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Tripathi N, Gebrael G, Chigarira B, Sahu KK, Balasubramanian I, Caparas C, Mathew Thomas V, Cohan JN, Pelletier K, Maughan BL, Agarwal N, Swami U, Gupta S. Treatment Patterns and Outcomes by Age in Metastatic Urinary Tract Cancer: A Retrospective Tertiary Cancer Center Analysis. Cancers (Basel) 2024; 16:2143. [PMID: 38893262 PMCID: PMC11172373 DOI: 10.3390/cancers16112143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Metastatic urinary tract cancer (mUTC) is challenging to treat in older adults due to comorbidities. We compared the clinical courses of younger and older (≥70 years) adults with mUTC receiving first-line (1L) systemic therapy in a tertiary cancer center. Baseline clinical characteristics, treatments received, tolerability, and survival outcomes were analyzed. Among 212 patients (103 older vs. 109 younger), the older patients had lower hemoglobin at baseline (84% vs. 71%, p = 0.03), the majority were cisplatin-ineligible (74% vs. 45%, p < 0.001), received more immunotherapy-based treatments in the 1L (52% vs. 36%, p = 0.01), received fewer subsequent lines of treatment (median 0 vs. 1, p = 0.003), and had lower clinical trial participation (30% vs. 18%, p = 0.05) compared to the younger patients. When treated with 1L chemotherapy, older patients required more dose adjustments (53.4% vs. 23%, p = 0.001) and received fewer cycles of chemotherapy (median 4 vs. 5, p= 0.01). Older patients had similar OS (11.2 months vs. 14 months, p = 0.06) and similar rates of treatment-related severe toxicity and healthcare visits, independent of the type of systemic treatment received, compared to younger patients. We conclude that select older adults with mUTC can be safely treated with immunotherapy and risk-adjusted regimens of chemotherapy with tangible survival benefits.
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Affiliation(s)
- Nishita Tripathi
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
- Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA
| | - Georges Gebrael
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Beverly Chigarira
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Kamal Kant Sahu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Ishwarya Balasubramanian
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Constance Caparas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Vinay Mathew Thomas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Jessica N. Cohan
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Kaitlyn Pelletier
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Benjamin L. Maughan
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Sumati Gupta
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA
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Cabrera C, Fernández-Llaneza D, Ghazoui Z, D'Abrantes S, Esparza-Franco MA, Sopp C, Maj B, Chiou VL, Valastro B, Pangalos MN, Galbraith S, Ghiorghiu S, Massacesi C. Diversity of US participants in AstraZeneca-sponsored clinical trials. Contemp Clin Trials 2024; 140:107496. [PMID: 38467274 DOI: 10.1016/j.cct.2024.107496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/08/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND To develop medicines that are safe and efficacious to all patients, clinical trials must enroll appropriate target populations, but imbalances related to race, ethnicity and sex have been reported. A comprehensive analysis and improvement in understanding representativeness of patient enrollment in industry-sponsored trials are key public health needs. METHODS We assessed race/ethnicity and sex representation in AstraZeneca (AZ)-sponsored clinical trials in the United States (US) from 2010 to 2022, compared with the 2019 US Census. RESULTS In total, 246 trials representing 95,372 patients with complete race/ethnicity and sex records were analyzed. The proportions of different race/ethnicity subgroups in AZ-sponsored clinical trials and the US Census were similar (White: 69.5% vs 60.1%, Black or African American: 13.3% vs 12.5%, Asian: 1.8% vs 5.8%, Hispanic: 14.4% vs 18.5%). We also observed parity in the proportions of males and females between AZ clinical trials and US Census (males: 52.4% vs 49.2%, females: 47.6% vs 50.8%). Comparisons of four distinct therapy areas within AZ (Respiratory and Immunology [R&I]; Cardiovascular, Renal, and Metabolism [CVRM]; Solid Tumors; and Hematological Malignancies), including by trial phases, revealed greater variability, with proportions observed above and below US Census levels. CONCLUSION This analysis provides the first detailed insights into the representativeness of AZ trials. Overall, the proportions of different race/ethnicity and sex subgroups in AZ-sponsored clinical trials were broadly aligned with the US Census. We outline some of AZ's planned health equity initiatives that are intended to continue to improve equitable patient enrollment.
