New Insight with Dr. Veeral Sheth

Diabetes Dialogue

Don’t Miss a Beat

Crisis Point

Connor Iapoce is an associate editor for 

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

Sociodemographic factors influence visit adherence among individuals with 

neovascular age-related macular degeneration (nAMD)

, according to a new analysis presented at the 

2024 Association for Research in Vision and Ophthalmology (ARVO) Meeting

Across a large healthcare system, patient factors, including type of insurance, social deprivation index, marital status, and race, were each linked with a significant impact on visit adherence for those with nAMD.

“These findings offer insight into how we can improve adherence and outcomes for patients with this debilitating eye disease,” said the investigative team, led by Alison Choi, department of ophthalmology, University of Pittsburgh School of Medicine.

Owing to their substantial efficacy in preserving and improving vision, the standard of care treatments for nAMD remains intravitreal anti-vascular endothelial growth factor (VEGF) injections.

 Although there are understood barriers to vision care, particularly anti-VEGF injections, there are limits to its effect on nAMD patients in the United States.

A notable barrier is the need for frequent injections, requiring regular follow-up and impacting access to lower socioeconomic classes.

 Patients may struggle with the cost of treatment, lack of transportation, and living in a low-resource area, which contributes to disparities in adherence and access to eye care. Individuals who experience delays in care, or were lost to follow-up in nAMD treatment, are known to exhibit a significant decline in visual acuity down the line.

Thus, social determinants of health may be a significant factor in the management of nAMD and create inequities in vision impairment in the US. In this study, Choi and colleagues conducted a retrospective, observational review to determine how socioeconomic barriers impact visit adherence in nAMD across a large healthcare system.

A total of 962 patients over the age of 18 years with nAMD in ≥1 eye, who were seen between 2018 and 2022, were included for analysis. Investigators obtained demographic and encounter data from the electronic medical records for the patient population.

The team measured the average number of days between visits and the distance from the home address to the preferred treatment center. Neighborhood socioeconomic disadvantage was determined and ranked using the Area Deprivation Index (ADI).

For the analysis, a Mann-Whitney U test evaluated the correlation between demographic variables and the mean number of days. Moreover, a Pearson correlation coefficient assess the relationship between ADI rank and distance, as well as the mean number of days between visits. Choi and colleagues set the significance at 

Upon analysis, the team found that insurance type, social deprivation level, marital status, and race significantly impacted the mean number of days between clinic visits. Individuals with Medicaid or Medicare (70 days; n = 762) experienced a higher mean number of days (

 = .007) than individuals with private insurance (63 days; n = 85) or those who paid out of pocket (64 days; n = 101).

Meanwhile, Choi and colleagues found the ADI rank was significantly, but weakly positively, associated with the mean number of days (

 = .012) and distance from home to the treatment center (

 = .00). By marriage status, those who were married (66 days; n = 460) had a lower number of days (

 = .035) than non-married individuals (68 days; n = 469).

Although the participant numbers were low, demographic data showed both Black (105 days; n = 14) and Asian (92 days; n = 18) patients experienced a higher mean number of days between visits (

 = .002) than White patients (67 days; n = 909).

“Several sociodemographic factors including insurance type, social deprivation, marital status, and race significantly impacted visit adherence for nAMD patients,” Choi and colleagues wrote.

Choi A, Nawash BS, Ong J, Sahel JA, Chhablani J. Evaluating the Influence of Sociodemographic Factors on Visit Adherence for Patients with Neovascular Age-Related Macular Degeneration. Poster presented at the Association for Research in Vision and Ophthalmology (ARVO) 2024 Meeting, May 5–9, 2024.

Tan CS, Ngo WK, Chay IW, Ting DS, Sadda SR. Neovascular Age-Related Macular Degeneration (nAMD): A Review of Emerging Treatment Options. Clin Ophthalmol. 2022;16:917-933. Published 2022 Mar 25. doi:10.2147/OPTH.S231913

Scanzera AC, Sherrod RM, Potharazu AV, et al. Barriers and Facilitators to Ophthalmology Visit Adherence in an Urban Hospital Setting. Transl Vis Sci Technol. 2023;12(10):11. doi:10.1167/tvst.12.10.11

Articles

Factors, including social deprivation and race, significantly affected visit adherence for patients with nAMD across a large healthcare system.

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Ophthalmology

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Age-Related Macular Degeneration

age-related macular degeneration condition center page is a comprehensive resource for clinical news and insights on retina disease. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for patients with AMD.

