New Drug Formulary Management and Utilization: Evidence in Sex, Race, and Ethnicity: 2019-2020

Abstract

Background It is well established that females and persons of racial and ethnic minorities are frequently underrepresented in clinical trials. These disparities are potentially important aspects of evidence-based formulary management and drug utilization review (DUR) processes. Objective The purpose of this study was to review the demographic composition of pivotal trials and post-approval study requirements for recent FDA-approved drugs, analyzing the representation of minority groups and its generalizability to the US population or corresponding disease state. Methods Drugs approved between July 2019 and June 2020 were identified and demographic data including race, ethnicity, and sex was extracted from their pivotal trials. Demographic data was compared to US demographics and/or the disease state demographics for the respective approved drug. Results There were a total of 85 drugs and 142 pivotal trials included in the study. Compared to the estimated US population, the minority groups with a statistically significant underrepresentation across all pivotal trials included Black or African Americans and American Indian or Alaska Natives. The Hispanic/Latinx population had a statistically significant underrepresentation in 55.4% of trials. Females had a statistically significant underrepresentation in 21.2% of trials when compared to the disease state demographics of the respective approved drug. Conclusion and Relevance Persons of minorities are underrepresented in the generation of evidence of safety and efficacy for many new drugs. Formulary management and DUR offer an integrated strategic opportunity for the clinical community to formally and carefully consider the data on sex, race, and ethnicity to address disparities in health care.

Diversity in modern heart failure trials: Where are we, and where are we going

“…For many clinical trials that have led to FDA approval of drugs or medical devices, their study population was composed of nearly 90% Whites [ 16 ]. This disparity means the majority of conclusions on the efficacy of new medical innovations in racial/ethnic minorities are based on extrapolation and the assumption that most drugs and innovations have the same homogenous effect on all populations; the results are less generalizable [ 17 ]. Applying trial results to patients who did not participate has been associated with harm [ 18 ].…”