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E14 – The Clinical Evaluation of QT/QTc Interval Prolongation and Proarrhythmic Potential for Non-Antiarrhythmic Drugs

Guideline number: E14
Status: Implementation (Step 5)
Adopted (Step 4): 12 May 2005

The ICH harmonised Guideline was finalised under Step 4 in May 2005.

This document provides recommendations to sponsors concerning the design, conduct, analysis, and interpretation of clinical studies to assess the potential of a drug to delay cardiac repolarisation.

This assessment should include testing the effects of new agents on the QT/QTc interval as well as the collection of cardiovascular adverse events.

The investigational approach used for a particular drug should be individualised, depending on the pharmacodynamic, pharmacokinetic, and safety characteristics of the product, as well as on its proposed clinical use.

The assessment of the effects of drugs on cardiac repolarisation is the subject of active investigation.

When additional data (non-clinical and clinical) are accumulated in the future, this document may be reevaluated and revised.

The ICH Harmonised Guideline was finalised under Step 4 in July 1997. This document covers the preclinical safety testing requirements for biotechnological products. It addresses the use of animal models of disease, determination of when genotoxicity assays and carcinogenicity studies should be performed, and the impact of antibody formation on duration of toxicology studies.

An addendum was proposed to provide clarification on S6 and an update of the following topics discussed in the original ICH S6 Guideline: species selection, study design, immunogenicity, reproductive and developmental toxicity and assessment of carcinogenic potential. The Harmonised addendum provides further complementary guidance to the S6 Guideline and helps to define the current recommendations and reduce the likelihood that substantial differences will exist among regions.

The addendum reached Step 4 of the harmonisation process in June 2011 and was integrated as part II in the core Guideline that was then renamed S6(R1).

Guideline

Annexes

No results found.

Guideline implementation

ANMAT, Argentina

-

Not yet implemented;
ANVISA, Brazil

-

Implemented; Date: 4 January 2021; Reference: RDC 413/2020
COFEPRIS, Mexico

-

Not yet implemented;
EC, Europe

-

Implemented; Date: 1 November 2005; Reference: CHMP/ICH/2/04
EDA, Egypt

-

Implemented; Date: 8 July 2021; Reference: Regulatory Guide for mechanisms, procedures and rules of implementing the Decree of Egyptian Drug Authority No.343 of 2021
FDA, United States

-

Implemented; Date: 1 October 2005; Reference: Vol. 70, No. 202, p. 61134-35
HSA, Singapore

-

Implemented; Date: 1 January 2008; Reference: HSA, Singapore webpage: Guidance documents for clinical trials
Health Canada, Canada

-

Implemented; Date: 5 April 2006; Reference: File #: 06-106861-656
JFDA, Jordan

-

Not yet implemented;
MFDS, Republic of Korea

-

Implemented; Date: 16 December 2020; Reference: Guideline on Clinical Evaluation of Cardiovascular Safety [Guideline-0193-03]
MHLW/PMDA, Japan

-

Implemented; Date: 1 October 2009; Reference: PFSB/ELD Notification No. 1023-1
MHRA, UK

-

Implemented; Date: 1 May 2005;
NAFDAC, Nigeria

-

Not yet implemented;
NMPA, China

-

Implemented; Date: 31 July 2023; Reference: NMPA, China Announcement No. 61 (2022)
SAHPRA, South Africa

-

In the process of implementation;
SFDA, Saudi Arabia

-

In the process of implementation;
Swissmedic, Switzerland

-

Implemented; Date: 1 May 2005; Reference: ICH Guidelines apply in Switzerland automatically upon reaching Step 4: Swissmedic Journal 05/2006, p. 504
TFDA, Chinese Taipei

-

Implemented; Date: 19 January 2012; Reference: Points to Consider on Efficacy and Safety for NCE Application
TITCK, Türkiye

-

Not yet implemented;

Q+A

Q+A number: E14/S7B Q&A (R1)
Q+A Status: Implementation (Step 5)
Q+A Adopted (Step X): 20 August 2026

Q+A implementation

The ICH E14 and ICH S7B Guidelines describe clinical and nonclinical risk assessment strategies to inform the potential risk for delayed depolarisation and proarrhythmia of a test substance and contribute to the design of clinical investigations. Emergent data over the past several years allow a more integrated nonclinical and clinical approach to evaluate delayed cardiac depolarisation.

The first combined E14/S7B Q&As, published in February 2022, provide information on how this integration may be approached. These Q&As have been replaced by E14/S7B Q&As (R1), which comprise the original Q&As plus new ones that provide clarity on making the testing framework sustainable and flexible enough to limit potential regional differences in the recommended approach to this important safety endpoint for existing and emerging modalities.

ANMAT, Argentina

-

Not yet implemented;
ANVISA, Brazil

-

Not yet implemented;
COFEPRIS, Mexico

-

Not yet implemented;
EC, Europe

-

Implemented; Date: 27 August 2022; Reference: EMA/CHMP/ICH/415588/2020
EDA, Egypt

-

Implemented; Date: 1 January 2022; Reference: Regulatory Guide for mechanisms, procedures and rules of implementing the Decree of Egyptian Drug Authority No.343 of 2021
FDA, United States

-

Implemented; Date: 30 August 2022; Reference: Vol 87 No 166 p.52786-52789
HSA, Singapore

-

Implemented; Date: 1 December 2022;
Health Canada, Canada

-

Implemented; Date: 10 June 2022; Reference: File # 22-105019-395
JFDA, Jordan

-

Not yet implemented;
MFDS, Republic of Korea

-

Implemented; Date: 25 October 2024; Reference: Guideline on Clinical Evaluation of Cardiovascular Safety [Guideline-0193-03]; Guideline on Non-clinical Evaluation of the Potential for Delayed Ventricular Repolarization (QT Interval Prolongation) by Human Pharmaceuticals [Guideline-0915-02]
MHLW/PMDA, Japan

-

Implemented; Date: 22 July 2022; Reference: PSEHB/PELD Administrative Notice
MHRA, UK

-

Not yet implemented;
NAFDAC, Nigeria

-

Not yet implemented;
NMPA, China

-

Implemented; Date: 31 July 2023; Reference: NMPA, China Announcement No. 33 (2023)
SAHPRA, South Africa

-

In the process of implementation;
SFDA, Saudi Arabia

-

Not yet implemented;
Swissmedic, Switzerland

-

Implemented; Date: 21 February 2022; Reference: ICH Guidelines apply in Switzerland automatically upon reaching Step 4: Swissmedic Journal 05/2006, p. 504
TFDA, Chinese Taipei

-

Implemented; Date: 30 May 2023; Reference: Updated-Announcement for ICH Guidelines Recognition List
TITCK, Türkiye

-

Not yet implemented;