Sociodemographic Factors Impact Visit Adherence in Patients with Wet AMD

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

This discussion covered the topic of vaping and its potential treatment with cytisinicline, a plant-based medication which may help vapers to quit.

New Findings on Cytisinicline Treatment for Quitting E-Cigarettes, with Nancy Rigotti, MD

 known as ‘ORCA-V1,’ 160 adults who used nicotine e-cigarettes (vaping) but not cigarettes were treated for 12 weeks with cytisinicline, a plant-based alkaloid designed to reduce nicotine dependence by targeting nicotinic acetylcholine receptors, or a placebo. Both the treatment and placebo arms received behavioral support.

Nancy A. Rigotti, MD, a study investigator, spoke with 

 on her team’s findings, noting that the treatment was well tolerated and led to substantially more continuous abstinence from vaping compared to those in the placebo group within the final 4 weeks of drug treatment (31.8% versus 15.1%, respectively).

“What we know is that an increasing number of adults, especially young adults are using e-cigarettes, they're vaping nicotine, so I'm gonna use those terms interchangeably,” Rigotti explained. “...What we know is that a lot of them don't want to be doing it and realize they're nicotine addicted, so they'd like to stop.”

Rigotti noted that some studies indicate that as many as half of those who vape are attempting to quit every year but a lot of them are having trouble. While there is research suggesting the benefits of text messaging programs and behavioral support, as well as stories of the effectiveness of varenicline (Chantix) for vaping cessation, Rigotti noted there is no data to prove that these are effective.

“Cytisinicline is this new product that we have that is being developed in the United States for smoking cessation,” Rigotti said. “It's not FDA-approved at this point but it has been available for decades as a consumer product in eastern and central Europe…So it's widely used, but it's not available in the US and it works in the same way as Chantix does in the brain to help make help cure nicotine addiction, and make it easier for people to stop whatever way they're getting nicotine.”

Rigotti noted that the difference between the treatment arm and the placebo arm was about 32% of people who got cytisinicline quit and were not vaping for the last 4 weeks of the trial, more than double the 15% of those in the placebo arm. However, there were some developments afterward which suggest the need for larger trials.

“Each week, there were more people who were not vaping when we looked at every single week,” Rigotti said. “Now we did follow it up 4 weeks after we stopped giving the medicine and we found that there was relapse in both groups, but more in the cytisinicline group. So 4 weeks later, which was Week 16. The difference was not statistically significant, but there was still a considerable difference and we interpreted that to say that a lot of it was the sample size issue. We had a small trial.”

While the use of varenicline for quitting cigarettes has been demonstrated in prior research, more data may be warranted regarding the use of cytisinicline for vaping.

For additional information on the study results, view the full interview with Rigotti posted above.

The quotes contained in this interview summary were edited for clarity. Rigotti has provided consultation to and received a research grant from Achieve Life Sciences.

Rigotti NA, Benowitz NL, Prochaska JJ, et al. Cytisinicline for Vaping Cessation in Adults Using Nicotine E-Cigarettes: The ORCA-V1 Randomized Clinical Trial. JAMA Intern Med. Published online May 06, 2024. doi:10.1001/jamainternmed.2024.1313.

Harris E. Systematic Review Finds the Most Effective Smoking Cessation Aids. JAMA. 2023;330(15):1421–1422. doi:10.1001/jama.2023.18742.

Videos

This discussion covered the topic of e-cigarette use and its potential treatment with cytisinicline, a plant-based medication which may aid vapers in quitting.

Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

Katharine Phillips, MD: Various Treatments for Obsessive-Compulsive Disorders

Shame surrounds many people with obsessive-compulsive disorders, leading to conditions like OCD, body dysmorphic disorder, and trichotillomania being underrecognized in clinical settings. 

, professor of psychiatry at Weill Cornell Medical College, presented this topic, as well as obsessive-compulsive treatment options, at the annual 

American Psychiatric Association (APA) conference

Patients with OCD often can be embarrassed by their intrusive thoughts, whether that be sexual thoughts or thoughts of harming others.

“Those thoughts are sometimes hard for patients to spontaneously mention to clinicians,” Katharine Phillips, professor of psychiatry at Weill Cornell Medical College, told 

People with body dysmorphic disorder often do not mention their symptoms to clinicians because of embarrassment and worry they will be judged or viewed as vain.

