If a clinical trial is not an applicable clinical trial (ACT) at study initiation because it is conducted entirely outside the United States, but the trial subsequently opens a U.S. site, am I required to register the trial?

If a sponsor of a clinical trial in a foreign country that does not meet the definition of an ACT, and has an initiation date after the effective date of the regulations in 42 CFR Part 11, decides to add a location in the U.S. (or its territories), and as a result the trial meets the definition of an ACT, the sponsor becomes subject to 402(j) of the Public Health Service Act and 42 CFR Part 11. The requirements set forth in the regulation would need to be met, beginning with registration of the ACT not later than 21 days after the enrollment of the first participant at the U.S. site. Per 42 CFR 11.22(b), "[a] clinical trial or study that, at any point in time, meets the conditions listed in paragraph (b)(1) or (2) of this section will be considered to meet the definition of an applicable clinical trial." Therefore, this trial would become an ACT when it adds the U.S. site. Clinical trial registration information must include information applicable to the entire trial, as is the case with all multi-site trials with information in ClinicalTrials.gov, because the entire clinical investigation is considered to be the applicable device or drug clinical trial (see 81 FR 65013, 81 FR 65015).