Objective: To identify and characterize all European Medicines Agency (EMA) approvals that made use of adaptive designs in clinical trials and to evaluate the conditions where adaptive designs were required. Methods: We gathered relevant files derived from the EMA database based on a list of the keywords related to adaptive designs between 2008 and 2020. We collected the trial characteristics from approvals and Fisher exact test was used to compare the characteristics. Results: We found 41 approvals derived from 91 original EMA files contained adaptive designs. Group sequential was the most popular adaptive design (17/41). Most of the approvals (32/41) were pivotal trials and were not under accelerated assessment (38/41). Among 32 confirmatory trials planned with adaptive designs, the proportion of AM status showed a statistically significant increase (P < 0.0001) from 0% in 2008–2012 to 90.48% in 2017–2020. The percentage of antitumor drugs in approved drugs with ongoing clinical trials was 82.35%, compared to 20.83% with completed trials (P=0.0001). The proportion of companies that required post-authorization safety or efficacy studies or that were granted CMA for drugs that were approved but still had ongoing clinical trials significantly differed from the other group (P = 0.0230). Conclusion: An increasing trend was observed in the number of EMA approvals related to adaptive designs from 2008 to 2020. Extra regulations will be necessary for ongoing trials due to unknown, uncertain circumstances raised from adaptive design, such as addtitonal monitoring, conditional marketing authorization.