of devices intended to treat conditions prevalent in adults, in 2016, HBD established the "HBD-for-Children" program, which focuses on the development of pediatric devices as the development of medical devices for pediatric use lags behind that of medical devices for adults in both countries.Methods and Results:Activities of the program have included: (1) conducting a survey with industry to better understand the challenges that constrain the development of pediatric medical devices; (2) categorizing pediatric medical devices into five categories based on global availability and exploring concrete solutions for the early application and regulatory approval in both geographies; and (3) facilitating global clinical trials of pediatric medical devices in both countries. CONCLUSIONS The establishment of the HBD-for-Children program is significant because it represents a global initiative for the introduction of pediatric medical devices for patients in a timely manner. Through the program, academia, industry and regulatory agencies can work together to facilitate innovative pediatric device development from a multi-stakeholder perspective. This activity could also encourage industry partners to pursue the development of pediatric medical devices.
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Affiliation(s)
- Sara Takahashi
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency
| | - Nicole Ibrahim
- Division of Cardiovascular Devices, Office of Device Evaluation, Food and Drug Administration (FDA)
| | | | | | | | - Hideshi Tomita
- Showa University Hospital Pediatric Heart Disease & Adult Congenital Heart Disease Center
| | | | | | - Thomas J Forbes
- Children's Hospital of Michigan Pediatrics Wayne State University
| | | | - Mami Ho
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency
| | - Nicole Gillette
- Division of Cardiovascular Devices, Office of Device Evaluation, Food and Drug Administration (FDA)
| | - Yasuko Nakamura
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency
| | - Koji Mineta
- Office of Medical Devices II, Pharmaceuticals and Medical Devices Agency
| | | | | | | | | | | | | | | | - Carlos E Ruiz
- The Joseph M. Sanzari Children's Hospital, Hackensack University, Seton Hall Hackensack School of Medicine
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11
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Saito S, Krucoff MW, Nakamura S, Mehran R, Maehara A, Al-Khalidi HR, Rowland SM, Tasissa G, Morrell D, Joseph D, Okaniwa Y, Shibata Y, Bertolet BD, Rothenberg MD, Généreux P, Bezerra H, Kong DF. Japan-United States of America Harmonized Assessment by Randomized Multicentre Study of OrbusNEich's Combo StEnt (Japan-USA HARMONEE) study: primary results of the pivotal registration study of combined endothelial progenitor cell capture and drug-eluting stent in patients with ischaemic coronary disease and non-ST-elevation acute coronary syndrome. Eur Heart J 2019; 39:2460-2468. [PMID: 29931092 PMCID: PMC6037087 DOI: 10.1093/eurheartj/ehy275] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/13/2018] [Indexed: 01/07/2023] Open
Abstract
Aims Harmonized Assessment by Randomized Multicentre Study of OrbusNEich’s Combo StEnt (HARMONEE) (NCT02073565) was a randomized pivotal registration trial of the Combo stent, which combined sirolimus and an abluminal bioabsorbable polymer with a novel endoluminal anti-CD34+ antibody coating designed to capture endothelial progenitor cells (EPC) and promote percutaneous coronary intervention (PCI) site healing. Methods and results Clinically stabilized PCI subjects were randomized 1:1 to receive Combo or everolimus-eluting stents (EES). Between February 2014 and June 2016, 572 subjects with 675 coronary lesions underwent 1-year angiography and fractional flow reserve, with optical coherence tomography (OCT) in the first 140 patients. The primary clinical endpoint was non-inferior 1-year target vessel failure (TVF). The primary mechanistic endpoint of EPC capture activity was superior strut coverage by OCT. Target vessel failure occurred in 7.0% Combo (20/287) vs. 4.2% EES (12/285), a 2.8% [95% confidence interval (95% CI) −1.0%, 6.5%] difference, meeting the non-inferiority hypothesis (P = 0.02). There were no cardiac deaths, with one stent thrombosis observed in the EES group. Quantitative coronary angiography late loss with Combo was equivalent to EES. Optical coherence tomography strut coverage at 1 year was superior with Combo vs. EES [91.3% (95% CI 88.7%, 93.8%) vs. 74.8% (95% CI 70.0%, 79.6%), P < 0.001], with homogeneous tissue in 81.2% vs. 68.8%, respectively. Conclusion Combo stent demonstrated non-inferior 1-year TVF and late loss in a randomized comparison to EES, with superior strut-based tissue coverage by OCT as a surrogate of EPC capture technology activity. ![]()