“Because they're so worried about how they look, and [body dysmorphic disorder] is not about that,” she said. “It's about it's about having intrusive thoughts and not seeing yourself correctly.”

Trichillomania and the skin picking disorder are associated with a lot of shame. Since people feel ashamed to bring up their symptoms, Phillips said it is crucial to screen patients for these disorders and to ask questions to see if they have recurrent or intrusive, unwanted thoughts.

She said to screen for body dysmorphic disorder, a clinician can ask a simple question: “Are you worried about how you look?” They can even normalize the question by phrasing it as “Many people worry about how they look. Is that a problem for you?”

For both OCD and body dysmorphic disorder, she uses a cut point of about an hour or more a day for having these thoughts. People need at least an hour of clinically significant distress due to the thoughts of body dysmorphic disorder and an hour of significant impairment in functioning for OCD.

She said it can be straightforward to diagnose these disorders. People with body dysmorphic disorder may think their lips are asymmetrical or their head is not exactly even. People with trichotillomania may have noticeable lesions on their skin or patches of hair; clinicians should ask these patients if they are pulling out their hair and if it is hard to control or repetitive.

“It's important to make sure that the hair pulling, and the skin picking are not triggered by thoughts at the skin or the hair look bad because that is body dysmorphic disorder,” she said.

The first-line treatment for OCD and body dysmorphic disorder is serotonin reuptake inhibitors (SSRIs) and these patients tend to need higher doses than patients with other disorders, such as fluoxetine Prozac at 120 mg a day and sertraline 400 mg a day.

“Not everyone needs these high doses, but on average, the necessary doses of SSRIs are pretty high,” she explained.

For glutamate modulators, she prescribes n-acetyl cysteine as high as 18000 mg twice a day, starting with a lower dose, and memantine as high as 20 mg twice a day.

Hoarding disorder is more difficult to treat with medication, so cognitive behavioral therapy is often used. Cognitive behavioral therapy also can be used for body dysmorphic disorders and Phillip advises patients to look in the mirror and improve their ability to look at the bigger picture in their appearance.

“It's a quick mirror exercise about 5 minutes a day where they learn to describe themselves from head to toe, not zero in on the things they don't like, and using neutral non-judgmental language,” Phillips said.

Derman, C. Katharine Phillips, MD: Differences Between OCD, Body Dysmorphic Disorder. HCPLive. May 10, 2024. 

https://www.hcplive.com/view/katharine-phillips-md-differences-between-ocd-body-dysmorphic-disorder

Phillips, K. Obsessive-Compulsive Spectrum Disorders: Clinical Presentations and Treatments. Session presented at: American Psychiatric Association (APA) 2024 Annual Meeting. New York, NY. May 4, 2024.

Phillips emphasizes the importance of screening for obsessive-compulsive disorders, such as OCD, body dysmorphic disorder, and trichillomania.

Psychiatry

Psychiatry condition center page is a comprehensive resource for clinical news and insights on mental illnesses. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for depression, schizophrenia, bipolar disorder, anxiety, and more.

Abigail Brooks is an assistant editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

A new model based on cytokeratin 18 (CK18), cytokeratin 19 (CK19), albumin, platelet count, and α-fetoprotein (AFP) may offer a refined approach for detecting hepatocellular carcinoma (HCC) in patients with 

The model, coined the CK-HCC score, outperformed AFP alone for discriminating patients with HCC from those with liver cirrhosis by incorporating additional routine laboratory tests, offering a potential noninvasive alternative to liver biopsy in this high-risk patient population.

“There was an urgent need to identify more accurate and sensitive biomarkers for early detection of HCC patients,” Mahdi Al Haddad, of the department of chemistry at Helwan University in Egypt, and colleagues wrote.

The most common type of primary liver cancer, HCC occurs most often in people with chronic liver diseases, such as cirrhosis caused by viral hepatitis. People with long-term liver diseases and scarring on the liver are at an increased risk of HCC. Early detection is essential for ensuring prompt treatment and improving outcomes, underscoring the need for reliable biomarkers to detect HCC in its early stages.

To develop a novel score for accurately detecting HCC, investigators recruited patients with liver cirrhosis who developed HCC (n = 75) from the Damietta Cancer Institute from October 2017 - December 2018. In addition to the group of patients with HCC, investigators included a second group of patients with HCV with liver cirrhosis but no evidence of malignancy (n = 50) as well as a control group of healthy individuals with no evidence of any hepatitis markers (n = 20).

