Enhancing Diversity, Addressing Racial Disparities in Psoriatic Arthritis Research

In the final clip of this interview with Rebecca Haberman, MD, rheumatologist and associate director of the Psoriatic Arthritis Center at NYU Langone Health, she outlines strategies to improve diversity in future psoriatic arthritis (PsA) clinical trials, which have historically included a majority of White patients.

Based on her findings, Haberman also proposes additional research to better understand the underlying factors driving racial and ethnic disparities among patients with PsA.

Watch parts 1 and 2 of the interview to dive deeper into racial and ethnic disparities among patients with PsA.

This transcript has been lightly edited for clarity.

Transcript

Considering that PsA clinical trials predominantly include White patients, what steps should be taken to improve diversity in future research?

I think we really need to make a push for our studies to more accurately reflect at least the distribution of what we see in the general population, which I had talked about earlier with that NHANES [National Health and Nutrition Examination Survey] study. Really, this is not an easy task, so I'm not going to come out and say this is what we need to do, this is really easy, but we need to expand to more sites within the US. So, not those 10 classic sites with all the same types of patients. Even across the world, going to different sites where maybe drug companies don't necessarily want to set up because they don't think that the prevalence is so high. So, going out to other parts of the world.

The other thing is we really need to reach out to these populations because they are populations that are less likely to participate in trials, and there's many, many reasons for that. So, really doing a lot more outreach, education, making them feel more included within the research process. I do think there's already a push toward this, so I do look forward to seeing kind of the next generation of clinical trials coming out because I do think that there's a lot more awareness of this topic now and a lot more of a push to do that.

What additional research is needed to better understand the drivers of racial and ethnic disparities in PsA?

So, I think that the biggest thing to point out is that, in our study, we're looking at White vs non-White [patients], and that's not really a category that we can be looking at. We grouped it this way because of the sample size numbers; there was just no way to accurately look at each group individually. Even within each group, if you look at the category of Asian patients, for example, that's also broken down even more into different racial and ethnic type groups.

So, the biggest thing is that we created this very artificial divide that's most likely probably not, biologically, an accurate reflection of individual races and ethnic groups. Ultimately, we need to have a much bigger cohort of patients, ideally not just from New York, but looking at multicenters, and being able to break that down a little bit more.

We also need to couple all of that with really deep molecular endotyping. So, trying to understand not just who these people are clinically, but what their immune cells look like and what their genetics look like that might be causing some of these differences.

Then the last thing that I think also plays a big role in this is that it's not just all about race and ethnicity, but we have to think about other social determinants of health when we're thinking about these topics in general because a lot of disparities have to do with access to care, socioeconomic status, how far away a patient is from a big medical center, for example, education and medical literacy.

I think this is a great first step in understanding that there may be differences, but we need a lot more details to really nail down what those differences are, why they're occurring, and that's when we can really understand more how we can intervene on those.