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Affiliation(s)
- Shigeru Saito
- Shonan Kamakura General Hospital, Kamakura, Japan, and Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Mitchell W Krucoff
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Akiko Maehara
- Cardiovascular Research Foundation and Columbia University, New York, NY, USA
| | - Hussein R Al-Khalidi
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | | | - Gudaye Tasissa
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | | | - Diane Joseph
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | | | | | | | - Mark D Rothenberg
- Atlantic Clinical Research Collaborative - Cardiology, Atlantis, FL, USA
| | | | - Hiram Bezerra
- University Hospitals of Cleveland, Cleveland, OH, USA
| | - David F Kong
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
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12
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Selzman KA, Patel H, Cavanaugh K. Electrophysiology devices and the regulatory approval process within the U.S. FDA and abroad. J Interv Card Electrophysiol 2019; 56:173-182. [PMID: 31418099 DOI: 10.1007/s10840-019-00607-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022]
Abstract
Almost all electrophysiology (EP) devices need to obtain premarket approval before they can be commercially sold and available for use in the community. The US Food and Drug Administration (FDA) has different paths to market approval depending on the intended use and the associated risks of the device. The European Union and Japan have device approval processes that have many similarities as well as differences to the US regulatory system. This paper describes some of the history and background of the US device approval process with an emphasis on EP devices. It provides an overview of the different regulatory pathways in the USA that are currently being utilized and contrasts them to the procedures often used in the European Union and in Japan. It also touches on the impact of the twenty-first Century Cures Act and how the balance between premarket and postmarket regulatory oversight is continually being examined and refined.
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Affiliation(s)
- Kimberly A Selzman
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA.
| | - Hetal Patel
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Kenneth Cavanaugh
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
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13
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The East-West late lumen loss study: Comparison of angiographic late lumen loss between Eastern and Western drug-eluting stent study cohorts. Am Heart J 2018; 206:61-71. [PMID: 30342296 DOI: 10.1016/j.ahj.2018.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/31/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Regulatory decisions approving new coronary drug-eluting stent (DES) require mechanistic observations of angiographic late lumen loss (LLL). Patient safety and device approval times could be enhanced if angiographic follow-up data were found to be generalizable across jurisdictions and geographies. The objectives were to assess the comparability of in-segment LLL in Eastern and Western DES populations using the world's largest compilation of follow-up quantitative coronary angiography data. METHODS Data from 4 manufacturers involving 29 DES clinical trials in Eastern and Western hemispheres were compiled. "East" and "West" cohorts were defined by trial location. Independent core laboratories quantified in-segment LLL for all studies. East and West were compared before and after adjustment for clinical and anatomic covariates known to correlate with LLL via conditioning on propensity score quintiles. An international panel of experts and regulators prospectively established a clinically meaningful difference between East and West mean in-segment LLL of ±0.40 mm. RESULTS The data set comprised 2,047 East and 4,456 West patients. Unadjusted mean ± SD for West and East in-segment LLL (mm) was 0.25 ± 0.46 and 0.12 ± 0.42, respectively (difference 0.13 mm; 95% CI 0.11-0.16). Propensity score-adjusted in-segment LLL East and West least squares means were 0.11 and 0.26 mm, respectively (difference 0.15 mm; 95% CI 0.13-0.18). CONCLUSIONS In the world's largest compilation of DES protocol 8- to 13-month angiographic follow-up data, clinically meaningful comparability of in-segment LLL by independent core laboratory quantitative coronary angiography in East and West cohorts was demonstrated in both unadjusted and adjusted comparisons. These findings suggest that DES LLL, once characterized, could be generalized across regulatory jurisdictions over the course of global registration efforts.