Prior to applying any therapy protocol, 10 milliliters of blood was collected from each patient to assess laboratory values and assay serum CK18, CK19, AFP, albumin, and platelet count. Investigators then assessed their diagnostic accuracy for discriminating HCC from liver cirrhosis by plotting receiver operating characteristic (ROC) curves and selecting the best collection parameters based on their diagnostic utility.

In order to enhance the diagnostic performance of AFP alone, investigators combined AFP (Area under curve [AUC], 0.692) with other biomarkers of high AUC, including CK19 (0.864), albumin (0.811), CK18 (0.795), and platelet count (0.783). The proposed model, CK-HCC, is as follows:

CK 19 (ng/ml)×0.001+ CK18 (ng/dl)×0.004 + AFP (U/L)×5.4 - Platelets count (×109)/L×0.003 – Albumin (g/L)×0.27–36.

Investigators pointed out the score had a wide range from -0.68 to 4.2 and it showed notable significance for differentiating patients with HCC from those with cirrhosis (

 <.001). Compared to AFP, CK-HCC produced a greater AUC for distinguishing HCC from cirrhosis (0.919 vs 0.692). The greatest sensitivity (94%) and specificity (91%) were taken at a cut-off of 1.3, where above 1.3, the patient is considered to have HCC, and below 1.3, the patient is considered to have cirrhosis.

Additionally, investigators noted CK-HCC was superior to AFP for differentiating patients with low TNM stage, complete capsulation, low grade, small tumor size, absence of vascular invasion, and single focal lesions. Specifically, AFP alone had a weak diagnostic power for differentiating patients with HCC with small tumor size from those with cirrhosis (AUC, 0.512) versus the CH-HCC score, which produced an AUC of 0.756. Additionally, AFP was unable to discriminate patients with a low tumor grade from those with cirrhosis (AUC, 0.501) compared with the AUC of 0.815 produced by the CK-HCC score.

“For the first time, we report the clinical validation of four biomarkers (CK19, CK18, albumin, and platelets count) in combination with AFP to improve the accuracy for diagnosis of HCC among hepatitis C high-risk patients,” investigators concluded.

Al Haddad M, El-Mezayen H, El-Kassas M, et al. Clinical Utility of Cytokeratins for Accurate Diagnosis of Hepatocellular Carcinoma Among Hepatitis C Virus High-Risk Patients. 

Asian Pacific Journal of Cancer Prevention

(4), 1325-1332. doi: 10.31557/APJCP.2024.25.4.1325

Mayo Clinic. Hepatocellular carcinoma. Liver Cancer. April 18, 2023. Accessed May 10, 2024. 

https://www.mayoclinic.org/diseases-conditions/hepatocellular-carcinoma/cdc-20354552

A novel score based on a combination of cytokeratins and routine laboratory tests provided a more accurate diagnosis of HCC versus serum α-fetoprotein alone.

Hepatology

Hepatitis C

Hepatitis C page, resources on the topics of medical news and expert insight into HCV can be found. Content includes articles, interviews, videos, podcasts, and breaking news on hepatitis C virus research, treatment, and drug development.

Cytokeratins Could Aid Early Detection of Hepatocellular Carcinoma in Patients with HCV

Lana Pine is the editor of HCPLive Rheumatology. She is an experienced editor and technical writer with a demonstrated history of working in the banking and publishing industries. In her free time, she enjoys cooking, yoga, listening to podcasts, and drawing. She can be reached via email at LPine@mjhlifesciences.com.

The lack of diversity in both clinical trials and healthcare providers creates complex challenges across the industries of practice and research. Disparities such as the disproportionate number of White providers lead to a mismatch in cultural understanding and trust among diverse patient populations. This also extends to clinical trials, where an historical mistrust among minority communities and unequal access to healthcare providers limit recruitment and participation and, in turn, hinder research outcomes. Language barriers further complicate communication between patients and providers as well as access to care.

This lack of diversity not only affects research outcomes, but it also limits the understanding of disease manifestations and treatment responses across different populations.

Strategies designed to improve health equity and enhancing transparency—involving diverse healthcare providers and advocates—are critical steps towards promoting inclusivity and diversity in healthcare and research practices.

Lack of Diversity in Healthcare Providers and Clinical Trials

Across all medical indications, clinical research has historically been driven by North American and Western European countries, and predominantly involve White male populations in trials. The conventional teaching and understanding of diseases is therefore based on these populations.

