New Regulatory Framework for Medical Devices in Japan: Current Regulatory Considerations Regarding Clinical Studies

A Comparative Analysis of the Regulatory Framework and Collaborative Environment for Pediatric Medical Device Development in Japan and the United States: Identifying Challenges, Support Mechanisms, and Emerging Opportunities

There are specific obstacles to designing medical devices for children, such as commercial distortions and regulatory hurdles. This study compares the regulatory frameworks and collaborative ecosystems of the United States (US) and Japan, enabling the development of pediatric medical devices. The study illustrates the differences as well as parallels between the two countries by outlining their primary obstacles, channels of assistance, and prospects. The regulatory regimes of the US and Japan pose substantial challenges due to their intricate approval procedures and the dearth of pediatric-specific guidelines. However, while Japan's ecosystem is more dispersed, the US offers more well-established support mechanisms, such as funding initiatives and research alliances. Despite these difficulties, there are still prospects for innovative thinking and collaborative work. The article demonstrates successful partnerships between business, academia, and government in both countries, which have helped propel the advancement of pediatric devices. For stakeholders endeavoring to maneuver through the complex terrain of pediatric medical device development, this study offers valuable insights. With a comprehensive understanding of the regulatory and collaborative frameworks in Japan and the US, developers can more effectively leverage resources, overcome obstacles, and bring vital technology to market. The study's findings have implications for researchers, industry leaders, and policy regulators, providing recommendations for strategies aimed at stimulating innovation and enhancing children's healthcare outcomes internationally.

Research cartography of implantable medical devices in the three Maghreb countries: A comparative study between Morocco, Algeria, and Tunisia

BACKGROUND

Biosafety and efficacy are essential aspects in the use of implantable medical devices (IMD) in several medical and surgical disciplines. To this effect, and depending on the therapeutic indication, the diversity of IMD imposes enormous evaluation strategies from their design through to their impact on improving the patient's quality of life.

OBJECTIVE

To elaborate cartography which traces back the research tracks published on IMD regarding the three Maghreb countries, namely Morocco, Algeria, and Tunisia, and this through laying emphasis on a comparative study in view of highlighting the similarities and differences between them.

METHODS

First, the research work was concerned with studies on IMD published between 2013 and 2023, which met the inclusion criteria, and which used the above-mentioned keywords on the four databases Scopus, Web of Science, ScienceDirect and PubMed. Second, the results are processed for a comparative descriptive study. In second, a descriptive and inferential analysis of association and classification to establish a research map on IMD.

RESULTS

Articles selected; 86 articles out of 1081 for Morocco, 70 out of 900 for Algeria and 136 out of 1303 for Tunisia. Unlike domains (P=0.014), the research methods used highlights similarities in methodological research (P>0.05) ranging from simple descriptions to meta-analyses for the medical sciences with an inequitable distribution whose high share in favor of patient-reports.

CONCLUSION

The design of maps raises a diversity of fields that concern medical and engineering sciences, while medical economic studies have yet to be developed in all three countries.

Comparison of supportive regulatory measures for pediatric medical device development in Japan and the United States

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.

Recent Least Burdensome Approach for the Approval of Innovative Medical Devices in Japan -Regulatory Approval Review of an Everolimus-eluting Bioresorbable Scaffold

Although a domestic trial in Japan revealed that Absorb bioresorbable vascular scaffold (BVS) has no inferiority to everolimus-eluting stent (EES) cohort in the primary endpoint of the target lesion failure at 12 months, the scaffold/stent thrombosis (ST) rates with the BVS at 24 months were higher than those with the EES (Absorb BVS 3.1% vs. EES 1.5%), the ST rate of 3.1% with Absorb BVS is not an acceptable level in Japan. A cause-of-ST analysis revealed that cases in which diagnostic imaging and ensuing post-dilatation had been performed appropriately had lower ST rates than those without such management (within 1 year: 1.37% vs. 7.69%, from 1 to 2 years: 0.00% vs. 8.33%). Therefore, a further evaluation was needed to confirm that the ST rate with the Absorb BVS would be reduced by a proper implementation procedure. Regulatory approval was given conditionally to initiate rigorous post-marketing data collection in order to ensure the proper use of this device in limited facilities. The One-year Use-Result Survey in Japan for the Absorb BVS revealed no instances of ST. This approach to reducing the premarket regulatory burden of clinical trials and enhancing the post-marketing commitments of medical device regulation is useful for expediting patient access to innovative medical devices.

Partnership Between Japan and the United States for Early Development of Pediatric Medical Devices - Harmonization By Doing for Children

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.

Electrophysiology devices and the regulatory approval process within the U.S. FDA and abroad

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.

The ideal way to design clinical trials and establishment of evidence for human cellular and tissue-based products in Japan

In Japan, the Pharmaceuticals and Medical Devices (PMD) Act established in 2014 included an additional chapter dedicated to frameworks for human cellular and tissue-based products. To further evaluate the product considered to have "likely to predict efficacy" at the time of receiving "conditional and time-limited marketing authorization," a system has been introduced to determine whether the product is eligible for "full marketing authorization" through statistical "confirmation of the efficacy" in a postmarketing surveillance study using a registry. A movement similar to this regulation has been seen among Western nations. For example, in the United States, Regenerative Medicine Advanced Therapy Designation was introduced in 2017 as a provision of the 21st Century Cures Act. This is similar to Japan's conditional and time-limited marketing authorization, which presumes efficacy of a product based on surrogate endpoints in life-threatening diseases. It is true that the current study design has limitations, and study designs that are beyond our imagination should be developed in the future.