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Affiliation(s)
- Claudia Cabrera
- Real World Science and Analytics, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden.
| | | | - Zara Ghazoui
- Data Science and Artificial Intelligence, BioPharmaceuticals Research and Development, AstraZeneca, Cambridge, UK
| | - Sofia D'Abrantes
- Data Science and Artificial Intelligence, BioPharmaceuticals Research and Development, AstraZeneca, Cambridge, UK
| | - M Alejandro Esparza-Franco
- Data Science and Artificial Intelligence, BioPharmaceuticals Research and Development, AstraZeneca, Cambridge, UK
| | - Charles Sopp
- Real World Science and Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Beata Maj
- Chief Medical Office, AstraZeneca, Gothenburg, Sweden
| | - Victoria L Chiou
- Oncology Research and Development, AstraZeneca, Gaithersburg, MD, USA
| | - Barbara Valastro
- Research and Development Patient Science, Chief Medical Office, AstraZeneca, Gothenburg, Sweden
| | | | - Susan Galbraith
- Oncology Research and Development, AstraZeneca, Gaithersburg, MD, USA
| | - Serban Ghiorghiu
- Chief Medical Office and Oncology Research and Development, AstraZeneca, Cambridge, UK
| | - Cristian Massacesi
- Chief Medical Office and Oncology Research and Development, Research and Development, AstraZeneca, Gaithersburg, MD, USA
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Swanson MJ, Uyeki CL, Yoder SR, Dhruva SS, Miller JE, Ross JS. Reporting of Demographics & Subgroup Analyses in Premarketing Studies of FDA Approved High-Risk Cardiovascular Devices, 2014-2022. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2024; 17:165-172. [PMID: 38707869 PMCID: PMC11067925 DOI: 10.2147/mder.s457152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/21/2024] [Indexed: 05/07/2024] Open
Abstract
Background Representation of diverse study populations in pivotal clinical trials for medical devices and subgroup analyses for demographic groups to explore differences in safety and effectiveness are essential to understanding the benefits and risks in diverse populations. The US Food and Drug Administration (FDA) has taken many steps to improve transparency and subgroup analyses over the past decade, but there has not been a recent evaluation of demographic reporting and subgroup analyses. Methods We reviewed all FDA Premarket Approvals for high-risk cardiovascular devices from 2014 to 2022, focusing on pivotal studies supporting device approval. We abstracted detailed demographic data about the age, sex, race, ethnicity, and socioeconomic position of study participants. We also assessed the presence and results of subgroup analyses to understand the safety and effectiveness of devices across trial populations. Results Analysis of 92 pivotal studies revealed that age and sex were reported in 96.7% of the studies, while race and ethnicity were reported in 71.7% and 58.7%, respectively. However, only 7.9% of studies explicitly detailed the participation of older adults (≥65 years) and no studies reported patients' socioeconomic position. Subgroup analyses by sex were conducted in 70.7% of studies, with 12.3% reporting significant differences. In contrast, analyses by race and ethnicity were performed in only 12.0% of the studies, with 9.1% reporting significant differences. Conclusion Approximately one-third of pivotal studies for high-risk cardiovascular devices approved by the FDA from 2014 to 2022 did not report the race of study participants, nearly 40% did not report ethnicity, and more than 90% did not report the participation of older adults (≥65 years). Subgroup analyses were infrequently conducted by age or race and ethnicity. There is a need for better trial demographic reporting and conduct of subgroup analyses in premarketing studies to ensure the safety and effectiveness of medical devices for all patients.