Unfortunately, trials do not recruit participants who represent those most affected by a particular disease. Lupus, for example, is 3 times more prevalent in Black women compared with White women.

Due to this exclusion, “we don't have as much information about how lupus affects a larger, more diverse population of patients,” Ashira Blazer, MD, MSCI, assistant professor in the University of Maryland Division of Rheumatology, told 

This underrepresentation is also mirrored in the lack of diversity among health care providers which, of course, does not reflect the diversity of the general population.

“Our health care providers don't adequately represent the patient population,” John H. Stone, MD, MPH, professor of medicine at Harvard Medical School and a rheumatologist at Massachusetts General Hospital, told 

. “A majority of our health care providers are White, and while we are seeing more women entering the healthcare field, the profession still remains predominantly Caucasian.”

To combat this, increasing the percentage of minorities in healthcare is crucial. An influx of a more diverse population of providers could help patients feel more comfortable with their healthcare choices and accessing novel treatment approaches.

Organizations like the Arthritis Foundation offer Diversity, Equity, and Inclusion (DEI) awards to increase the number of specialists and support the training of a diverse generation of rheumatologists. These awards are designed to address disparities in patient care and outcomes with a focus on attracting historically underrepresented medical students and residents to rheumatology.

The lack of diversity in clinical trials stems from multiple factors. In the United States, there's a historical context of medical distrust among communities of color due to past unethical practices and disparities in healthcare access. This skepticism extends to clinical trials, where there's often a perception of minority groups being used as "guinea pigs" or not receiving the same level of care as others.

“I think there is a bias amongst people of color to not trust that participating in a clinical trial is in your best interest,” Judith Ng-Cashin, MD, chief medical officer at Novotech, told 

The most famous example of this is the US Public Health Service (USPHS) Untreated Syphilis Study at Tuskegee, which was designed to record the natural history of untreated syphilis. Starting in 1932, researchers enrolled 600 Black men (399 with syphilis and 201 without). The men did not give informed consent, and in exchange for their participation they were given free meals, free medical exams, and burial insurance.

By 1943, penicillin was becoming widely available and was considered the treatment of choice for this condition. However, over the course of the 40-year federal experiment, the men involved in this study were not offered this treatment and were left untreated for decades for research purposes.

According to a survey conducted by Kennedy et al., this underlying mistrust between poor and minority populations is also due in part to previous negative experiences with the health care system which can also impact recruiting for clinical trials.

“The healthcare system has not been trustworthy for all people,” Blazer said. “We know that there are big historical ills and I think many people are aware of those. But then also in the day-to-day when patients, particularly those of ethnic backgrounds that face heavy discrimination, see their physicians, they're not being treated the same and they're not being offered the same things.”

Another factor is the unequal distribution of healthcare providers across the country.

“The distribution of health care providers is in the country is not done in an equitable way so that minorities have equal access to healthcare providers and to clinical trials and cutting edge studies that are going on,” Stone added.

The Arthritis Foundation has introduced fellowship programs to help the approximately 60 million Americans are living with clinically diagnosed arthritis get access to care. This strategy focuses on expanding the number of fellowship opportunities for rheumatologists, with an emphasis on communities facing the most significant shortages.

Language barriers are also a hinderance to patient-provider communication and access to healthcare services.

Stone explained one important way to enhance diversity and participant recruitment for trials is language accessibility. To better serve his patients, he is currently learning Spanish as he believes it is increasingly important for American healthcare providers to be able to communicate with patients in their preferred language. He also encourages consent forms to be available in multiple languages.

“Healthcare providers, healthcare systems, and hospitals need to have adequate representation of translators and translating facilities, which can even be web-based, to bridge language barriers,” he added.

Inclusivity in clinical trials is essential to understand disease presentations and treatment responses across diverse populations.

“Our population is a diverse one—a melting pot, right? So, if we're unable to get patients of all backgrounds in our clinical trials, then we're not going to be able to find appropriate solutions,” Blazer said.

In rheumatology, the lack of diversity in clinical trials presents significant challenges for several reasons. Diseases in rheumatology, such as lupus, affect diverse populations differently, yet clinical trial participants often do not represent this diversity.

“Patients with lupus also have symptoms such as pain, depression, and fibromyalgia, can't be as closely tied to the inflammatory conditions—those are very difficult to treat,” Blazer explained. “Also, the way that people express their symptoms tends to be tied to their culture. And so, it's difficult to understand how a wider variety of patients experiences those symptoms and what we do about it.”

