By: Kelly Snow
Chief of Staff, Suvoda
From lifesavinganti-malaria therapeuticsto advancing cancer research with discoveries oncellular aging, women’s contributions have been instrumental to advancing science. Yet, women remain stubbornly underrepresented in one key area of research: clinical trial participation.
Areviewof federal data on 1,433 clinical trials reveals that only41.2%of participants were female despite making up50.5%of the U.S. population. Since women can react differently than men to treatments, their underrepresentation in studies – and especially the underrepresentationof women of color – may have severe implications forwidening health disparities.
The Foodand Drug Administration (FDA)is already taking necessary steps to close gender and racial gaps in clinical research with a new2023 omnibus spending billthat requires a diversity action plan in trials.It is apromising start, as a more representative patient population in clinical trials is essential for developing medicines to serve those who need them most.
Since March is Women’s History Month, I’d like to explore how the industry can encourage female participation in clinical trials to advance the discovery of lifesaving therapeutics. While this effort may feel daunting, it is both possible and necessary.
Underrepresentation in research
At one time, women of childbearing age were excluded by federal policy from participation in clinical trials primarily due tofearof thalidomide-like effects on a developing fetus. However, participation remained low even after the rule was rescinded in 1993, and women have been chronically underrepresented in clinical research ever since. This is furthercompoundedby women’s family and childcare responsibilities, financial barriers to study participation, and difficulty accessing study sites. As an example of these access challenges, oneMcKinsey & Costudy found that 70% of potential participants in clinical trials live further than two hours away from trial sites, and anothersurveyfound that 1 in 4 potential candidates declined toparticipate in clinical trials due to excessive distance.
Thegender gap in clinical trial participation is seen across multiple therapeutic areas. For example, among the 662 published neuro-oncology trials from 2000 to 2019, only37.5%of the participants were women. Overall, 51% of cancer patients are women, although only41%of cancer trial participants are female.Areviewofenrollment in heart failure clinical trials alsoshows that female participation remained stagnant at 20–30% over the past four decades.
当examining clinical trial participation among women by race and ethnicity, we see women of color are even less likely to participate. In 2021 alone, two novel therapies were approved by theFDAto treat endometrial cancer and metastatic cervical cancer, yetthe majority ofparticipants in those studies were white females. This is particularly concerning, considering black women havetwice the mortality rate为子宫内膜癌相比,白色的我们men.
Why diversity in clinical trialsmatters
Diversity in clinical trials leads to more representative study data that helps researchers better understand the impact of gender and racial differences in drug responses. Therapies designed for the specific needs of varied communities can contribute to reducing health disparities and ultimately, to saving lives.
For instance,a retrospective study that在cludeddata from a largeanddiverse group of lung cancer patients revealed the positive impact of Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor (EGFR-TKI) therapy on Asian females. It wasshown tohave a 26% reduction in premature death for Asian females but only about 16% fornon-Asianmales.
Effective clinical trial representation is also important for adequate patient enrollment.For example, aGlobal Datasurvey found that as many as 25% of rare disease trials fail due to insufficient enrollment. Thoughtfully recruiting a diverse group of patients can help ensure a larger study population with better patient demographic representation. By doing so, we cancontribute toclinical datathatreflects a more accurate picture of who could benefit from the studied在tervention andgive trials a better chance to avoid premature study termination.
Increasing diversity with practical solutions
Leadership is needed throughout all stages of research and development to ensure diversity in trial selection and patient recruitment if we are to serve the groups most impactedby diseaseeffectively. The FDA hashighlightedthe important role of academia and the biopharmaceutical industry in advancing clinical trial diversity through modifications to protocol design, eligibility criteria, and study enrollment practices—especially in making trial participation less burdensome for patients.
Employing digital tools and technology platforms that help decentralize aspects of clinical trials may help bridge the divide between patient and trial sites, making trial participation easier for patients and opening study sponsors’ access to a broader pool of potential candidates for greater diversity in their trials.Digital technologiescanmake it easier for patients to provide consent, submit accurate data,and receive direct delivery of study therapeutics remotely.For example,eConsentandeCOAcanenable easier access to studies,contributing togreater inclusion of remote patient populations and those from communities traditionally marginalized在the healthcare system.Theyalsohold the promise of facilitating在creaseddiversity in clinical trials by curbing unconscious bias on the part of investigators when selecting trial participantsor on the part of participants when evaluating whether to join a study.
Of course, technology isn’tthe only answer. Weneed commitment among institutions and organizations involved in clinical research todiversify participantpopulations. This means proactive, practicalstrategiesto build trust among underrepresented communities, beginning with developing a diverse pool of investigators and staff and establishing networks within these communities.
With effort, practical solutions, and leadership, I am optimistic we can improve representation in clinical trials,to increaseaccess to and effectiveness of life–储蓄的药物。
