[Federal Register Volume 62, Number 107 (Wednesday, June 4, 1997)]
[Notices]
[Pages 30600-30603]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-14599]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration
[Docket No. 97N-0190]


Cranial Electrotherapy Stimulators; Submission of Safety and 
Effectiveness Information

AGENCY: Food and Drug Administration, HHS.


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ACTION: Notice.

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SUMMARY: The Food and Drug Administration (FDA) is issuing an order 
requiring manufacturers of cranial electrotherapy stimulators (CES) to 
submit to FDA a summary of, and citation to, all information known or 
otherwise available to them respecting the device, including adverse 
safety and effectiveness information concerning the device that has not 
been submitted under the Federal Food, Drug, and Cosmetic Act (the 
act). FDA is requesting this information in order to determine whether 
the classification of the device should be revised, or whether a 
regulation requiring the submission of a premarket approval application 
(PMA) for the device should be issued. Elsewhere in this issue of the 
Federal Register, FDA is issuing a final rule to revoke the requirement 
that manufacturers of CES devices submit a PMA or notice of completion 
of a product development protocol (PDP) for the device.

DATES: Summaries and citations must be submitted by August 14, 1998.

ADDRESSES: Submit summaries and citations to the Documents Mail Center 
(HFZ-401), Center for Devices and Radiological Health, Food and Drug 
Administration, 9200 Corporate Blvd., Rockville, MD 20850.

FOR FURTHER INFORMATION CONTACT: Doreen M. Melling, Center for Devices 
and Radiological Health, Food and Drug Administration, 9200 Corporate 
Blvd., Rockville, MD 20850, 301-594-2186.

SUPPLEMENTARY INFORMATION:

I. Background

    Section 513 of the act (21 U.S.C. 360c) requires the classification 
of medical devices into one of three regulatory classes: Class I 
(general controls), class II (special controls), and class III 
(premarket approval). Generally, devices that were on the market before 
May 28, 1976, the date of enactment of the Medical Device Amendments of 
1976 (the amendments) (Pub. L. 94-295), and devices marketed on or 
after that date that are substantially equivalent to such devices, have 
been classified by FDA. This notice refers to both the devices that 
were on the market before May 28, 1976, and the substantially 
equivalent devices that were marketed on or after that date, as 
``preamendments devices.''
    Section 515(b)(1) of the act (21 U.S.C. 360e(b)(1)) establishes the 
requirement that a preamendments device that FDA has classified into 
class III is subject to premarket approval. However, submission of a 
PMA, or a notice of completion of a PDP is not required until 90 days 
after FDA issues a final rule requiring premarket approval for the 
device, or 30 months after final classification of the device, 
whichever is later. Also, such a device is exempt from the 
investigational device exemption (IDE) regulations of 21 CFR part 812 
until the date stipulated by FDA in the final rule requiring the 
submission of a PMA for that device. If a PMA or a notice of completion 
of a PDP is not filed by the later of the two dates, commercial 
distribution of the device is required to cease. The device may, 
however, be distributed for investigational use if the manufacturer, 
importer, or other sponsor of the device complies with the IDE 
regulations.
    The Safe Medical Devices Act of 1990 (the SMDA) (Pub. L. 101-629) 
changed the definition of class II devices from those for which a 
performance standard is necessary to provide reasonable assurance of 
safety and effectiveness to those for which there is sufficient 
information to establish special controls to provide such assurance. 
Special controls include performance standards, postmarket 
surveillance, patient registries, guidelines (including guidelines for 
the submission of clinical data in premarket notification submissions 
in accordance with section 510(k)), recommendations, and other 
appropriate actions the agency deems necessary to provide such 
assurance. Thus, the SMDA modified the definition of class II devices 
to permit reliance on special controls, rather than performance 
standards alone, to provide reasonable assurance of safety and 
effectiveness.
    The SMDA also added new section 515(i) of the act. This section 
requires FDA to order manufacturers of preamendments class III devices 
for which no final regulation has been issued requiring the submission 
of PMA's to submit to the agency a summary of, and a citation to, any 
information known or otherwise available to them respecting such 
devices, including adverse safety and effectiveness information which 
has not been submitted under section 519 of the act (21 U.S.C. 360i). 
Section 519 of the act requires manufacturers, importers, or 
distributors to maintain records and to report information that 
reasonably suggests that one of its marketed devices may have caused or 
contributed to a death or serious injury, or that a malfunction of the 
device is likely to cause death or serious injury on recurrence. 
Section 515 (i) of the act also directs FDA to either revise the 
classification of the device into class I or class II or require the 
device to remain in class III; and, for devices remaining in class III, 
to establish a schedule for the issuance of a rule requiring the 
submission of PMA's for the device.
    In the Federal Register of August 24, 1995 (60 FR 43967), FDA 
issued a final rule to require the submission of a PMA or a notice of 
completion of a PDP for the CES device. FDA had not issued an order 
under section 515(i) of the act for the CES device before issuing this 
final rule. FDA has since become aware of additional information 
relevant to the possible reclassification of the device from class III 
to class II or class I. As a result, in the Federal Register of January 
28, 1997 (62 FR 4023), FDA proposed to revoke the rule requiring the 
submission of a PMA or notice of completion of a PDP. At that time, FDA 
said that it believed that it is more appropriate to invoke the 
procedures under section 515(i) of the act for the CES device. 
Elsewhere in this issue of the Federal Register, FDA is issuing a final 
rule based on the proposal (62 FR 4023).
    In this document, FDA is requiring manufacturers of CES devices to 
submit a summary of, and citation to, all safety and effectiveness 
information known or otherwise available to them respecting such 
devices, including adverse information concerning the devices which has 
not been submitted under section 519 of the act.

