Understanding MDCG 2020-13: A Guide for Medical Device Manufacturers Preparing Clinical Evaluation Reports

October 1, 2023

The Medical Device Coordination Group (MDCG) plays a key role in setting the rules for medical devices in the European Union. One of its most important guidelines is MDCG 2020-13, which focuses on how to create Clinical Evaluation Reports (CER) under the EU’s Medical Device Regulation (MDR). Understanding this guideline is essential for complying with EU rules and successfully marketing your products there.

Why MDCG 2020-13 Matters?

The new MDR has significantly altered the compliance landscape, making it more complex but also more standardized. It has heightened the importance of a detailed and well-structured Clinical Evaluation Report as part of your Technical Documentation. The MDCG 2020-13 guidance provides manufacturers with valuable insights on how to prepare a CER that meets the requirements of the Medical Device Regulation (MDR). By following the guidance, manufacturers can increase their chances of successful regulatory approval for their medical devices.

MDCG 2020-13 is aimed at providing guidance on the clinical evaluation process for medical devices. Given the complexity and significance of clinical data in proving the safety and performance of a device, MDCG 2020-13 acts as a crucial resource. It details what should be included in the Clinical Evaluation Report, and it does so in a manner that aligns with the new MDR, thereby ensuring that you meet the most current regulatory requirements.

Aligning Clinical Evaluation (CER) with Clinical Evaluation Assessment Report (CEAR) Structure

Manufacturers should be aware that the Clinical Evaluation Report can also be prepared aligned with the Clinical Evaluation Assessment Report (CEAR) structure. This approach aids in a more streamlined, comprehensive evaluation of your device, making the regulatory journey smoother.

MDCG 2020-13 and Its Impact on Clinical Evaluation Plan

MDCG 2020-13 delves deeply into the specifics of the clinical evaluation plan, highlighting the importance of several key aspects that manufacturers must pay attention to. This guidance reiterates the necessity of aligning the clinical evaluation plan with the Annex XIV Part A Section 1a requirements.

MDCG 2020-13 explicitly instructs manufacturers to ensure the clinical evaluation plan encompasses the following:

  • General Safety and Performance Requirements: Identify which requirements necessitate support from clinical data.
  • Intended Purpose: Clearly specify the device’s intended purpose, which must be consistent throughout the evaluation process.
  • Target Groups: Detail the target groups, their indications, and contra-indications, a crucial aspect of ensuring patient safety.
  • Clinical Benefits: Define the clinical benefits and associated outcome parameters, providing concrete metrics for evaluation.
  • Qualitative and Quantitative Aspects of Clinical Safety: Specify the methods to be employed in assessing both qualitative and quantitative aspects of clinical safety, focusing on the identification of residual risks and side-effects.
  • Benefit-Risk Ratio: Include a comprehensive list of parameters to assess the benefit-risk ratio in line with the current state of medical science.
  • Special Components: Indicate how you will address benefit-risk issues tied to specialized components like pharmaceutical substances, animal tissues, or human tissues.
  • Clinical Development Plan: While a detailed description may not always be required, MDCG 2020-13 insists on the inclusion of a clinical development plan, complete with milestones and acceptance criteria.

MDCG 2020-13 also mandates that the clinical evaluation plan must:

  • Adequately Address Safety: Assess both qualitative and quantitative aspects of clinical safety, detailing methods for determining residual risks and side-effects.
  • Document Clinical Data for Performance: Summarize the clinical data that proves the device’s performance in achieving its intended purpose and thereby contributing to clinical benefits for patients.
  • Review Past Issues: If relevant, the plan should summarize any significant complaints or vigilance issues associated with earlier device iterations and evaluate their impact on the current clinical evaluation assessment.

