Racial and ethnic trends in antiseizure medications trial enrolment: A systematic review using ClinicalTrials.gov.

Abstract Objective To describe the racial and gender distribution in antiseizure medications (ASM) clinical trials using a systemic review of clinical trial registry database. Methods We searched ClinicalTrials.gov database for ASM trials registered from September 1988 to January 2019. All randomized and non-randomized trials investigating ASM for epilepsy were included. Trials with intervention other than ASM or condition other than epilepsy were excluded. Data on age, race, ethnicity, and gender were extracted directly from database and from published data where available. Study location, trial identifier, year of completion, and funding sources were also collected. Meta-analysis of proportions was conducted using R software. Result Two hundred and thirty studies conducted globally with 39576 participants were included. Overall, there are 53% male on all registered ASM studies globally. For trials conducted in the United States (61 studies/5126 participants), 52% of the participants were male with the following weighted racial distribution (80% White 13% Black 3% Asian 7% Hispanic). Subgroup analysis revealed that non-pharma-sponsored studies (50 studies, 4296 participants) have a higher representation of minorities as compared to pharma-sponsored studies (180 studies, 35280 participants), including Hispanic (9% vs 3% respectively) and Black (18% vs 11% respectively). Temporal trends in racial distribution were noted when the duration of 2007 to 2019 was split into two groups: 2007-2013 (0% Asian, 5% Hispanic, 20% Black); 2014-2019 (4% Asian, 7% Hispanic, 8% Black). Conclusion In this systematic review, participation of racial and ethnic minorities of Asian and Hispanic background was under-represented. Disparities of all minorities including Black participants was more notable over time and in studies sponsored by industry. Generalizability of ASM clinical trials to certain subgroups should be further examined.