Racial and Ethnic Minorities Underrepresented in Nail Psoriasis Clinical Trials

Shari R. Lipner, MD, PhD

A new investigation from Weill Cornell Medicine observed an underrepresentation of nonwhite participants in clinical trials for nail psoriasis. Investigators called for prioritized enrollment of racial and ethnic minority groups in further trials regarding nail psoriasis, psoriasis, and psoriatic arthritis.

In a recent letter to the editor investigators led by Shari R. Lipner, MD, PhD, Department of Dermatology at Weill Cornell Medicine, New York, noted that they had been inspired to conduct their study by a previous analysis of the ethnoracial composition of phase 3 clinical trials for biologic agents used for psoriatic arthritis treatment.

In the previous study, investigators identified 16 clinical trials, og which the majority of participants were white (80%), followed by Asian (5.56%), black (0.40%), American Indian (0.61%), more than one race (0.45%), and native Hawaiian/Pacific Islander (0.08%).

In the present study, Lipner and colleagues corroborated those findings with a study on the ethnoracial composition of nail psoriasis randomized clinical trials participants.

The Systematic Review

Investigators performed a systematic review of published randomized clinical trials on pharmacologic nail psoriasis treatments found in the MEDLINE database using search terms including “psoriasis” and “nails”.

From there, 2 investigators independently applied eligibility criteria.

Of the 45 studies selected during the review, 16 (36%) reported race and/or ethnicity with 15 (33%) reporting race alone. Only 1 (2%) reported both race and ethnicity.

Regarding studies that reported race, 66% of them listed the percentage of race(s) other than White.

Amongst studies with ≥1 43 United States (US)-based site (8,118 participants), 86.6% of participants were white, followed by 8.4% 44 Asian, and 2.3% Black participants. A total of 11.5% of participants were Hispanic/Latino.

Investigators observed non-White participants were significantly underrepresented in nail psoriasis randomized clinical trials, with ≥1 US-based site compared to 2019 US census ethnoracial composition (13.4% vs. 39.9%; P<.001).

Lipner and colleague noted that the inclusion of international clinical trials in both studies may have inadequately estimated ethnoracial proportions.

“Nonetheless, these results may serve as a reference for future research and promote more equitable care amongst underrepresented populations,” the team wrote. “Ethnoracial differences in nail psoriasis disease severity treatments has not been adequately explored, but merits further study.”

The study, "Underrepresentation of racial and ethnic minorities in nail psoriasis randomized clinical trials: A call to action," was published online in the Journal of the Amwrican Academy of Dermatology.