Addressing diversity gaps in esketamine clinical trials: a registry-based cross-sectional analysis of sex, race and ethnicity.
Damian Swieczkowski, Aleksander Kwaśny, Michal Pruc, Lukasz Szarpak, Wiesław Jerzy Cubała
International journal of psychiatry in clinical practice June 1, 2026 DOI: 10.1080/13651501.2026.2622532 via PubMed
Summary
Women made up 62.9% of participants across 13 esketamine clinical trials for mental health disorders, while men comprised 37.1%. The racial distribution showed White participants at 69.08%, Asian at 13.31%, Black or African American at 3.60%, American Indian or Alaska Native at 0.08%, and Native Hawaiian or Other Pacific Islander at 0.04%. Hispanic or Latino representation ranged from 10.57% to 11.02% due to reporting discrepancies in one trial. These trials demonstrate significant racial and ethnic disparities, with underrepresentation of minority groups, highlighting the need for regulatory efforts to improve diversity and fair representation in future research.
Study at a glance
| Characteristics | Registry-based cross-sectional analysis Peer reviewed |
|---|---|
| Sample size | 5,116 |
| Population | Participants in interventional esketamine trials with results posted on ClinicalTrials.gov |
| Topics | Depression Ketamine |
| Keywords | Clinical trial Ethnicity Race |
| Registration | NCT02493868 |
| Key finding | Esketamine clinical trials show significant racial and ethnic disparities, with underrepresentation of racial and ethnic minority groups. |
Abstract
To explore sex, racial and ethnic disparities in esketamine clinical trials for mental health disorders registered on ClinicalTrials.gov. We conducted a registry-based cross-sectional analysis of interventional esketamine trials with results posted on ClinicalTrials.gov (cut-off date: 10 February 2025). Using predefined eligibility criteria, two investigators independently extracted and verified trial-level data on sex, race, ethnicity and site locations as reported in the registry. Among 13 eligible trials (n = 5116), women constituted 62.9% of participants, while men comprised 37.1%. The racial distribution included White (69.08%), Asian (13.31%), Black or African American (3.60%), and American Indian or Alaska Native (0.08%). Native Hawaiian or Other Pacific Islander participants accounted for only 0.04%. Hispanic or Latino representation ranged from 10.57% to 11.02% due to discrepancies in results reporting in trial NCT02493868. Esketamine clinical trials demonstrate significant racial and ethnic disparities, with underrepresentation of racial and ethnic minority groups. Regulatory efforts to improve diversity must lead to more effective recruitment for fair representation in future research.