Over the past decade, hundreds of randomized controlled trials on the effectiveness and safety of various rheumatoid arthritis (RA) medications have been conducted. While many of these studies have yielded useful information, they don’t necessarily provide doctors and patients with all the information they need to make informed treatment decisions with patients.
The reason: Not everyone with RA is being adequately represented in these trials.
According to a study published in the journal JAMA Network Open, ethnic minorities, men, and older adults are significantly underrepresented in RA research. To conduct the study, researchers from the University of California, San Francisco analyzed 240 randomized, double-blind controlled trials on disease-modifying therapies for RA that were published between 2008 to 2018.
The authors found that study participants tended to lacked diversity, and that there was “no trend toward improved representation of minority racial/ethnic groups… during the 10-year period.”
Although arthritis is less common among U.S. blacks and Hispanics compared to whites, its impact is greater as minorities report more joint pain and more difficulties doing regular physical and work-related activities. “Meanwhile, emerging evidence suggests that race and ethnicity may influence an individual’s response to DMARD therapy, and several studies have indicated that new RA therapies may be less effective in racial/ethnic minority groups,” the authors wrote.
“Given the disproportionate burden of RA among racial/ethnic minority groups, it is imperative that policy makers better incentivize the inclusion of racial/ethnic minority populations in RA [randomized controlled trials].”
Men, too, tended to be lacking in RA studies. “We found that the enrollment of men was significantly lower than the proportion of men with RA nationally,” the authors wrote.
They also found that 40 percent of the trials excluded elderly patients — despite the fact that RA becomes more common with age. That’s concerning because adults metabolize drugs differently than younger people, so they’re more apt to experience side effects and might require different doses.
Get Involved in Arthritis Research
If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.
Brooks M. Arthritis Disproportionately Affects Certain Minorities. Medscape. April 19, 20210. https://www.medscape.com/viewarticle/720455.
Ethnicity in Rheumatoid Arthritis Trials Not Reflective of Disease Burden. Rheumatology Advisor. December 24, 2019. https://www.rheumatologyadvisor.com/home/rheumatoid-arthritis-advisor/ethnicity-in-rheumatoid-arthritis-trials-not-reflective-of-disease-burden.
Pharmacokinetics in Older Adults. Merck Manual Professional Version. https://www.merckmanuals.com/professional/geriatrics/drug-therapy-in-older-adults/pharmacokinetics-in-older-adults.
Strait A, et al. Demographic Characteristics of Participants in Rheumatoid Arthritis Randomized Clinical Trials. JAMA Network Open. November 2019. doi: http://dx.doi.org/doi:10.1001/jamanetworkopen.2019.14745.