In her research regarding health disparities in systemic lupus erythematosus (SLE), Blazer and her team examined the relationship between self-reported race and ethnicity and disease outcomes. They found that—as race and ethnicity are social taxonomies as opposed to biological determinants—differences in severity and outcomes observed across racial and ethnic groups are largely due to the differences in access to care opportunities to achieve optimal health.

This lack of access leads to gaps in understanding how treatments affect various patient groups and limits the ability to tailor treatments effectively. Limited diversity in these trials ultimately leads to a limited understanding of disease manifestations and treatment responses across different populations. This makes it challenging to develop medications that effectively address the needs of diverse patients.

“Not only is it harder to recruit patients when you can only recruit from a small subset, but it's also harder to understand how the different phenotypes that we see in rheumatology could respond to certain medications,” she explained.

When considering timing issues and other opposing factors, Blazer acknowledges drug companies face pressures to enroll specific types of patients in clinical trials. They prefer patients with manageable symptoms, good access to care, health literacy, and few comorbidities or pain.

“That criteria are not often met by people who are underserved and underprivileged in medicine because those patients have worse disease, those patients don't have access, those patients can't get to the doctor very quickly, etc,” she said. “All of those complications are going to influence the trial outcome.”

Consequently, trial outcomes may not accurately reflect real-world patient experiences, and drugs may be approved based on limited data from a less diverse patient pool, which can slow down the pace of research and impact the development of potentially effective treatments.

“A driving factor of wanting to be more inclusive and promote diversity in these trials is to better understand the scope of what the disease looks like, and what we should target,” Ng-Cashin said.

Additionally, the settings where these trials occur, often large academic centers, are not easily accessible to underprivileged populations, further exacerbating the issue. This highlights a systemic issue where those already failed by healthcare systems are further disadvantaged in clinical research, creating a cycle of inequity.

However, there is a growing awareness in the clinical trial landscape that researchers need to broaden their view of diseases and how they presentation across diverse populations. Conditions like lupus highlight the importance of inclusivity in research to capture a more comprehensive understanding of diseases and their impact.

Creating trust within minority communities and educating them about the importance of clinical research are key strategies to overcome barriers, address biases on both the investigator and participant sides, and enhance diversity in clinical trials. Engaging with community leaders and providing culturally competent care are vital steps toward inclusivity and representation in healthcare research.

To overcome these challenges, Blazer emphasizes the importance of strategies like community engagement, partnering with trusted leaders, and providing education about the importance of clinical research are essential. These efforts aim to address biases and build rapport to ensure a more inclusive and representative participant pool in quality trials.

I think we are starting to make progress by partnering with people within the community to facilitate that trust that has been lacking in the medical establishment,” she added.

To foster inclusive and representative research practices, improving health equity and access to clinical trials is essential, as patients who lack consistent care are often not included in trials.

“People who can't have access to health care can't have access to clinical trust,” Blazer said. “The reason why a lot of patients aren't able to be enrolled is because they don't have consistent care. And even if they do have consistent care, the thought that they'd be able to, for example, be a part of a trial and go to a follow-up visit every 3 months or so is not feasible for those patients.”

Additionally, transparency in research practices and trustworthy, culturally competent care are vital to building patient trust and engagement. Increasing diversity among healthcare providers and involving non-physician providers in trials can also help bridge the gap and ensure trials reflect the diversity of the patient population.

“The path to making the physician population more diverse is going to be a long one,” Blazer said. “But I think that we can also engage allied health professionals and other patient advocates who can help educate around clinical trials and help be a part of that infrastructure that gets people in.”

Ultimately, a collaborative effort across healthcare systems, research institutions, and communities is needed to address these challenges and promote inclusive research practices in rheumatology and beyond.

Lupus: Hard to diagnose, disproportionately affects black women, but fairly little known in the community. MSBWR. Accessed May 4, 2024. https://msbwr.org/lupus-hard-to-diagnose-disproportionately-affects-black-women-but-fairly-little-known-in-the-community

Diversity, equity & inclusion initiatives. Science & DEI | Arthritis Foundation. Accessed May 7, 2024. https://www.arthritis.org/science/focus/workforce-development/dei.

Public Health Service study of untreated syphilis at Tuskegee and Macon County, al - timeline - cdc - os. Centers for Disease Control and Prevention. December 5, 2022. Accessed May 7, 2024. https://www.cdc.gov/tuskegee/timeline.htm.

