Regulations for clinical trials of medical devices

Switzerland has adapted its medical devices regulations to the EU rules in the interests of patient safety and EU market access for the Swiss medical devices industry. The changes will also have implications for human research legislation.

What are medical devices?

Items as varied as plasters, hospital beds, cardiac pacemakers, disinfectants and x-ray equipment, have one thing in common: they are all medical devices. In other words, they are products “which are intended to have, or are presented as having, a medical use and whose principal effect is not obtained with a medicinal product” (Therapeutic Products Act, TPA, Art. 4 let. b).

As a result of the new EU rulings, products that are used without a medical purpose will be considered to be medical devices if they are used as such or are associated with similar risks, for example coloured contact lenses that do not correct vision.

EU Regulation on Medical Devices

In 2012 the EU Commission presented for discussion a draft for stricter rules for medical devices. This had been prompted by various serious incidents – for example flawed silicone breast implants and defective hip implants.

In 2017 the EU finally approved two regulations, one on medical devices (MDR) and one on in vitro diagnostic devices (IVDR). These have been coming into force in stages since 26 November 2017.

You can find more information about these regulations and the changes to Swiss law on the website on the Therapeutic Products Act (TPA). This is the law mainly affected by these changes.

Better quality assurance for medical devices

The rules are primarily designed to better protect patients from defective medical devices. Consequently, manufacturers will have to submit stronger scientific evidence to substantiate the safety and quality of their devices before being allowed to place them on the market. They must also continue to collect data after the products are placed on the market. This is why the laws and ordinances relating to human research were also adapted as part of the revision of the TPA. Due to the COVID-19 pandemic, the amended rules entered into force on 26 May 2021, one year later than planned, at the same time as the EU-MDR.

EU rules affect the law on human research and its implementation

Switzerland and the EU pursue the same objectives when it comes to regulating research:

Protect affected persons
Promote quality and transparency of research
Ensure a regulatory environment that is as favourable to research as possible

The EU embodies these objectives in the context of market access to medical devices, whereas the HRA regulates the research independently of market access. There is a need for action at implementation level: the cantonal ethics committees and Swissmedic implement the procedures for approving and reviewing research projects involving medical devices. They will now have to adapt and, in some cases, reorganise these procedures.

Certain EU definitions are now incorporated into Swiss law. For example, the definition of a "clinical trial" with a medical device now corresponds to the definition of a "clinical investigation" in the MDR. The categorization of individual research projects also changes. The transparency requirements of the MDR go further than in Switzerland, especially with regard to the documents of the approval procedure and the publication of the research results.

Ordinance on clinical trials with medical devices

The definitions in the EU rules prompted the Federal Council to propose a new “Ordinance on clinical trials with medical devices (ClinO-MD)”. The ClinO-MD will conveniently list in one legal text all the provisions relating to research with medical devices.

The consultation for the amended ordinance took place from 15 May to 5 September 2019.

The amended human research regulations were scheduled to enter into force in May 2020, but were postponed to 26 May, 2021 as a result of the COVID-19 pandemic.

Inclusion of clinical trials with in vitro diagnostics (IVDs) in the ClinO-MD

Since 26 May 2022, clinical trials with IVDs in Switzerland have been regulated in the ClinO-MD and no longer in the ClinO.

The title of the ordinance (Ordinance on Clinical Trials with Medical Devices, ClinO-MD) remains unchanged despite the inclusion of IVDs, as under the HRA IVDs are also deemed medical devices.

Since 26 May 2022, the ClinO-MD has therefore governed clinical trials involving devices as defined in the Medical Devices Ordinance (MedDO) (‘clinical investigations’) and involving devices as defined in the In-vitro Diagnostic Medical Device Regulation (IVDR) (‘performance studies’). Since this date, the Clinical Trials Ordinance (ClinO) has only contained provisions for clinical trials with medicinal products, transplant products and transplantation, and other clinical trials.

You can find more information on this on the website on the Therapeutic Products Act (TPA).

Implementation of the regulations in the European Union

The FOPH is actively monitoring developments in the European Union regarding the EU regulations on medical devices. Between August 2019 and February 2024, the FOPH published regular updates on the implementation of the regulations in the EU and its member states. The reports will appear in English and can be found under the heading ‘Documents’.