Tag: clinical trial

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Exploring the EU COMBINE Programme

Understanding and Bridging the Gap in Clinical Research


The European Union’s (EU) healthcare landscape is continuously evolving, driven by the need to integrate
innovative treatments and technologies. One of the most ambitious initiatives in this realm is the EU
COMBINE Programme, launched in June 2023. This programme aims to address the complexities
and challenges at the intersection of three critical regulations: the Clinical Trials Regulation (CTR),
the Medical Devices Regulation (MDR), and the In Vitro Diagnostic Medical Devices Regulation
(IVDR).


Understanding the Need for COMBINE
In the EU, clinical trials of medicinal products, clinical investigations of medical devices, and
performance studies of in vitro diagnostics (IVDs) are governed by distinct regulatory frameworks.
These regulations, while comprehensive, often create operational challenges when combined
studies are required. Combined studies involve:

  • A clinical trial of a medicinal product alongside a performance study of an IVD
  • A clinical trial of a medicinal product alongside a clinical investigation of a medical device

    The COMBINE Programme was initiated to streamline these processes, ensuring that innovative
    treatments combining medicinal products with medical devices or IVDs can be developed more
    efficiently.

    One of the challenges presented by the stakeholders, was the duplication of work by submitting
    combined study application across multiple countries within the EU. Studies spanning multiple
    countries require multiple applications to each competent authority. In some cases, the information
    required, and outcome can vary depending on the country. Not only is this a duplication of work, it
    can put clinical study progression at risk.




The Goals of the COMBINE Programme
The primary objectives of the COMBINE Programme are to:

  1. Analyse Challenges: Identify and understand the root causes of difficulties faced by sponsors
    in conducting combined studies.
  2. Propose Solutions: Develop practical solutions to address these challenges, facilitating
    smoother regulatory processes.

Key Phases of the Programme
The COMBINE Programme is structured into two main phases:

  1. Analysis Phase: This initial phase involved collecting and analysing feedback from various
    stakeholders, including competent authorities, medical research ethics committees, and the
    European Medicines Agency (EMA). The findings were published in an analysis report in May
    2024, highlighting the primary issues and proposing potential solutions.
  2. Implementation Phase: Following the analysis, the Member States endorsed a strategy for
    the second phase in December 2024. This phase focuses on implementing the proposed
    solutions through a series of projects. These projects aim to align the regulatory frameworks
    and simplify the processes for combined studies.

Stakeholder Involvement
The success of the COMBINE Programme hinges on the collaboration of a diverse group of
stakeholders, including:

  • Competent Authorities: National bodies responsible for overseeing clinical trials and
    medical devices.
  • Medical Research Ethics Committees: Groups ensuring that clinical studies meet ethical
    standards.
  • European Medicines Agency (EMA): The agency providing scientific evaluation, supervision,
    and safety monitoring of medicines in the EU.
  • Industry Representatives: Stakeholders from the pharmaceutical and medical device sectors, including associations like the European Federation of Pharmaceutical Industries and Associations (EFPIA) and MedTech Europe.

Progress and Future Directions
As of early 2025, the projects within the COMBINE Programme are progressing according to the
established timelines. Regular reviews and updates ensure that the programme remains on track
and responsive to emerging challenges.


The ultimate goal is to create a more cohesive and efficient regulatory environment that supports
the development of innovative treatments, benefiting patients across the EU

The role of EUDAMED
EUDAMED (European Database on Medical Devices) is an IT system developed by the European
Commission to implement the Medical Devices Regulation (MDR) and the In Vitro Diagnostic Medical
Devices Regulation (IVDR). With the transition to the new regulations, EUDAMED will be enhanced
to create a more transparent and efficient regulatory tool for all industry stakeholders. However, the
implementation of EUDAMED has seen a number of delays, largely due to the complexity of the
system and resources required to implement. The result has been a lack of coordination between
competent authorities, this can be attributed to some of the challenges identified as part of the
COMBINE programme.

Conclusion
The EU COMBINE Programme represents a significant step forward in harmonizing the regulatory
landscape for combined studies. By addressing the complexities at the intersection of CTR, MDR, and
IVDR, the programme aims to foster innovation and improve patient access to cutting-edge
treatments.

The eventual roll out of EUDAMED will enable greater transparency and communication between
member states, and regulatory authorities.

