Medical device

Explore key EU MDR updates and strategies for effective clinical evaluations

Explore key EU MDR updates and strategies for effective clinical evaluation

January 22, 2024
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EU MDR, medical device regulation, clinical evaluation

The EU Medical Devices Regulation (EU MDR), effective since May 2021, has introduced significant changes in the clinical evaluation of medical devices. This blog post delves into the pivotal elements of the EU MDR clinical evaluation efforts, updates, and challenges.

Understanding the EU MDR Framework

The EU MDR has replaced the EU Active Implantable Medical Devices Directive (AIMDD) and the EU Medical Devices Directive (MDD). It mandates more detailed and specific requirements for evaluating clinical data. Understanding these requirements is crucial for manufacturers to ensure their products meet the necessary safety and performance standards.

The Role of Notified Bodies and Clinical Evaluation

Notified bodies play a critical role in the assessment of medical devices under the EU MDR. They are responsible for evaluating the sufficiency of clinical data provided by manufacturers. This includes assessing the use of real-world data and evidence, particularly in postmarket clinical follow-up, to confirm device safety and performance. They are tasked with critically assessing the clinical data provided by manufacturers to ensure its sufficiency and relevance. This process involves:

  1. Thorough Review of Clinical Data: Notified bodies scrutinize all available clinical evidence to ascertain its adequacy in demonstrating the safety and performance of a device.
  2. Assessment of Methodological Rigor: The clinical data must be collected and presented following rigorous methodological standards. Notified bodies evaluate the reliability and validity of the data, including study design, data collection methods, and statistical analyses.
  3. Evaluation of Real-World Data and Evidence: Increasingly, notified bodies consider real-world data (RWD) and real-world evidence (RWE) in their assessments. They examine the relevance and applicability of such data in the context of the device’s intended use.
  4. Continuous Postmarket Surveillance: Notified bodies also oversee postmarket clinical follow-up, ensuring that manufacturers continuously monitor and report on their device's performance and safety post-launch.

EU MDR Clinical Evaluation Requirements

Clinical evaluation under the EU MDR involves a comprehensive assessment of clinical data pertaining to a medical device. Key requirements include:

  1. Clinical Data Sufficiency: Manufacturers must ensure the availability and adequacy of clinical data demonstrating the safety and performance of the device (MEDDEV 2.7/1 rev. 4, section 6).
  2. Scientific Rigor: The clinical evaluation process demands rigorous methodological approaches, ensuring reliability and validity of data (MEDDEV 2.7/1 rev. 4, section 6).
  3. Continuous Data Assessment: Manufacturers are expected to continuously update their clinical evaluation throughout the product lifecycle (MEDDEV 2.7/1 rev. 4, section 6).

Establishing Equivalence under EU MDR

Establishing equivalence is crucial when using existing clinical data from a similar device. According to the MDCG 2020-5 guidelines, equivalence needs to be demonstrated in three areas:

  1. Technical Characteristics: Similarity in design, use conditions, and specifications, including physicochemical properties (MDCG 2020-5, section 3.1).
  2. Biological Characteristics: The devices should use the same materials or substances in contact with human tissues or body fluids (MDCG 2020-5, section 3.2).
  3. Clinical Characteristics: Devices must be used for the same clinical condition or purpose, in a similar population (MDCG 2020-5, section 3.3).

MDCG 2020-5 Guidelines on Equivalence

The MDCG 2020-5 document provides detailed guidance on demonstrating equivalence:

  • Demonstration of Equivalence: Manufacturers need to prove that the differences between the devices will not result in clinically significant differences in safety and performance (MDCG 2020-5, section 4).
  • Use of Data from Similar Devices: If equivalence cannot be established, data from similar devices can still be useful for risk management and clinical evaluation (MDCG 2020-5, section 5).

Updates and Challenges

The EU MDR anticipates new guidance on clinical evaluation, with an update of MEDDEV 2.7/1 rev. 4, and a definition of orphan devices. Manufacturers must stay abreast of these updates to ensure compliance. One significant challenge is establishing sufficient clinical data levels for devices incorporating artificial intelligence, reflecting a rapidly evolving technological landscape.

The International Organization for Standardization’s ISO/AWI 189697 is a new standard in development for clinical evaluation that aims to provide a horizontal standard to the clinical evaluation approach.

The EU MDR has introduced an additional level of scrutiny with the clinical evaluation consultation procedure (CECP) in Article 54 and requirement for expert panels (see here) to support and advise on the scientific assessment of medical devices and in vitro diagnostic medical devices. These additional steps are to enhance the transparency of clinical evaluation assessments of high-risk devices by notified bodies. Note that only Class III implantable and Class IIb active devices that administer and/or remove medicinal products are applicable for CECP.

Real-World Data and Evidence

The EU MDR emphasizes the use of real-world data (RWD) and real-world evidence (RWE) in clinical evaluations. These data sources, including device registry data and patient self-reported data, are becoming increasingly relevant. However, manufacturers must ensure that data acquisition is methodologically sound and addresses any potential biases.

Market Impact and Compliance Strategies

The increased regulatory burden under the EU MDR might affect market dynamics, including the availability of certain devices. Manufacturers need to develop robust strategies for clinical evaluation, considering the nuances of the EU MDR, to avoid market withdrawal or non-compliance penalties.


Navigating the EU MDR landscape requires a thorough understanding of its requirements and the evolving regulatory environment. Manufacturers, whether seasoned experts or novices, must align their product development and clinical evaluation strategies with these regulations to ensure market success and patient safety.

Contact us here if you need help with your clinical evaluation efforts

Disclaimer - This post intended for informational purposes and does not constitute legal information or advice. The materials are provided in consultation with US federal law and may not encompass state or local law.