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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. Cardiovasc Revasc Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lai J, Forney L, Brinton DL, Simpson KN. Drivers of Start-Up Delays in Global Randomized Clinical Trials. Ther Innov Regul Sci 2021; 55:212-27. [PMID: 32959207 DOI: 10.1007/s43441-020-00207-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022]
Abstract
Background Global, randomized clinical trials are extremely complex. Trial start-up is a critical phase and has many opportunities for delay which adversely impact the study timelines and budget. Understanding factors that contribute to delay may help clinical trial managers and other stakeholders to work more efficiently, hastening patient access to potential new therapies. Methods We reviewed the available literature related to start-up of global, Phase III clinical trials and then created a fishbone diagram detailing drivers contributing to start-up delays. The issues identified were used to craft a checklist to assist clinical trial managers in more efficient trial start-up. Results We identified key drivers for start-up delays in the following categories: regulatory, contracts and budgets, insurance, clinical supplies, site identification and selection, site activation, and inefficient processes/pitfalls. Conclusion Initiating global randomized clinical trials is a complex endeavor, and reasons for delay are well documented in the literature. By using a checklist, clinical trial managers may mitigate some delays and get clinical studies initiated as soon as possible.
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Ayuso E, Geller RJ, Wang J, Whyte J, Jenkins M. Evaluation of worldwide clinical trials by gender: An FDA perspective. Contemp Clin Trials 2019; 80:16-21. [PMID: 30890465 DOI: 10.1016/j.cct.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/11/2019] [Accepted: 03/15/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The US Food and Drug Administration (FDA) has undertaken efforts to promote representation of women in clinical trials. The objectives of this research are to assess women's participation in clinical trials from a global perspective and to analyze the demographic characteristics of clinical trial participants. METHODS FDA's Center for Drug Evaluation and Research-Professional Affairs and Stakeholder Engagement (CDER/PASE) and Office of Women's Health (OWH) collaborated to evaluate demographic data (race, ethnicity, gender, and age) of pivotal trials of New Molecular Entities (NMEs) approved in 2015-2016 by geographic location. One hundred fifty-four pivotal clinical trials supporting 66 NMEs were identified, and the research team analyzed demographic characteristics of 131,749 participants from 70 countries. RESULTS U.S. sites contributed 31% of the 131,749 study participants. On the country level, the United States contributed the largest number of participants and other individual countries contributed 5% or less of the total trial population. Overall, 43% (n = 56,272) of the 131,747 clinical trial participants were women. Of the 40,833 U.S. participants, 49% were women as compared to 40% of the 90,914 non-U.S. PARTICIPANTS Similar levels of participation were seen after the exclusion of sex-specific drug indications, and by therapeutic area for U.S. and non-U.S. sites. CONCLUSIONS Clinical trials are becoming increasingly multi-national, and the increasing representation of women across countries is promising. FDA approval processes ensure that global data used in the drug approval process meets regulatory standards and that data can be generalized to the U.S. POPULATION
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Affiliation(s)
- Emily Ayuso
- Office of Women's Health, OC, FDA (Address: 10903 New Hampshire Avenue, WO32-2333, Silver Spring, MD 20993, USA.
| | - Ruth J Geller
- Office of Women's Health, OC, FDA (Address: 10903 New Hampshire Avenue, WO32-2333, Silver Spring, MD 20993, USA.
| | - Junyang Wang
- Professional Affairs and Stakeholder Engagement, CDER, FDA (Address: 10903 New Hampshire Avenue, Bldg. 51, Rm 2341, Silver Spring, MD 20993-0002, USA.
| | - John Whyte
- Professional Affairs and Stakeholder Engagement, CDER, FDA (Address: 10903 New Hampshire Avenue, Bldg. 51, Rm 2341, Silver Spring, MD 20993-0002, USA.
| | - Marjorie Jenkins
- Office of Women's Health, OC, FDA (Address: 10903 New Hampshire Avenue, WO32-2333, Silver Spring, MD 20993, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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