Kennedy BR, Mathis CC, Woods AK. African Americans and their distrust of the health care system: healthcare for diverse populations. J Cult Divers. 2007;14(2):56-60.

Fellowships. Science Fellowships | Arthritis Foundation. Accessed May 8, 2024. https://www.arthritis.org/science/focus/workforce-development/fellowships.

Parodis I, Lanata C, Nikolopoulos D, Blazer A, Yazdany J. Reframing health disparities in SLE: A critical reassessment of racial and ethnic differences in lupus disease outcomes. Best Pract Res Clin Rheumatol. Published online December 5, 2023. doi:10.1016/j.berh.2023.101894

As disparate representation in pivotal research impacts the outcomes of common diseases like lupus, clinicians and researchers alike are working to foster trust and collaboration with more patients of color.

Rheumatology

Rheumatology condition center page is a comprehensive resource for clinical news and insights on rheumatologic disease. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for arthritis, gout, nr-AxSpA, and more.

Rheumatoid Arthritis

The HCPLive rheumatoid arthritis page is a comprehensive resource for clinical news and insights on arthritis. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for RA, and more.

Lupus

Inclusive Trials, Informed Treatments: Prioritizing Diversity in Clinical Research

Providers in inflammatory diseases discuss the instrumental role nurses and support staff play in educating patients on adalimumab biosimilars.

Biosimilars

Peer Exchange

HCPLive® Peer Exchange panel discussions feature authoritative insights, opinions, and perspectives on important issues facing today's care professionals.

The Role of Nurses and Support Personal in Educating Patient on Adalimumab Biosimilars

These data suggest that a multidisciplinary clinic approach results in several benefits including reduced risk of cardiovascular events among those with psoriasis.


Plaque Psoriasis

The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

Internal Medicine

Internal Medicine condition center page, resources on the topics of medical news and expert insight into internal medicine can be found. Content includes articles, interviews, videos, podcasts, and breaking news on internal medicine research, treatment, and drug development.

Coordinated Approach with Dermatologists, Internists Leads to Improvement in Psoriasis

Drs Lio, Botsoglou, and Alexrad discuss the most asked questions and common concerns patients have on adalimumab biosimilars.

Common Questions From Patients About Adalimumab Biosimilars

This clinical quiz will test your knowledge of the 2023 American Association for the Study of Liver Diseases/Infectious Diseases Society of America Hepatitis C guideline. 

Quizzes

Clinical Quiz: HCV DAA Treatment After Solid Organ Transplantation

At ARVO 2024, Roger Goldberg, MD explores the greater reductions in hard exudates achieved with faricimab than aflibercept in eyes with DME. 

Diabetic Macular Edema

The HCPLive diabetic macular edema page is a comprehensive resource for clinical news and insights on DME. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for the leading cause of blindness, and more.

Roger A. Goldberg, MD: Impact of Dual Inhibition on Hard Exudates in DME 

This analysis was designed to look into the timing and specific elements which mediate the relationship between eczema and systemic antibiotic use.


Atopic Dermatitis

Atopic Dermatitis condition center page, resources on the topics of medical news and expert insight into eczema can be found. Content includes articles, interviews, videos, podcasts, and breaking news on dermatitis research, treatment, and drug development.

Antibiotics in First Year Given to Infants Linked to Increased Eczema Risk, Microbiome Disruption

In an interview with HCPLive, Barnett discussed the ethical concerns of using psychedelics for treating substance use disorders.

Addiction

Addiction medicine condition center page, resources on the topics of medical news and expert insight into clinical addiction can be found. Content includes articles, interviews, videos, podcasts, and breaking news on addiction therapy research, treatment, and drug development.

Brian Barnett, MD: Psychedelics Fitting into the SUDs Treatment Paradigm

Results suggest chronic hepatitis B virus is globally underassessed and undertreated, especially among women and Asian minorities in the West.

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Sociodemographic Factors Impact Visit Adherence in Patients with Wet AMD

New Findings on Cytisinicline Treatment for Quitting E-Cigarettes, with Nancy Rigotti, MD

Katharine Phillips, MD: Various Treatments for Obsessive-Compulsive Disorders

Cytokeratins Could Aid Early Detection of Hepatocellular Carcinoma in Patients with HCV

Inclusive Trials, Informed Treatments: Prioritizing Diversity in Clinical Research