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14
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Cavanaugh KJ, Buckley DC, Malone ML. Harmonization by Doing Proposal for Global Clinical Trial Designs for Endovascular Devices for Treatment of Critical Limb Ischemia: The United States Food and Drug Administration Perspective. Circ J 2018; 82:3110-3111. [PMID: 30381695 DOI: 10.1253/circj.cj-18-0817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kenneth J Cavanaugh
- Division of Cardiovascular Devices, Office of Device Evaluation, US Food and Drug Administration
| | - Donna C Buckley
- Division of Cardiovascular Devices, Office of Device Evaluation, US Food and Drug Administration
| | - Misti L Malone
- Division of Cardiovascular Devices, Office of Device Evaluation, US Food and Drug Administration
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15
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Yokoi H, Ho M, Iwamoto S, Suzuki Y, Ansel GM, Azuma N, Handa N, Iida O, Ikeda K, Ikeno F, Ohura N, Rosenfield K, Rundback J, Terashi H, Uchida T, Yokoi Y, Nakamura M, Jaff MR. Design Strategies for Global Clinical Trials of Endovascular Devices for Critical Limb Ischemia (CLI) - A Joint USA-Japanese Perspective. Circ J 2018; 82:2233-2239. [PMID: 29962385 DOI: 10.1253/circj.cj-18-0014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
For more than 10 years, the Harmonization by Doing (HBD) program, a joint effort by members from academia, industry and regulators from the United States of America (USA) and Japan, has been working to increase timely regulatory approval for cardiovascular devices through the development of practical global clinical trial paradigms. Consistent with this mission and in recognition of the increasing global public health effects of critical limb ischemia (CLI), academic and government experts from the USA and Japan have developed a basic framework of global clinical trials for endovascular devices for CLI. Despite differences in medical and regulatory environments and complex patient populations in both countries, we developed a pathway for the effective design and conduct of global CLI device studies by utilizing common study design elements such as patients' characteristics and study endpoints, and minimizing the effect of important clinical differences. Some of the key recommendations for conducting global CLI device studies are: including patients on dialysis; using a composite primary endpoint for effectiveness that includes 6-month post-procedure therapeutic success and target vessel patency; and using a 30-day primary safety endpoint of perioperative death and major adverse limb events. The proposed approach will be uniquely beneficial in facilitating both the initiation and interpretation of CLI studies and accelerating worldwide CLI device development and innovation.
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Affiliation(s)
- Hiroyoshi Yokoi
- Department of Cardiovascular Medicine, Fukuoka Sanno Hospital
| | - Mami Ho
- Office of Medical Devices III, Pharmaceuticals and Medical Devices Agency
| | - Shin Iwamoto
- Office of Medical Devices II, Pharmaceuticals and Medical Devices Agency
| | | | - Gary M Ansel
- Center for Critical Limb Care, OhioHealth/Riverside Methodist Hospital
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Nobuhiro Handa
- Office of Medical Devices III, Pharmaceuticals and Medical Devices Agency
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | | | | | - Norihiko Ohura
- Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine
| | | | | | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine
| | | | | | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center
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16
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Murakami M, Suzuki Y, Tominaga T. Rapid Globalization of Medical Device Clinical Development Programs in Japan ― The Case of Drug-Eluting Stents ―. Circ J 2018; 82:636-643. [DOI: 10.1253/circj.cj-17-0533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Yuka Suzuki
- Pharmaceuticals and Medical Devices Agency (PMDA)
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17
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Rationale and design of the Japan-USA harmonized assessment by randomized, multicenter study of OrbusNEich's combo StEnt (Japan-USA HARMONEE): Assessment of a novel DES platform for percutaneous coronary revascularization in patients with ischemic coronary disease and non-ST-elevation acute coronary syndrome. Am Heart J 2017; 187:112-121. [PMID: 28454795 DOI: 10.1016/j.ahj.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 02/08/2017] [Indexed: 12/20/2022]
Abstract
Tissue trauma associated with stent implantation continues to generate early thrombosis rates of 0.9% to 1.3% for both bare-metal and drug-eluting stent platforms. The Combo sirolimus-eluting stent combines an abluminal, bioabsorbable polymer with a luminal CD34+ antibody designed to capture endothelial progenitor cells. This article describes the design and methods of the HARMONEE trial (NCT02073565), which represents the first randomized controlled trial of the Combo design against a best-in-class contemporary everolimus-eluting stent. Up to 50 sites in Japan and the United States will enroll 286 subjects (271 evaluable) in each of 2 arms, for a total sample size of 572 subjects (542 evaluable). The statistical plan includes both superiority to imputed bare-metal stent control and noninferiority to everolimus-eluting stent on a primary clinical end point of target vessel failure at 1 year. In addition, fractional flow reserve assessment to evaluate the physiology of target vessels in the entire population will augment the end point definition of ischemia-driven target vessel revascularization. Finally, key safety considerations will be evaluated with a subpopulation with optical coherence tomography imaging for strut coverage, late strut malapposition, and plaque volume, as well as serial human antimurine antibody assessments. As the first international prospective randomized coronary intervention study under the "Harmonization by Doing" program, this study represents a unique collaboration between regulators and investigators in Japan and the United States.