II. Statutory Authority and Enforcement

    In addition to the provisions of section 515(i) of the act 
described in section I of this document, this order is issued under 
section 519 of the act, as implemented by Sec. 860.7(g)(2) (21 CFR 
860.7(g)(2)). This regulation authorizes FDA to require reports or 
other information bearing on the classification of a device. Section 
519 of the act also requires the reporting of any death or serious 
injury caused by a device or by its malfunction.
    Failure to furnish the information required by this order results 
in the device being misbranded under section 502(t) of the act (21 
U.S.C. 352(t)) and is a prohibited act under sections 301(a) and (q) of 
the act (21 U.S.C. 331(a) and (q)). The agency will use its enforcement 
powers to deter noncompliance. Violations of section 301 of the act may 
be subject to seizure or injunction under sections 304(a) and 302(a) of 
the act (21 U.S.C. 334(a) and 332(a) respectively). In addition, 
violations under section 301 of the act may be subject to civil 
penalties under section 303(f) of the act (21 U.S.C. 333(f)), and 
criminal prosecution under section 303(a) of the act.

[[Page 30602]]

III. Order

    The agency is hereby issuing this order under sections 515(i) and 
519 of the act and Sec. 860.7(g)(1) of the regulations. Under the 
order, the required information shall be submitted by August 14, 1998, 
so that FDA may begin promptly the process established by section 
515(i) of the act to either revise or sustain the current 
classification of these devices.

