Why the study?
Can the effect of a standardized meal on QTc be used to show assay sensitivity in early-phase studies?
Can the effect of a standardized meal on QTc be used to show assay sensitivity in early-phase studies?
A standardized meal can be used as a reliable positive control to demonstrate assay sensitivity for QTc evaluation in early-phase clinical studies with small sample sizes.
Phase 1 QT studies without positive controls at supratherapeutic exposures may fail to exclude effects; extends ICH E14 interpretation for early-phase cardiac safety.
The most recent International Conference on Harmonisation E14 Q&A document states that a separate positive control would not be necessary provided sufficiently high exposures are achieved in the early-phase studies. Realistically, a phase 1 study is unlikely to include a pharmacological positive control, and in cases in which plasma levels of the drug exceeding therapeutic levels are not achieved, the lack of a positive control can constitute a limitation when excluding an effect of regulatory concern. It has been proposed to use the effect of a standardized meal on the estimate of the diurnal time course of QTc to show assay sensitivity. We conducted simulations by subsampling subjects from a 3 different studies and could show that the effect on food on QTc can be reliably prove assay sensitivity for sample sizes as low as 3 × 6 subjects with a power greater than 80%.
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Ferber et al. (2017) studied this question.
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