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Affiliation(s)
- Matthew J Swanson
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
- Leonard N. Stern School of Business, New York University, New York, NY, USA
| | - Colin L Uyeki
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Sarah R Yoder
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Sanket S Dhruva
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Joseph S Ross
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
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Long C, Williams AO, McGovern AM, Jacobsen CM, Hargens LM, Duval S, Jaff MR. Diversity in randomized clinical trials for peripheral artery disease: a systematic review. Int J Equity Health 2024; 23:29. [PMID: 38350973 PMCID: PMC10865563 DOI: 10.1186/s12939-024-02104-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Significant race and sex disparities exist in the prevalence, diagnosis, and outcomes of peripheral artery disease (PAD). However, clinical trials evaluating treatments for PAD often lack representative patient populations. This systematic review aims to summarize the demographic representation and enrollment strategies in clinical trials of lower-extremity endovascular interventions for PAD. METHODS Following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched multiple sources (Medline, EMBASE, Cochrane, Clinicaltrials.gov, WHO clinical trial registry) for randomized controlled trials (RCTs), RCT protocols, and peer-reviewed journal publications of RCTs conducted between January 2012 and December 2022. Descriptive analysis was used to summarize trial characteristics, publication or study protocol characteristics, and the reporting of demographic characteristics. Meta-regression was used to explore associations between demographic characteristics and certain trial characteristics. RESULTS A total of 2,374 records were identified. Of these, 59 met the inclusion criteria, consisting of 35 trials, 14 publications, and 10 protocols. Information regarding demographic representation was frequently missing. While all 14 trial publications reported age and sex, only 4 reported race/ethnicity, and none reported socioeconomic or marital status. Additionally, only 4 publications reported clinical outcomes by demographic characteristics. Meta-regression analysis revealed that 6% more women were enrolled in non-European trials (36%) than in European trials (30%). CONCLUSIONS The findings of this review highlight potential issues that may compromise the reliability and external validity of study findings in lower-extremity PAD RCTs when applied to the real-world population. Addressing these issues is crucial to enhance the generalizability and impact of clinical trial results in the field of PAD, ultimately leading to improved clinical outcomes for patients in underrepresented populations. REGISTRATION The systematic review methodology was published in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022378304).
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Affiliation(s)
- Chandler Long
- Duke Vascular and Endovascular Surgery, Duke University Medical Center, Duke University, Durham, NC, 27707, USA
| | - Abimbola O Williams
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA.
| | - Alysha M McGovern
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
| | - Caroline M Jacobsen
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
| | - Liesl M Hargens
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
| | - Sue Duval
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Michael R Jaff
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
- Peripheral Interventions, Boston Scientific, Maple Grove, MN, 55133, USA
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Thomas S, Kelliher S, Krishnan A. Heterogeneity of platelets and their responses. Res Pract Thromb Haemost 2024; 8:102356. [PMID: 38666061 PMCID: PMC11043642 DOI: 10.1016/j.rpth.2024.102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/22/2024] [Accepted: 02/06/2024] [Indexed: 04/28/2024] Open
Abstract
There has been increasing recognition of heterogeneity in blood platelets and their responses, particularly in recent years, where next-generation technologies and advanced bioinformatic tools that interrogate "big data" have enabled large-scale studies of RNA and protein expression across a growing list of disease states. However, pioneering platelet biologists and clinicians were already hypothesizing upon and investigating heterogeneity in platelet (and megakaryocyte) activity and platelet metabolism and aggregation over half a century ago. Building on their foundational hypotheses, in particular Professor Marian A. Packham's pioneering work and a State of the Art lecture in her memoriam at the 2023 International Society on Thrombosis and Haemostasis Congress by Anandi Krishnan, this review outlines the key features that contribute to the heterogeneity of platelets between and within individuals. Starting with important epidemiologic factors, we move stepwise through successively smaller scales down to heterogeneity revealed by single-cell technologies in health and disease. We hope that this overview will urge future scientific and clinical studies to recognize and account for heterogeneity of platelets and aim to apply methods that capture that heterogeneity. Finally, we summarize other exciting new data presented on this topic at the 2023 International Society on Thrombosis and Haemostasis Congress.