IV. Required Contents of Submissions

    By the date listed in section III of this document, all 
manufacturers currently marketing CES devices shall provide a summary 
of, and citation to, any information known or otherwise available to 
them respecting the devices, including adverse safety and effectiveness 
data which has not been submitted under section 519 of the act. FDA 
suggests that it may be in the best interest of submitters to summarize 
the information submitted under section 519 of the act to facilitate 
FDA's decision making, even though such information is not required.
    The information should be submitted in one of the two following 
formats depending on whether the applicant is aware of any information 
which would support the reclassification of the device into class I 
(general controls) or class II (special controls). Information which 
would support the reclassification of the device must consist of 
adequate, valid scientific evidence showing that general controls alone 
(class I), or general controls and special controls (class II) will 
provide a reasonable assurance of the safety and effectiveness of the 
device.
    For manufacturers who do not believe that existing information 
would support the reclassification of their device into class I or 
class II, the information provided should be submitted in the following 
format:
    1. Indications for use. A general description of the disease or 
condition to be diagnosed, treated, cured, mitigated, or prevented, 
including a description of the patient population for which the device 
is intended.
    2. Device description. An explanation of how the device functions, 
significant physical and performance characteristics of the device, and 
basic scientific concepts that form the basis for the device.
    3. Other device labeling. Other device labeling that includes 
contraindications, warnings and precautions and/or promotional 
materials.
    4. Risks. A summary of all adverse safety and effectiveness 
information and identification of the risks presented by the device as 
well as any mechanisms or procedures which will control the risk.
    5. Alternative practices and procedures. A description of 
alternative practices or procedures for diagnosing, treating, 
preventing, curing, or mitigating the disease or condition for which 
the device is intended.
    6. Summary of preclinical and clinical data. The summary of 
preclinical and clinical data should include the conclusions drawn from 
the studies which support the safety and effectiveness of the device as 
well as special controls, if any, which address the adverse effects of 
the device on health. The summary should include a brief description of 
the objective of the studies, the experimental design, how the data 
were collected and analyzed, and a brief description of the results of 
the studies, whether positive, negative, or inconclusive. The summary 
of the clinical study(ies) should also include a discussion of the 
subject inclusion and exclusion criteria, the study population, reasons 
for patient discontinuations, and results of statistical analyses.
    7. Bibliography. A copy of the key references, a brief summary of 
the salient features of each key reference, and a brief discussion of 
why the reference is relevant to an evaluation of the safety and 
effectiveness evaluation of the device.
    Manufacturers who believe that existing information would support 
the reclassification of their device into class I or class II may 
either submit information using the format described below or may 
submit a formal reclassification petition which should include the 
information described below in addition to the information required 
under 21 CFR 860.123.
    1. Identification. A brief narrative identification of the device. 
Where appropriate, this identification should include a listing of the 
materials, and the component parts, and a description of the intended 
use of the device.
    2. Risks to health. An identification of the risks to health should 
summarize all adverse safety and effectiveness information, which have 
not been submitted under section 519 of the act particularly the most 
significant. The mechanisms or procedures which will control the risk 
should be described. A list of the general hazards associated with the 
device and a bibliography with copies of the referenced material should 
be provided.
    3. Recommendation. A statement whether the manufacturer believes 
the device should be reclassified into class I or class II.
    4. Summary of reasons for recommendation. Each manufacturer should 
include a summary of the reasons for requesting reclassification of its 
device and an explanation why it believes the device meets the 
statutory criteria for reclassification into class I or class II. Each 
manufacturer should also identify the special controls that it believes 
would be sufficient to provide reasonable assurance of the safety and 
effectiveness of its device if it believes the device should be 
reclassified into class II.
    5. Summary of valid scientific evidence on which the recommendation 
is based. Manufacturers are advised that, when considering a formal 
reclassification petition, FDA will rely only upon valid scientific 
evidence to determine that there is a reasonable assurance of the 
safety and effectiveness of the device, if regulated by general 
controls alone (class I) or by general controls and special controls 
(class II). Valid scientific evidence consists of evidence from well-
controlled investigations, particularly controlled studies, studies and 
objective trials without matched controls, well documented case 
histories conducted by qualified experts, and reports of significant 
human experience with a marketed device, from which it can fairly and 
responsibly be concluded by qualified experts that there is reasonable 
assurance of the safety and effectiveness of a device under its 
conditions of use. The evidence required may vary according to the 
characteristics of the device, its conditions of use, the existence and 
adequacy of warnings and other restrictions, and the extent of 
experience with its use. Isolated case reports, random experience, 
reports lacking sufficient details to permit scientific evaluation, and 
unsubstantiated opinions are not regarded as valid scientific evidence 
to show safety or effectiveness. (See Sec. 860.7(c)(2)).
    According to Sec. 860.7(d)(1), there is reasonable assurance that a 
device is safe when it can be determined, based upon valid scientific 
evidence, that the probable benefits to health from use of the device 
for its intended uses and conditions of use, when accompanied by 
adequate directions and warnings against unsafe use, outweigh any 
probable risks. The valid scientific evidence used to determine the 
safety of a device shall adequately demonstrate the absence of 
unreasonable risk of illness or injury associated with the use of the 
device for its intended uses and conditions for use. Moreover, in 
accordance to Sec. 860.7(e)(1), there is reasonable assurance that a 
device is

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effective when it can be determined, based upon valid scientific 
evidence, that in a significant portion of the target population, the 
use of the device for its intended uses and conditions of use, when 
accompanied by adequate directions for use and warnings against unsafe 
use, will provide clinically significant results.
    Manufacturers submitting a formal reclassification petition may 
wish to request two petitions as examples of successful 
reclassification petitions.
    Magnetic resonance imaging devices, Docket Nos. 87P-0214/CP1 
through CP13, and Nd:YAG Laser for posterior capsulotomy devices, 
Docket No. 86P-0083, were both reclassified from class III to class II 
following the submission of reclassification petitions. Both petitions 
are available upon submission of a Freedom of Information request to 
the Freedom of Information Staff (HFI-35), Food and Drug 
Administration, 5600 Fishers Lane, rm. 12A-30, Rockville, MD 20857.

V. Submission of Required Information

    The summary of and citation to, any information required by the act 
must be submitted by August 14, 1998, to the Document Mail Center 
(address above).

    Dated: May 28, 1997.
Joseph A. Levitt,
Deputy Director for Regulations Policy, Center for Devices and 
Radiological Health.
[FR Doc. 97-14599 Filed 6-3-97; 8:45 am]
BILLING CODE 4160-01-F