A framework for setting enrollment goals to ensure participant diversity in sponsored clinical trials in the United States

• Published in: Contemporary clinical trials Vol. 129; p. 107184
• Main Authors: Cullen, Mark R., Lemeshow, Adina R., Amaro, Sandra, Bandera, Elisa V., Cooper, Lisa A., Kawachi, Ichiro, Lunyera, Joseph, McKinley, Laura, Poss, Christopher S., Rottas, Melinda M., Schachterle, Stephen E., Thadeio, Peter F., Russo, Leo J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2023
• Subjects: Clinical trials; Clinical Trials as Topic; COVID-19; Diversity; Equity; Ethnicity; Goals; Health Equity; Humans; Multiple Myeloma; Race; Underrepresentation; United States; United States; CT; Ethnicity; OMB; Diversity; Race; Clinical trials; Equity; SEER; Underrepresentation; EHR; RWD
• ISSN: 1551-7144; 1559-2030
• DOI: 10.1016/j.cct.2023.107184

Diversity in clinical trials (CTs) has the potential to improve health equity and close health disparities. Underrepresentation of historically underserved groups compromises the generalizability of trial findings to the target population, hinders innovation, and contributes to low accrual. The aim of this study was to establish a transparent and reproducible process for setting trial diversity enrollment goals informed by the disease epidemiology.
An advisory board of epidemiologists with expertise in health disparities, equity, diversity, and social determinants of health was convened to evaluate and strengthen the initial goal-setting framework. Data sources used were the epidemiologic literature, US Census, and real-world data (RWD); limitations were considered and addressed where appropriate. A framework was designed to safeguard against the underrepresentation of historically medically underserved groups. A stepwise approach was created with Y/N decisions based on empirical data.
We compared race and ethnicity distributions in the RWD of six diseases from Pfizer's portfolio chosen to represent different therapeutic areas (multiple myeloma, fungal infections, Crohn's disease, Gaucher disease, COVID-19, and Lyme disease) to the distributions in the US Census and established trial enrollment goals. Enrollment goals for potential CTs were based on RWD for multiple myeloma, Gaucher disease, and COVID-19; enrollment goals were based on the Census for fungal infections, Crohn's disease, and Lyme disease.
We developed a transparent and reproducible framework for setting CT diversity enrollment goals. We note how limitations due to data sources can be mitigated and consider several ethical decisions in setting equitable enrollment goals.
•Lack of participant diversity in clinical trials compounds health disparities•A framework to establish diverse enrollment goals for clinical trials was built•Building blocks were the epidemiologic literature, US Census, and RWD sources.•Limitations of data sources and ethical decisions must be navigated.•Setting enrollment goals clearly and transparently creates quantifiable accountability