The FDA is advocating for greater diversity, equity, and inclusion (DEI) in clinical trials, prompting a reevaluation of practices that have historically excluded underrepresented populations. This push aims to align research study populations more closely with real-world demographics, enhancing the applicability and effectiveness of medical treatments.
Historical Exclusion and the Modern Reality
Historically, clinical trials often excluded specific patient subgroups, particularly those with comorbidities like HIV. This was largely due to concerns about increased susceptibility to adverse events and unpredictable responses to investigational drugs, given the significant immunosuppression associated with untreated HIV. However, the introduction of antiretroviral therapy in 1987, and later highly active antiretroviral therapies, has transformed HIV into a manageable condition, allowing patients to lead largely normal and healthy lives.
The Case for Inclusion
A recent paper in the Journal of Oncology by Uldrick et al. reviewed the potential inclusion of HIV patients in cancer trials, which represent over 30% of clinical studies globally. The authors concluded that “Expanding clinical trial eligibility to be more inclusive of patients with HIV is justified in most cases and may accelerate the development of effective therapies in this area of unmet clinical need.” This endorsement supports a more inclusive approach, suggesting that the benefits of including HIV patients in trials outweigh the risks.
Lessons from the NIH Revitalization Act
The 1993 NIH Revitalization Act serves as a powerful example of the benefits of DEI initiatives. Prior to this legislation, women and underrepresented racial and ethnic minority populations were often excluded from clinical research. The mandate to include these groups has led to critical insights, such as the understanding that heart attack symptoms in women differ from those in men, improving health outcomes across diverse groups.
Overcoming Challenges with Technology
One of the primary concerns regarding the inclusion of HIV patients in clinical trials is drug adherence. Historically, this has been a challenge due to complex medication regimens, side effects, and socioeconomic barriers. However, advancements in technology and patient engagement strategies offer solutions. Tech companies are developing predictive behavioral models to anticipate and address potential non-compliance, providing tailored support to patients.
Embracing Diversity for Better Outcomes
By embracing diversity and including those with manageable conditions like HIV, clinical trials can become more representative and effective. Updating exclusionary policies not only helps understand how diverse populations respond outside of controlled settings but also reduces stigma and bias, advances Health Equity initiatives, and achieves better real-world outcomes.
