VIDEO: Access to care, racial diversity in clinical trials needed to improve IBD outcomes
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In the latest installment of our diversity, equity and inclusion video series with ASGE, Anna H. Owings, DO, discusses racial disparities in treatment initiation and response in patients with inflammatory bowel disease.
“A commentary systematic review published in Gastroenterology in 2022 indicated that almost 40% of the studies on IBD treatment had no report of race at all, and further, 23% reported only the portion of white participants without mention of the other races,” Owings, a second-year gastroenterology fellow at the University of Mississippi Medical Center, said. “This is pertinent because without more representative patient populations in our clinical trials, we will likely see variable responses to medications.”
She continued: “Patients with different genetic makeups may demonstrate differences in the pathways driving disease, pharmacokinetics [and] metabolism, as well as effectiveness and safety.”
In a retrospective review, Owings and colleagues evaluated the safety and efficacy of anti-tumor necrosis factor agents in a racially diverse group of patients with IBD at a university-based tertiary medical center. Despite achieving adequate drug levels, Black patients with IBD had lower therapeutic response and higher IBD-related hospitalization compared with white patients.
A large, multicenter study also conducted by Owings’ team further assessed factors causing delays in initiating biologics or novel small-molecule therapy in patients with IBD.
“Surprisingly, our retrospective study demonstrated that there may be a significant delay of a median 20 days,” Owings said, noting Black patients experienced the longest overall delay (34 days), followed by white patients (19 days), Hispanic or Latino patients (18 days) and Asian (17 days) patients.
Variables associated with this delay included race, distance to the medical center and coverage denial, she said.
“Future efforts should focus predominantly on improving access to care among minority patients which would allow timely diagnosis and treatment of IBD,” Owings concluded. “And lastly, that a more intentional effort be made for appropriate and equal representation of participation of all races and ethnic groups in clinical trials to improve the overall outcome in IBD treatment for all patients.”
References:
- Burstiner LS, et al. IBD. 2023;doi:10.1093/ibd/izad005.
- Burstiner LS, et al. Am J of Medical Sciences. 2023;doi:10.1016/j.amjms.2023.02.013.
- Cohen NA, et al. Gastroenterology. 2021;doi:10.1053/j.gastro.2023.09.035.
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