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Affiliation(s)
- Sally Thomas
- Sheffield Teaching Hospitals, National Health Services, Sheffield, UK
| | - Sarah Kelliher
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Anandi Krishnan
- Stanford University School of Medicine, Stanford University, Stanford, California, USA
- Rutgers University, Piscataway, New Jersey, USA
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Hagège M, Bringuier M, Martinez-Tapia C, Chouaïd C, Helissey C, Brain E, Lempdes GR, Dubot C, Bello-Roufai D, Geiss R, Kempf E, Gourden A, Elgharbi H, Garrigou S, Gregoire L, Derbez B, Canouï-Poitrine F. Disentangling the reasons why older adults do not readily participate in cancer trials: a socio-epidemiological mixed methods approach. Age Ageing 2024; 53:afae007. [PMID: 38346934 PMCID: PMC10861365 DOI: 10.1093/ageing/afae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/13/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Few studies of the under-representation of older adults in cancer clinical trials (CTs) have encompassed the entire pathway from a trial being available in a cancer centre to the patient's invitation to participate and then agreement or refusal to participate. OBJECTIVES The study's primary objective was to evaluate CT non-invitation and refusal rates. The secondary objectives were to identify factors associated with non-invitation and refusal and to assess experiences of CT participation from the patients' and professionals' perspectives. METHODS Here, we used mixed methods and a socio-epidemiological approach to analyse reasons for the non-participation of eligible older patients with a solid cancer in cancer CTs in France. RESULTS We found that non-invitation and low CT participation are mainly related to the patients' sociodemographic characteristics and living conditions (such as social isolation, being single, divorced or widowed, not having children and the absence of close family members) and the healthcare professionals' perceptions of insufficient informal support or a high homecare requirement. CONCLUSION Our results suggest that efforts to increase fair inclusion and the participation of older adults in CTs should target the physician-patient relationship, the medical profession and hospital funding, rather than the patient alone.
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Affiliation(s)
- Meoïn Hagège
- Department of Health, French institute for health research, Institut Mondor de Recherche Biomédicale, InsermU955, Eq. CEpiA & University Paris Est Créteil, 8 rue du general Sarrail, F-94010 Créteil, France
| | | | - Claudia Martinez-Tapia
- Department of Health, French institute for health research, Institut Mondor de Recherche Biomédicale, InsermU955, Eq. CEpiA & University Paris Est Créteil, 8 rue du general Sarrail, F-94010 Créteil, France
| | - Christos Chouaïd
- Department of Health, French institute for health research, Institut Mondor de Recherche Biomédicale, InsermU955, Eq. CEpiA & University Paris Est Créteil, 8 rue du general Sarrail, F-94010 Créteil, France
- Department of Pneumology, Centre Hospitalier Intercommunal Créteil, 40 Av. de Verdun, F-94000 Créteil, France
| | - Carole Helissey
- Departement of Oncology, Hôpital d'Instruction des Armées Bégin, 69 Av. de Paris, F-94160 Saint-Mandé, France
| | - Etienne Brain
- Institut Curie, 35 Rue Dailly, F-92210 Saint-Cloud, France
| | | | - Coraline Dubot
- Institut Curie, 35 Rue Dailly, F-92210 Saint-Cloud, France
| | | | - Romain Geiss
- Institut Curie, 35 Rue Dailly, F-92210 Saint-Cloud, France
| | - Emmanuelle Kempf
- Department of Oncology, Hôpital Henri Mondor, 54 avenue du maréchal lattre de tassigny, F-94010 Créteil, France
| | - Audrey Gourden
- Departement of Oncology, Hôpital d'Instruction des Armées Bégin, 69 Av. de Paris, F-94160 Saint-Mandé, France
| | - Hanane Elgharbi
- Department of Pneumology, Centre Hospitalier Intercommunal Créteil, 40 Av. de Verdun, F-94000 Créteil, France
| | - Sonia Garrigou
- Department of Oncology, Hôpital Henri Mondor, 54 avenue du maréchal lattre de tassigny, F-94010 Créteil, France
| | - Laetitia Gregoire
- Department of Oncology, Hôpital Henri Mondor, 54 avenue du maréchal lattre de tassigny, F-94010 Créteil, France
| | - Benjamin Derbez