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18
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Azuma K, Yamanaka S. Recent policies that support clinical application of induced pluripotent stem cell-based regenerative therapies. Regen Ther 2016; 4:36-47. [PMID: 31245486 PMCID: PMC6581825 DOI: 10.1016/j.reth.2016.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/07/2016] [Accepted: 01/28/2016] [Indexed: 02/04/2023] Open
Abstract
In Japan, a research center network consisting of Kyoto University to provide clinical-grade induced Pluripotent Stem Cells (iPSC) and several major research centers to develop iPSC-based regenerative therapies was formed for the clinical application of iPSCs. This network is under the supervision of a newly formed funding agency, the Japan Agency for Medical Research and Development. In parallel, regulatory authorities of Japan, including the Ministry of Health, Labour and Welfare, and Pharmaceuticals and Medical Devices Agency, are trying to accelerate the development process of regenerative medicine products (RMPs) by several initiatives: 1) introduction of a conditional and time-limited approval scheme only applicable to RMPs under the revised Pharmaceuticals and Medical Devices Act, 2) expansion of a consultation program at the early stage of development, 3) establishment of guidelines to support efficient development and review and 4) enhancement of post-market safety measures such as introduction of patient registries and setting user requirements with cooperation from relevant academic societies and experts. Ultimately, the establishment of a global network among iPSC banks that derives clinical-grade iPSCs from human leukocyte antigens homozygous donors has been proposed. In order to share clinical-grade iPSCs globally and to facilitate global development of iPSC-based RMPs, it will be necessary to promote regulatory harmonization and to establish common standards related to iPSCs and differentiated cells based on scientific evidence.
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Key Words
- AMED, Japan Agency for Medical Research and Development
- BLA, Biological License Approval
- CFR, Code of Federal Regulations
- CiRA, Center for iPS Cell Research and Application
- DMF, Drug Master File
- ESC, embryonic stem cell
- FDA, Food and Drug Administration
- FY, fiscal year
- GAiT, Global Alliance for iPS Cell Therapies
- GCTP, Good Gene, Cell, Cellular and Tissue-based Products Manufacturing Practice
- GMP, good manufacturing practice
- HLA, human leukocyte antigen
- Haplobank
- IBRI, Institution of Biomedical Research and Innovation
- ICH, The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use
- IND, Investigational New Drug
- INTERMACS, Interagency Registry for Mechanically Assisted Circulatory Support
- IRB, Institutional Review Board
- J-MACS, Japanese Registry for Mechanically Assisted Circulatory Support
- JST, Japan Science and Technology Agency
- Japan
- LVAD, left ventricular assist device
- METI, Ministry of Economy, Trade and Industry
- MEXT, Ministry of Education, Culture, Sports, Science and Technology
- MHLW, Ministry of Health, Labour and Welfare
- NEDO, New Energy and Industrial Technology Development Organization
- NIBIO, National Institute of Biomedical Innovation
- NIHS, National Institute of Health Science
- PAL, Pharmaceutical Affairs Law
- PIC/S, The Pharmaceutical Inspection Convention and Pharmaceutical Inspection Co-operation Scheme
- PMD Act, Pharmaceuticals and Medical Devices Act
- PMDA, Pharmaceuticals and Medical Devices Agency
- Policy
- R&D, research and development
- RM Act, the Act on the Safety of Regenerative Medicine
- RMP, regenerative medicine product
- Regenerative medicine
- Regulation
- Riken CDB, Riken Center for Developmental Biology
- U.S., United States
- WHO, World Health Organization
- iPS cells
- iPSC, induced pluripotent stem cell
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Affiliation(s)
- Kentaro Azuma
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan
| | - Shinya Yamanaka
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan
- Gladstone Institute of Cardiovascular Disease, San Francisco, California 94158, USA
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Zeitler EP, Al-Khatib SM, Slotwiner D, Kumar UN, Varosy P, Van Wagoner DR, Marcus GM, Kusumoto FM, Blum L. Proceedings from Heart Rhythm Society's emerging technologies forum, Boston, MA, May 12, 2015. Heart Rhythm 2016; 13:e39-49. [PMID: 26801401 PMCID: PMC4724379 DOI: 10.1016/j.hrthm.2015.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Indexed: 11/15/2022]
Abstract
Physicians are in an excellent position to significantly contribute to medical device innovation, but the process of bringing an idea to the bedside is complex. To begin to address these perceived barriers, the Heart Rhythm Society convened a forum of stakeholders in medical device innovation in conjunction with the 2015 Heart Rhythm Society Annual Scientific Sessions. The forum facilitated open discussion on medical device innovation, including obstacles to physician involvement and possible solutions. This report is based on the themes that emerged. First, physician innovators must take an organized approach to identifying unmet clinical needs and potential solutions. Second, extensive funds, usually secured through solicitation for investment, are often required to achieve meaningful progress, developing an idea into a device. Third, planning for regulatory requirements of the US Food and Drug Administration and Centers for Medicare & Medicaid Services is essential. In addition to these issues, intellectual property and overall trends in health care, including international markets, are critically relevant considerations for the physician innovator. Importantly, there are a number of ways in which professional societies can assist physician innovators to navigate the complex medical device innovation landscape, bring clinically meaningful devices to market more quickly, and ultimately improve patient care. These efforts include facilitating interaction between potential collaborators through scientific meetings and other gatherings; collecting, evaluating, and disseminating state-of-the-art scientific information; and representing the interests of members in interactions with regulators and policymakers.
