Beyond Diversity: Reaching all Patient Populations in Clinical Research

-By Howard Chipman, MD, IMA Principal Investigator, St. Petersburg, Florida

There has been considerable discussion about “diversity in clinical trials” so I thought I would explore these concepts and think about what that really means.  When the medical community investigates a new drug, we want to know the safety and effectiveness profile of that drug for the population that will be using it.

The FDA has issued guidance that promotes the inclusion of diverse populations in clinical trials to better understand the risk and benefits across all groups. The traits of these groups can include gender, race, ethnicity, age and location of residency.

We should consider more than that to ensure true diversity in clinical research. Non-demographic traits include patients with organ dysfunction, co-morbidities, disabilities, weight extremes and diseases of low prevalence. 

Location. Location. Location.

Since the diversity of study participants often reflect the demographics of the study location, having locations in different socioeconomic and ethnic areas could help generate a more representative population.

What is unknown is the impact of those differences on these various groups and if they are significant for that particular new drug.  Another concern is the possible increase in the size and complexity of trials if different subgroups are identified.

Therefore, it should be a priority to increase the diversity of study participants in clinical trials so that trials approximate the population to be treated, leading to more refined and improved FDA recommendations.   Other approaches to consider include:

        • Broadening eligibility criteria
        • Increasing flexibility of visit windows
        • Making the process more convenient for participants
        • Offering “virtual” visits

Finding the right study site

While many of these changes need to be made by the study designer, study sites can prioritize their efforts to recruit from a diverse population by trying to obtain a representative sampling.

The IMA Group has a large footprint of offices, both in urban and rural areas, that see a significant volume of diverse individuals on a weekly basis.  This allows us to reach clinical trial participants from every background, making sure that clinical trials are an available choice to everyone, everywhere, and enroll enough that mimic the population demographics.

IMA’s large geographic footprint allows an expanded reach to access these diverse populations.  This reach fosters a greater likelihood of achieving a more robust diversity among the clinical study participants and thus, helps to ensure better outcomes from the study.

Clinical Trials in the Time of COVID-19

by James Greenwald, MD, PhD, Principal Investigator, IMA Clinical Research, New York

Managing clinical trials during the COVID-19 outbreak has been challenging, especially in New York City.

The first COVID-19 outbreak severely affected New York State and most specifically the New York City area.  All of us who lived in New York City in March and April experienced the incessant sound of ambulance sirens in response to citizens sickened with the virus and daily news stories of overwhelmed hospitals with these patients.  In early March we closed our research facility to participant visits in order to both protect our participants and medical staff from unnecessary exposure to the virus.  We had to take multiple factors into consideration before making this decision.  First, New York, unlike most other American cities, relies heavily on public transportation (ie. Buses and subways).  Because of the density of bus and subway riders, our staff and participants did not want to use public transportation because of the potential safety risks. Thus, our participant visits became virtual.  Virtual visits can feel very different;  however, we adapted quickly and were able to keep in contact with our participants, record symptomatology, and perform study drug accountability.

New York and its citizens suffered greatly but by early June the city and state was able to get the virus under control and achieve the lowest infection rate in the US. It was at this time our participants and staff felt comfortable traveling on public transportation and we opened our clinic to participant visits. Since opening, we have followed strict CDC guidelines for the use of PPE and physical distancing.  We have re-organized our facility to ensure the quality of the indoor air, cleanliness of surfaces, and strict use of PPE and physical distancing.  We also strictly monitor out of town visitors to ensure none are coming for areas of high infectivity without following quarantine guidelines.

We continue to be flexible and prioritize our participant and staff safety. New Yorkers and our clinic are committed to solutions that promote low COVID-19 infection rates.