Enrollment of race/ethnicity in ophthalmic clinical trials before and after the Final Rule

The Final Rule (42 CFR Part 11) conditionally requires race/ethnicity reporting among clinical trials registered on Clinicaltrials.gov, but the effect of this policy on the demographic makeup of ophthalmic clinical trials is unknown. We analyzed the effect of the Final Rule on the enrollment of racial and ethnic groups in ophthalmic clinical trials.

In this retrospective database study, ClinicalTrials.gov was queried for "eye," "eye diseases," and "ocular." US-based trials with a completed status, results available, and enrollment greater than or equal to 50 participants were included (n=872). Trials with a study start date on or after April 18, 2017 (the compliance date of the Final Rule) were categorized as "post-requirement" (n=200) trials. Trials with a study start date prior to this date were categorized as "pre-requirement" (n=672) trials. The primary and secondary outcome was the enrollment of each race/ethnicity category and the disclosure rate of any race/ethnicity information, respectively. The enrollment and disclosure rate before and after the implementation of the Final Rule was compared with the Mann-Whitney U-test and Pearson's chi-squared test, respectively.

White participant enrollment significantly increased while the enrollment of participants with an unknown race significantly decreased among post-requirement trials compared to pre-requirement trials (p<.005). The enrollment of American Indian/Alaskan Native, Native Hawaiian/Other Pacific Islander, and White enrollment was significantly higher among trials funded by the National Institutes of Health (NIH) compared to non-NIH funded trials among pre-requirement but not post-requirement trials (p<.005). The disclosure rate of any race/ethnicity information increased significantly (p<.001) among post-requirement trials (91.00%) compared to pre-requirement trials (38.39%).

The enrollment rate by race/ethnicity remained unchanged for minority racial and ethnic groups, despite the increased race/ethnicity disclosure rate in ophthalmic clinical trials after the implementation of the Final Rule. Additional mechanisms may be needed to bridge persistent disparities in racial/ethnic minority enrollment into clinical trials.