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Affiliation(s)
- Emily P Zeitler
- Duke Clinical Research Institute; Duke University Hospital, Durham, North Carolina.
| | - Sana M Al-Khatib
- Duke Clinical Research Institute; Duke University Hospital, Durham, North Carolina
| | | | - Uday N Kumar
- Biodesign Program, Stanford University, Stanford, California
| | - Paul Varosy
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David R Van Wagoner
- Cleveland Clinic Lerner College of Medicine, Case Western Research University, Cleveland, Ohio
| | - Gregory M Marcus
- University of California, San Francisco, San Francisco, California
| | | | - Laura Blum
- Heart Rhythm Society, Washington, District of Columbia
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Vaduganathan M, Tahhan AS, Greene SJ, Kelkar AA, Georgiopoulou VV, Kalogeropoulos AP, Fonarow GC, Gheorghiade M, Butler J. Contemporary cardiovascular device clinical trials (trends and patterns 2001 to 2012). Am J Cardiol 2015; 116:307-12. [PMID: 25963222 DOI: 10.1016/j.amjcard.2015.03.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
Device uptake and development have progressed over the last decade, but few quantitative data exist examining the overall operating characteristics and temporal trends of these clinical trials. We performed a systematic analysis of all cardiovascular device clinical trials from 2001 to 2012 published in medical and cardiovascular journals with the 8 highest impact factors. Of the 1,224 identified cardiovascular clinical trials, 299 (24.4%) focused specifically on devices. Each trial included a median of 335 patients (162 to 745) recruited from a median of 14 sites (3 to 38) over a median enrollment duration of 1.9 years (1.2 to 3.3). Median enrollment rate was 1.1 patients/site/month (0.5 to 4.2). Most device trials targeted coronary artery disease (55.2%), followed by arrhythmias (17.4%). Most were industry sponsored (53.6%) and included mortality as a primary end point (69.6%). The median number of patients (225 to 499, p <0.001 for trend) and enrolling sites (11 to 19, p = 0.07 for trend) increased from 2001 to 2012. During the study period, multinational enrollment grew and approached 50% (p = 0.03), whereas trials enrolling in North America exclusively decreased from 30% to 17% (p = 0.10 for trend). Approximately 70% of device trials met their primary end points; this rate did not significantly change over time. In conclusion, this descriptive study of the contemporary cardiovascular device clinical trials highlights recent trends toward larger, more international trial programs. These aggregate data may help inform future cardiovascular device development.
