Dr Chesahna Kindred Discusses the Strengths of Diversity in Psoriasis Clinical Trials


Chesahna Kindred, MD, MBA, FAAD, board-certified dermatologist, Kindred Hair & Skin Center, discusses how to accurately represent findings from diverse populations and translate them into clinical practice.

More diverse patient participation is needed to ensure the effectiveness and applicability of treatments for patients with psoriasis, says Chesahna Kindred, MD, MBA, FAAD, board-certified dermatologist, Kindred Hair & Skin Center.


What measures or strategies are currently being implemented in clinical practice to ensure diversity among participants in clinical trials for psoriasis treatments?

I'm seeing a lot of policies being implemented with a lot of intentionality, meaning [that] pharmaceutical companies and organizations are intentionally looking for PIs, principal investigators, with diverse backgrounds. And it’s smart because, generally, patients tend to have more satisfaction with a physician that looks like them. I've also seen the recruitment material be more diverse. So not just men, but also women; not just Whites, but also Blacks, Asians, Latinx, and Latine. And I've seen them think out of the box with trying to help with recruitment for diverse backgrounds.

Can you explain the importance of diversity in clinical trials for patients with psoriasis, and how it impacts the effectiveness and applicability of treatments?

Diversity in clinical trials, in general, is important for the most obvious reason, we live in the US. And if we don't study these medications in our population, then we'll be doing a disservice for one, which ends up being a disservice for all.

Psoriasis is more common in Whites, less common in Blacks, but more severe in Blacks. What you end up having, instead of a really cutting edge understanding of psoriasis, you end up not being able to treat anyone with very severe psoriasis, because it was never studied generally in that population.

Also, we have genetic differences. And our medications are becoming more and more precise, right? Cortisones just reduce the immune system in a blanket way. Whereas biologics, which is where we're headed, it's targeting, right? One type of receptor, on one cell, in one pathway. And if we have these genetic differences, then we'll be precise for one group and not the other. When we see patients in the real world, we have to base it initially off clinical trials. So, then we end up giving a patient a medication that just is not catered towards them, it doesn't target the type of receptor or phenotype or genotype they may have.

There's psoriatic arthritis. Psoriatic arthritis is also more severe in Blacks. Some of our medications we found achieves complete clearance. So, our goal used to be a little bit clearer, be 50% clear, 75% clear. Now we want 100% clearance and improvement in arthritis.

When those studies included Blacks, I think it helped both dermatologists and rheumatologists to feel confident in those studies. And there are studies from pharmaceutical companies where they say, our data is incomplete; it was skewed. And they'll intentionally have a clinical trial just in skin of color. And so, we're able to pull that data and we can make sure that with confidence, which medication is the right one for which patient. And [it’s] not just race, and race very important. But [it’s] sometimes based on weight, or age, or prior history, whether biologic naive or not. And we have to do that for all of our diseases, because the knowledge is only going to help us to do better for our patients.

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