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JAMA. 2009 Dec 23;302(24):2679-85. doi: 10.1001/jama.2009.1899.

Strength of study evidence examined by the FDA in premarket approval of cardiovascular devices.

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  • 1Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0124, USA.

Erratum in

  • JAMA. 2010 Feb 3;303(5):422.

Abstract

CONTEXT:

Medical devices are common in clinical practice and have important effects on morbidity and mortality, yet there has not been a systematic examination of evidence used by the US Food and Drug Administration (FDA) for device approval.

OBJECTIVES:

To study premarket approval (PMA)--the most stringent FDA review process--of cardiovascular devices and to characterize the type and strength of evidence on which it is based.

DATA SOURCES AND STUDY SELECTION:

Systematic review of 78 summaries of safety and effectiveness data for 78 PMAs for high risk cardiovascular devices that received PMA between January 2000 and December 2007 [corrected].

DATA EXTRACTION:

Examination of the methodological characteristics considered essential to minimize confounding and bias, as well as the primary end points of the 123 studies supporting the PMAs.

RESULTS:

Thirty-three of 123 studies (27%) used to support recent FDA approval of cardiovascular devices were randomized and 17 of 123 (14%) were blinded. Fifty-one of 78 PMAs (65%) were based on a single study. One hundred eleven of 213 primary end points (52%) were compared with controls and 34 of 111 controls (31%) were retrospective. One hundred eighty-seven of 213 primary end points (88%) were surrogate measures and 122 of 157 (78%) had a discrepancy between the number of patients enrolled in the study and the number analyzed.

CONCLUSION:

Premarket approval of cardiovascular devices by the FDA is often based on studies that lack adequate strength and may be prone to bias.

Comment in

PMID:
20040556
[PubMed - indexed for MEDLINE]
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