Introduction To generalize safety and efficacy findings, it is essential that diverse populations are well represented in Alzheimer's disease (AD) drug trials. In this review, we aimed to investigate participant diversity in disease-modifying AD trials over time, and the frequencies of participant eligibility criteria. Methods A systematic review was performed using Medline, Embase, the Cochrane Library, and Clinicaltrials.gov, identifying 2247 records. Results In the 101 included AD trials, participants were predominantly White (median percentage: 94.7%, interquartile range: 81.0-96.7%); and this percentage showed no significant increase or decrease over time (2001-2019). Eligibility criteria such as exclusion of persons with psychiatric illness (78.2%), cardiovascular disease (71.3%) and cerebrovascular disease (68.3%), obligated caregiver attendance (80.2%), and specific Mini-Mental State Examination scores (90.1%; no significant increase/decrease over time) may have led to a disproportionate exclusion of ethnoracially diverse individuals. Discussion Ethnoracially diverse participants continue to be underrepresented in AD clinical trials. Several recommendations are provided to broaden eligibility criteria.
Bibliographical noteFunding information
TheNetherlandsOrganisation forHealth Research andDevelopment/Alzheimer Nederland,Grant/Award Number:
733050834; National Science Foundation; NIH, Grant/Award Number: P30 AG066530; NIH/NIA, Grant/Award Numbers:
R01AG068183,R01AG067428, A2021142S;BrightFocus Foundation, Grant/AwardNumber:A2021142S;NIA/NIH, Grant/Award
Numbers:R13AG071313-01,R01AG065110- 01A1, NIH/NIA 5U19AG024904-14,NIH/NIAR01AG066471-01A1; NIH/NIMH,
Grant/Award Number:U24MH100931- 03; NIH/NIA, Grant/Award Number: 5R24AG065163; theGenentech Health Equity
2020 Fund,Grant/Award Number: G-89294;Alzheimer’s Association, Grant/AwardNumber: AARGD-16-446038