在FDA批准高风险医疗器械的非并发控制使用
Maryam Mooghali1, Sanket S Dhruva2,3, Hollin R L Hakimian4
1Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
JAMA network open
|April 22, 2025
概括
大多数高风险医疗器械批准都使用非并发的控制,没有充分的理由或细节,引发了对安全性和有效性的证据的担忧.
科学领域:
- 医疗器械规则 医疗器械规则
- 临床研究设计
- 监管科学 监管科学
背景情况:
- 美国食品和药物管理局 (FDA) 允许对高风险医疗器械评估进行非并发控制 (历史控制,客观性能标准,性能目标).
- 然而,非并发控制的使用在确定设备安全性和有效性方面存在固有的局限性.
研究的目的:
- 分析美国FDA批准的高风险治疗医疗器械的关键研究中非并发对照使用的频率,理由和临床细节.
- 评估是否建立的绩效标准或目标是FDA定义的.
主要方法:
- 2019年至2023年期间FDA批准的高风险治疗医疗器械原始的横截面研究.
- 审查了关键研究设计,重点是使用并发与非并发的对照,并提供理由和临床细节.
主要成果:
- 在基于关键研究的88项高风险产品批准中,59.1%的初级安全性/有效性分析使用了非并发的控制.
- 绩效目标是最常见的非并发对照 (79.7%),但理由和临床细节有限 (分别为3.8%和24.1%).
- 只有7个客观绩效标准中的4个和没有一个绩效目标是FDA建立的.
结论:
- 大多数高风险医疗器械审批依赖于缺乏充分理由和临床细节的非同时进行的控制.
- 这种做法可能会导致患者,临床医生和支付人对支持设备安全和有效性的证据的稳定性产生不确定性.
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