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21
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Saito S, Valdes-Chavarri M, Richardt G, Moreno R, Iniguez Romo A, Barbato E, Carrie D, Ando K, Merkely B, Kornowski R, Eltchaninoff H, James S, Wijns W. A randomized, prospective, intercontinental evaluation of a bioresorbable polymer sirolimus-eluting coronary stent system: the CENTURY II (Clinical Evaluation of New Terumo Drug-Eluting Coronary Stent System in the Treatment of Patients with Coronary Artery Disease) trial. Eur Heart J 2014; 35:2021-31. [PMID: 24847155 PMCID: PMC4200026 DOI: 10.1093/eurheartj/ehu210] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 04/26/2014] [Accepted: 05/01/2014] [Indexed: 12/26/2022] Open
Abstract
AIM The aim of this study was to establish safety and efficacy of a new sirolimus-eluting stent with bioresorbable polymer, Ultimaster (BP-SES). Sirolimus-eluting stent with bioresorbable polymer was compared with everolimus-eluting, permanent polymer, Xience stent (PP-EES) in the frame of a CENTURY II clinical trial designed to make global clinical data compliant with regulatory requirements in Europe and Japan. METHODS AND RESULTS The CENTURY II is a prospective, multicentre, randomized (1 : 1), single blind, controlled, non-inferiority clinical trial conducted at 58 study sites in Japan, Europe, and Korea. A total of 1123 patients requiring a percutaneous coronary intervention (PCI) procedure, with implantation of drug-eluting stent (DES), were enrolled [total population (TP)]. Randomization of patients was stratified for the subset of patients matching requirements for DES in Japan (Cohort JR, n = 722). Baseline patient demographic and angiographic characteristics were similar in both study arms, with minimal differences between the TP and Cohort JR. The primary endpoint, freedom from target lesion failure (TLF) at 9 months-TLF [composite of cardiac death, target-vessel-related myocardial infarction (MI) and target lesion revascularization]-was 95.6% with BP-SES and 95.1% with PP-EES (Pnon-inferiority<0.0001). Composite of cardiac death and MI rate was 2.9 and 3.8% (P = 0.40) and target vessel revascularization was 4.5% with BP-SES and 4.2% with PP-EES (P = 0.77). The stent thrombosis rate was 0.9% in both arms. In Cohort JR, freedom from TLF was 95.9 and 94.6% (Pnon-inferiority < 0.0005) with BP-SES and PP-EES, respectively. CONCLUSION The new bioresorbable polymer sirolimus-eluting stent showed safety and efficacy profiles similar to durable polymer everolimus-eluting stent at 9-month follow-up. STUDY REGISTRATION NUMBER UMIN000006940.
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Affiliation(s)
| | | | | | | | | | | | | | - Kenji Ando
- Kokura Memorial Hospital, Fukuoka, Japan
| | - Bela Merkely
- Semmelweis University Hospital, Budapest, Hungary
| | | | | | | | - William Wijns
- Cardiovascular Centre Aalst, OLV Hospital, Aalst, Belgium Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 165, 9301 Aalst, Belgium
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Tamura A, Kutsumi H. Multiregional medical device development: regulatory perspective. Clin J Gastroenterol 2014; 7:108-16. [PMID: 26183624 DOI: 10.1007/s12328-014-0478-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
There are difficulties in conducting worldwide medical device development simultaneously because each country and/or region has their own medical device regulations. However, to aid globalization of the medical device market, and to quickly provide innovative medical devices to patients, attempts have been made to encourage harmonization and convergence of medical device regulations. 'Harmonization by doing' is a bilateral effort from the United States and Japan to develop global clinical trials and address regulatory barriers that may be impediments to timely device approval. The Global Harmonization Task Force (GHTF) was conceived in 1992 in an effort to achieve greater uniformity between national medical device regulatory systems. Since 2012, the GHTF has been replaced by the International Medical Device Regulators Forum.
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Affiliation(s)
- Atsushi Tamura
- Pharmaceuticals and Medical Devices Agency, Kansai Branch, Knowledge Capital Tower C9, Grand Front Building, 3-1 Ofuka-cho, Kita-ku, Osaka, 530-0011, Japan,
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Ikeno F, Ikeda K, Uchida T. Patient access to medical devices-what about Japan, the second largest medical device market? Cardiovasc Interv Ther 2013; 29:1-3. [PMID: 23975639 DOI: 10.1007/s12928-013-0202-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
Abstract
Patients' access to innovative medical devices in Japan still shows the gap between the other countries. The cause of this device gap is researched from the prior published data. We searched the review time of new innovative devices by the Pharmaceuticals and Medical Devices Agency (PMDA) and the submission time lag compared with the US and EU from the prior published data. The average review time was 9.5 months and the total time from PMDA to introduction of the device to patients in Japan is almost similar to the US and the four European countries. However, the time lag of the file submission between Japan and the US was 2.42 years, on average, between 2001 and 2009. The review time for new innovative medical devices by the PMDA has been improving year after year. On the contrary, the pre-submission delay still exists in Japan.
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Affiliation(s)
- Fumiaki Ikeno
- Falk Cardiovascular Research Center, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-5406, USA,
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