Regulatory Open Forum

 View Only
  • 1.  RE: Clinical Study Using a Custom Made Device (TGA)

    This message was posted by a user wishing to remain anonymous
    Posted 30-Aug-2019 08:59
    This message was posted by a user wishing to remain anonymous

    Hi Experts,

    We are a small manufacturer based in Australia. A surgeon who is an inventor of a surgical instrument (class IIa) would like to use a custom made device manufactured for him for clinical publication. 

    Can someone please advise whether the custom made device can be used in clinical trials (surgeon to use custom device at his own practice) for publishing in scientific journals etc. Where do ethics committees come into play here or do they at all in this case? We know cosmetic and plastic surgeons publish new methods all the time under the declaration of Helsinki, without a separate committee (like NHMRC) assessment.

    If the custom made device is cleared to be used by TGA on actual patients, why would a separate ethics committee process be needed to gather data in this case? The medical procedures are being done regardless during a surgeon's practice.

    Aim is to generate clinical data for registering this device with the TGA (ARTG entry) under conformity assessment and prepare CER using both literature from the comparator device and subject device.

    Any advise will be greatly appreciated.

    Thank you in advance.


  • 2.  RE: Clinical Study Using a Custom Made Device (TGA)

    Posted 31-Aug-2019 01:17
    Edited by Arthur Brandwood 31-Aug-2019 01:42
    It's not exactly clear from the question precisely what is planned, but here are a few pointers.

    Custom devices currently are exempt from entry onto the ARTG in Australia.  So it's currently not actually possible to obtain a direct ARTG registration for a custom device, nor to apply for conformity assessment.  There are some work-arounds which involve things like putting a custom device in a kit and registering the kit, but they are contrived and probably won't persist in the face of upcoming regulatory change.

    There is a separate notification database where manufacturers of custom devices are required to notify TGA of their activities.

    TGA is actively looking at changing the regulations to require registration of some higher risk custom devices (e.g. implants).  If this happens, registration and conformity assessment will be required.

    Irrespective of registration, custom devices must still meet the essential principles and manufacturers are required to keep Technical Files showing safety and performance.  There is some leeway for custom devices, in that TGA accepts they may be used in special circumstances and there may be some gaps in compliance which may be justified by risk.-benefit comparisons, but that does need to be justified in the Technical File.

    Now, if a clinician is contemplating a clinical trial, that implies there is an evaluation required of clinical performance.  This in turn means that there is unknown compliance for the outcomes being assessed in the trial.  Therefore a clinical trial approval should be obtained via an ethics committee and TGA notified of the trial under the Clinical Trials Notification (CTN) scheme.  It's important to understand that if the data from the trial are to be used in a future regulatory approval (anywhere in the world), then a regulator will only recognise those data if there is evidence that the trial was properly approved and managed.

    Having said all of this, there is widespread lack of understanding of these requirements and it's not uncommon for custom devices to be manufactured and used with less than perfect documentation and evidence of compliance.  So it's advisable to be cautious when looking at what others are doing as precedent.

    Hope this all helps.

    ------------------------------
    Arthur Brandwood PhD FRAPS
    Director and Principal Consultant
    Brandwood CKC
    Sydney, Australia
    Arthur.brandwood@brandwoodckc.com
    ------------------------------



  • 3.  RE: Clinical Study Using a Custom Made Device (TGA)

    Posted 31-Aug-2019 08:23



    Arthur, this is all really good information-as usual from you. 

    Ted





  • 4.  RE: Clinical Study Using a Custom Made Device (TGA)

    Posted 31-Aug-2019 22:46
    Edited by Julie Omohundro 01-Sep-2019 01:47
    Just have to say it again, because it is so true, and regulatory wisdom that seems hard to come by:
    "It's advisable to be cautious when looking at what others are doing as precedent."




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



  • 5.  RE: Clinical Study Using a Custom Made Device (TGA)

    This message was posted by a user wishing to remain anonymous
    Posted 03-Sep-2019 09:53
    This message was posted by a user wishing to remain anonymous

    We would like to understand if clinical data collected by the inventor (surgeon) from custom device using at his own practice be used as clinical evidence when we seek TGA conformity assessment later. Thank you.


  • 6.  RE: Clinical Study Using a Custom Made Device (TGA)

    Posted 04-Sep-2019 00:23
    Edited by Arthur Brandwood 04-Sep-2019 00:24
    Please see my earlier reply.

    1. You cannot currently obtain TGA conformity assessment for a custom made device.  Custom devices cannot be entered onto the ARTG.
    2. Any clinical data obtained from a surgical practice should be subject to HREC approval if the activity is experimental. 
    3. If you are gathering case reports from ad hoc clinical use, then such evidence is of low value as support for future regulatory submissions.  Regulators expect to see higher quality data such as systematic and controlled studies.

    Feel free to message me privately if you wish to discuss in more detail.

    ------------------------------
    Arthur Brandwood PhD FRAPS
    Director and Principal Consultant
    Brandwood CKC
    Sydney, Australia
    Arthur.brandwood@brandwoodckc.com
    ------------------------------