- Department of Sociology, Université Paris 8, Cresspa CSU, 2 Rue de la Liberté, F-93200 Saint-Denis, France
| | - Florence Canouï-Poitrine
- Department of Health, French institute for health research, Institut Mondor de Recherche Biomédicale, InsermU955, Eq. CEpiA & University Paris Est Créteil, 8 rue du general Sarrail, F-94010 Créteil, France
- Department of Oncology, Hôpital Henri Mondor, 54 avenue du maréchal lattre de tassigny, F-94010 Créteil, France
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Idris MY, Fitzsimmons WE, Pemu P. Quantifying Clinical Trial Diversity in Pivotal Registration Trials of FDA Novel Drug Approvals. Ther Innov Regul Sci 2024; 58:175-183. [PMID: 37872439 DOI: 10.1007/s43441-023-00583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Health care inequity includes the lack of adequate representation of various populations in clinical trials. Government, academic and industry organizations have highlighted these issues and committed to actions to improve. In order to assess the current status and future success of these initiatives a quantitative objective measure to assess the state of clinical trial diversity is needed. METHODS FDA review documents for all novel drug approvals from January 2022 through March 2023 were assessed using a scorecard that considers diversity across different demographic subgroups including age (≥ 65 years old), sex (female), race (Black and Asian) and ethnicity (Hispanic/Latino). The scorecard assigns each drug a letter grade, between A and F, for each subgroup (and overall) based on (1) the percent of each sub-population included in the trials and grades relative to the percent of the US population per the 2020 Census, (2) the number of participants from each subpopulation that received the novel new drug in the trials, (3) the incidence or prevalence of the disease/condition in each of the sub-populations. RESULTS The FDA approved 49 novel new drugs for 50 indications (one drug was simultaneously approved for two indications). There was good representation of elderly and females with only two drugs receiving a D grade in either of these sub-populations. In contrast, Black (5 F grades) and Hispanic (4 F grades) representation was often inadequate. There were 10 drugs (20.0%) where there were no Black participants receiving the novel new drug and 16 (32.0%) approvals where there were 1-9 Black participants receiving the novel drug. In the Hispanic/Latino population there were 4 (8.0%) approvals with no Hispanic participants receiving the novel drug and 15 (30.0%) approvals where there were 1-9 Hispanic participants receiving the drug. CONCLUSIONS This scorecard provides an objective quantitative approach to assess the current state of diversity in clinical trials supporting new drug approvals. Substantial improvement in racial and ethnic representation is needed. Meaningful change will require actions and cooperation among all stakeholders to address this multifaceted issue and will take commitment, perseverance, and appropriate incentives.
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Affiliation(s)
- Muhammed Y Idris
- Department of Medicine and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA, USA
- CARER Group, Catalyzing Access to Research Equity in Representation, San Diego, CA, USA
| | - William E Fitzsimmons
- Colleges of Pharmacy and Medicine, University of Illinois at Chicago, 833 S. Wood St., Chicago, IL, 60607, USA.
- CARER Group, Catalyzing Access to Research Equity in Representation, San Diego, CA, USA.
| | - Priscilla Pemu
- Department of Medicine and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA, USA
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Wong AK, Miller JE, Mooghali M, Ramachandran R, Ross JS, Wallach JD. Pivotal Trial Demographic Representation and Clinical Development Times for Oncology Therapeutics. JAMA 2023; 330:2392-2394. [PMID: 38079163 PMCID: PMC10714278 DOI: 10.1001/jama.2023.21958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/06/2023] [Indexed: 12/27/2023]
Abstract
This study evaluates whether FDA-approved novel cancer therapeutics supported by pivotal trials with adequate representation of minoritized groups were associated with slower clinical development times than those with inadequate representation.