Aligning IFU and Promotional Materials with the CER Following MDCG 2020-13

The synergy between Instructions for Use (IFU), promotional materials, and the Clinical Evaluation Report (CER) is crucial for regulatory compliance and, more importantly, for ensuring patient safety and device efficacy. Following MDCG 2020-13 guidelines can be a strategic move to align these critical documents. Below we explore this alignment:

  • Information Materials Supplied by the Manufacturer: In accordance with MDCG 2020-13, it is essential to conduct a review of all documents supplied by the manufacturer. This includes IFUs, promotional materials, Summary of Safety and Clinical Performance (SSCP), labeling, and more.
  • Intended Purpose: Verify that the clinical evidence cited in the CER supports the intended purpose of the device as described in the IFU and promotional materials.
  • Intended Patient Population: Ensure that the patient population identified in the CER aligns with that in the IFU and promotional materials.
  • Safety Measures: Assess whether all appropriate warnings or contraindications are included for the intended patient population.
  • Intended Users: Identify whether the device is designed for healthcare professionals or lay users. Check if the IFU includes information for the intended user, taking into account their technical knowledge, experience, and educational background.
  • User Training: Determine if training is required for the intended users and verify that this is justified in both the risk management file and the CER.
  • Limitations and Contraindications: The manufacturer must clearly describe any limitations and contraindications for the device. The CER should support these statements.
  • Warnings and Precautions: Verify that warnings, precautions, and measures for malfunctions are adequately described.
  • Associated Risks: Evaluate if the estimation of associated risks and residual risk is either quantitative or qualitative and whether this description is appropriate for both patients and users.

By aligning these documents in accordance with MDCG 2020-13, manufacturers not only assure compliance but also build a strong foundation for market success, bolstered by robust clinical evidence and transparent communication.

How to Incorporate these Aspects in Your Clinical Evaluation

1. Perform a Gap Analysis

  • Action: Perform a gap analysis to compare your existing clinical evaluation against the new requirements outlined in MDCG 2020-13.
  • Outcome: This will help you identify areas that need attention and allow you to make data-driven decisions for improvement.

2. Engage Multidisciplinary Teams

  • Action: Assemble a team  of regulatory experts, clinical professionals, and statisticians to holistically address the facets of the new guidelines.
  • Outcome: Leveraging diverse expertise ensures a thorough and compliant clinical evaluation process.

3. Update Documents

  • Action: Revise your clinical evaluation documentation to ensure it encompasses all the points highlighted in the gap analysis.
  • Outcome: With all the critical elements in place, you will be well-prepared for any regulatory scrutiny and audits.

4. Consistent Device Description

  • Action: Ensure the device description used for the clinical evaluation aligns with other documents such as the IFU and promotional materials.
  • Outcome: This will ensure clarity and cohesion across all documentations, making regulatory compliance easier to demonstrate.

5. Integrate Available Clinical Data

  • Action: Incorporate data from clinical investigations, Post-Market Clinical Follow-up (PMCF) studies, and other relevant sources into your updated clinical evaluation.
  • Outcome: This enhances the credibility of your CER and provides a richer context for assessing the device’s safety and performance.

6. Utilize PMS Reports or PSUR

  • Action: Review Post-Market Surveillance (PMS) reports or Periodic Safety Update Reports (PSUR) and incorporate updates as necessary into the IFU and other promotional materials.
  • Outcome: By doing this, you align your clinical evaluation with real-world data, thereby improving the reliability of your overall evaluation.

7. Consistency with Risk Management File

  • Action: Verify that all risk-related information across different documents, including the IFU and promotional materials, is consistent with the risk management file.
  • Outcome: Such alignment strengthens your compliance while also enhancing patient safety by ensuring that risk assessments are uniform across all materials.

By following MDCG 2020-13 to the letter, you don’t just comply with the regulations—you elevate the robustness and credibility of your clinical evaluation, thereby mitigating risks and accelerating your time-to-market.

Final Thoughts

MDCG 2020-13 is more than just another regulatory guideline; it’s a foundational element for any manufacturer looking to market their medical devices in the EU.

Aligning your Clinical Evaluation Report with the CEAR structure can provide an additional layer of robustness to your documentation, potentially accelerating your time to market. Understanding and implementing the recommendations from MDCG 2020-13 is not just about compliance; it is about ensuring the safety and performance of medical devices that have a profound impact on human health.

For any further assistance on navigating the complexities of MDCG 2020-13, feel free to reach out to us. We specialize in supporting medical device manufacturers in their journey towards MDR compliance.

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