Systematic review of gender bias in clinical trials of monoclonal antibodies for the treatment of multiple sclerosis

Introduction: This article analyses the presence of gender bias in clinical trials of monoclonal antibodies used to treat multiple sclerosis. Material and methods: We performed a systematic review of controlled clinical trials of 4 monoclonal antibodies used to treat multiple sclerosis (natalizumab, rituximab, alemtuzumab, and ocrelizumab). We searched the PubMed/MEDLINE database for articles published in English before March 2020. The study was conducted in accordance with the relevant international recommendations. Results: The search identified 89 articles, 55 of which met the inclusion criteria. Of all patients included in these trials, 64.6% were women. The lead authors of 10 of the studies were women. Fifteen of the 55 studies included a sex-based analysis of the primary endpoint. Only 8 articles discussed the results separately for men and for women. Conclusions: The clinical trials of these 4 monoclonal antibodies present a significant gender bias. In most cases, the primary and secondary endpoints are not analyzed according to patient sex, despite the fact that international recommendations include this as a minimum require-ment for ensuring scientific validity and obtaining appropriate results for extrapolation to the wider population. (C) 2021 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Neurologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).