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Affiliation(s)
- Alissa K. Wong
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jennifer E. Miller
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Maryam Mooghali
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Reshma Ramachandran
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Joseph S. Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Joshua D. Wallach
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia
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Racadio ER, Rai A, Kizilirmak P, Agarwal S, Sosa E, Desborough C, Adnan T, Zhou L, Balasubramanian A, Sharma A, Motsepe-Ditshego P. Diversity and Representation Among United States Participants in Amgen Clinical Trials. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01768-2. [PMID: 37755687 DOI: 10.1007/s40615-023-01768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Describe the demographic profile of US participants in Amgen clinical trials over a 10-year period and variations across therapeutic areas, indications, and geographies. METHODS Cross-sectional retrospective study including participants enrolled (2005-2020) in phase 1-3 trials completed between January 1, 2012 and June 30, 2021. RESULTS Among 31,619 participants enrolled across 258 trials, one-fifth represented racial minority populations (Asian, 3%; Black or African American, 17%; American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, multiracial, each < 1%); fewer than one-fifth (16%) represented an ethnic minority population (Hispanic or Latino). Compared with census data, representation of racial and ethnic groups varied across US states. Across most therapeutic areas (bone, cardiovascular, hematology/oncology, inflammation, metabolic disorders, neuroscience) except nephrology, participants were predominantly White (72-81%). A similar proportion of males and females were enrolled between 2005 and 2016; male representation was disproportionately higher than female between 2016 and 2020. Across most medical indications, the majority of participants were 18-65 years of age. CONCLUSIONS AND RELEVANCE While the clinical research community is striving to achieve diversity and proportional representation across clinical trials, certain populations remain underrepresented. Our data provide a baseline assessment of the diversity and representation of US participants in Amgen-sponsored clinical trials and add to a growing body of evidence on the importance of diversity in clinical research. These data provide a foundation for strategies aimed at supporting more equitable and representative research, and a baseline from which to assess the impact of future strategies to advance health equity.
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Affiliation(s)
| | | | | | | | | | | | | | - Lei Zhou
- Amgen Inc, Thousand Oaks, CA, USA
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Tannenbaum SH, Miller JE. Clinical Trial Diversity: A Bend in the Arc Toward Justice. JCO Precis Oncol 2023; 7:e2300380. [PMID: 37725783 DOI: 10.1200/po.23.00380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 09/21/2023] Open
Affiliation(s)
- Susan H Tannenbaum
- Carole and Ray Neag Comprehensive Cancer Center, UConn Health UConn School of Medicine, Farmington, CT
| | - Jennifer E Miller
- Yale School of Medicine, New Haven, CT
- Bioethics International, New Haven, CT
- Good Pharma Scorecard, New Haven, CT
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11
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Varma T, Gross CP, Miller JE. Clinical Trial Diversity-Will We Know It When We See It? JAMA Oncol 2023; 9:765-767. [PMID: 37022678 DOI: 10.1001/jamaoncol.2023.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
This Editorial discusses the existing policy efforts in the US for ensuring adequate racial and ethnic diversity in clinical trials, identifies barriers to consistency and acceptable representation, and suggests measures to address them.
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Affiliation(s)
- Tanvee Varma
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Cary P Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Jennifer E Miller
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Equity Research and Innovation Center (ERIC), New Haven, Connecticut
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Miller JE, Latham S. What is Fair Representation in Research? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:89-91. [PMID: 37220359 DOI: 10.1080/15265161.2023.2201543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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13
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Kozlov M. FDA to require diversity plan for clinical trials. Nature 2023:10.1038/d41586-023-00469-4. [PMID: 36797519 DOI: 10.1038/d41586-023-00469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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14
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Varma T, Miller JE. Ranking pharmaceutical companies on clinical trial diversity. BMJ 2023; 380:334. [PMID: 36764687 DOI: 10.1136/bmj.p334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
| | - Jennifer E Miller
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Equity Research and Innovation Center (ERIC), New Haven, Connecticut, USA
- Yale Interdisciplinary Center for Bioethics, New Haven, Connecticut, USA
- Bioethics International
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