As the projects within the programme continue to unfold, the healthcare community remains
optimistic about the potential for streamlined processes and enhanced collaboration.

Stay tuned for more updates on the progress and impact of the COMBINE Programme as it continues
to shape the future of clinical research in the EU.

How IVDEOLOGY is supporting the industry
The IVD regulation is a key cog in the mechanism for combined studies. We work with a number of
manufactures developing Companion Diagnostic medical devices, or clinical trial assays which fall
under this regulation. We help build regulatory strategies, and technical documentation to support
regulatory submissions.

Book a call with us to discuss your regulatory challenges or questions and see how IVDeology can
help you

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Understanding Companion Diagnostics: A Key to Personalised Medicine

The first companion diagnostic (CDx) was approved by the US Food and Drug Administration (FDA) in 1998 with the European Medicines Agency (EMA) following with approval 2 years later focussed on the cancer treatment drug Herceptin. Since then, the rise of precision medicine has played an increasing part in eliminating the trial-and-error approach to identifying effective treatments for individual patients ensuring that therapies are tailored to their unique biological characteristics.

What Are Companion Diagnostics?

Companion diagnostics are in vitro diagnostic (IVD) tests (or may be an imaging tool), that provide critical information for the safe and effective use of a corresponding drug or biological product. These tests are co-developed with a therapeutic drug and are essential in determining whether a patient will benefit from a specific treatment, be at risk for severe side effects, or require adjustments in their therapy to achieve optimal results.

The labelling of a CDx must include the specific drug it was developed for and likewise the labelling of the drug must indicate the use of the CDx for prescription of the drug.

The US FDA approach to CDx Submission

In the US, the FDA is the central authority and requires that the drug and device are submitted for review and approval at the same time. Thus, the device and drug are developed at the same time and if possible, the device should be used as the Clinical Trial Assay (CTA). The therapeutic drug and it’s proposed CDx need Investigational Drug Application (IND) and Investigational Device Exemption (IDE) submissions and approvals before investigational clinical studies can commence.

During the development process the drug developer will be able to request meetings with the Centre for Drug Evaluation and Research (CDER) and the device developer will be able to meet with the Centre for Devices and Radiological Health (CDRH) via the Q-Submission process. For each of these meetings the respective developer should make it clear that they are co-developing the CDx and it is always useful to request a representative from the other centre to attend for awareness.

In the past the majority of CDx have been submitted and approved via the Pre-Market Approval process (PMA) and are classified as Class III devices. However, in 2024, the FDA announced plans to reclassify many Class IIIs to be Class II and enable manufacturers to submit for market authorisation via the 510K route.

The EU approach to CDx submission

In the EU, CDx are Class C following the classification rule 3(f) under the IVD Regulation 2017/746 and the key difference to the US process is the consultation process between the Notified Body of the device manufacturer and the EMA. The Notified Body will assess the technical documentation of the CDx and when that is complete, they will then consult with EMA for the final assessment alongside the drug file. This secondary process can add around 6 to 8 months to the approval process and needs to be planned carefully to allow sufficient time for market authorisations.

As with the US process, the CDx should be used as the CTA as early as possible, and the clinical use of the assay is often seen as an interventional clinical study requiring complex and lengthy applications to the separate member state competent authorities for approval.

The Future of Companion Diagnostics

Since the first CDx was approved by the FDA in 1998, there are now over 200 cleared or approved listed by the FDA. IVDeology Ltd is seeing the development of companion diagnostics growing alongside advancements in genomics and biotechnology. As our understanding of the genetic and molecular basis of diseases expands, manufacturers have the ability to create more precise and effective diagnostic tests, leading to better patient outcomes and more efficient healthcare systems.

Conclusion

Companion diagnostics are leading the way in the field of personalized medicine. By ensuring that treatments are tailored to the individual needs of patients, these diagnostics not only improve the efficacy and safety of therapies but also pave the way for a more personalized approach to healthcare. As technology continues to evolve, the role of companion diagnostics will undoubtedly become even more integral to modern medicine.

IVDeology Ltd can support small pharmaceutical developers understand the CDx requirements to enable clear and concise discussions with your identified device developers. Likewise we can support CDx developers understand the requirement for consultation with the FDA and the pathway to market approval.