Racial Disproportionality in Covid Clinical Trials

There are sufficient data demonstrating that coexisting conditions in patients with Covid-19 influence clinical outcomes and that older age and male sex are associated with a greater risk of death. But despite disproportionately higher rates of Covid-19 infection, hospitalization, and death in racial and ethnic minority groups, the direct effects of genetic or biologic host factors remain unknown.¹

As we strive to overcome the social and structural causes of health care disparities, we must recognize the underrepresentation of minority groups in Covid-19 clinical trials. Although the Food and Drug Administration hailed remdesivir as the standard of care for Covid-19 and is actively distributing supplies throughout the United States, data supporting the drug’s efficacy and safety in minority groups are limited. Data on race and ethnicity were not provided for the 53 patients treated with remdesivir under the “compassionate use” program.² Though we acknowledge that these early results were obtained from a limited data set, Black Americans accounted for only about 20% of the 1063 patients in the placebo-controlled Adaptive Covid-19 Treatment Trial (ACTT-1) funded by the National Institute of Allergy and Infectious Diseases (NIAID)³ and 11% of the 397 patients randomly assigned to 5 or 10 days of remdesivir in the Gilead-funded study (GS-U.S.-540-5773).⁴ The proportions of Latinx and Native American patients were provided only for ACTT-1 and were 23% and 0.7%, respectively.