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Review
. 2022 Mar;7(3):e008173.
doi: 10.1136/bmjgh-2021-008173.

Attention for sex in COVID-19 trials: a review of regulatory dossiers

Sieta T de Vries  1   2 , Viktoriia Starokozhko  1   2 , Ingrid M M Schellens  2 , Leonoor Wijnans  2 , Harald Enzmann  3   4 , Marco Cavaleri  5 , Peter G M Mol  6   2   7
Affiliations
Review

Attention for sex in COVID-19 trials: a review of regulatory dossiers

Sieta T de Vries et al. BMJ Glob Health. 2022 Mar.

Abstract

An under-representation of women and a lack of sex-specific analyses in COVID-19 trials has been suggested. However, the higher number of men than women who are severely affected by COVID-19 and the restricted information in scientific publications may have biased these suggestions. Therefore, we evaluated sex proportionality and sex-specific efficacy and safety data in trials of COVID-19 treatments and vaccines using both publicly available regulatory documents and confidential documents used by regulators in their review of medicinal products. Included were two treatments (ie, remdesivir and dexamethasone) and four vaccines (ie, BNT162b2 mRNA (BioNTech/Pfizer), mRNA-1273 (Moderna), ChAdOx1-S (AstraZeneca) and Ad26.COV2-S (Janssen)) that received marketing authorisation by the European Commission at the time of the study conduct. An under-representation of women was shown in three of the nine data sets for one treatment (ie, remdesivir), but the proportion of women included was representative in each of the data sets for the other five products. This indicates that there is no structural under-representation of women in the COVID-19 trials. Currently, sex-specific efficacy data are available for five of the six assessed products and sex-specific safety data are available for half of the products only. It is important that this information will also be made available for the other products. There are only small differences in efficacy and safety between men and women which are likely to be of limited clinical relevance. Sex-specific efficacy information can generally be found in the publicly available regulatory documents other than the Summary of Product Characteristics, for which more awareness might be required.

Keywords: COVID-19; public health; review; treatment; vaccines.

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Conflict of interest statement

Competing interests: All authors are affiliated to a regulatory authority and therefore had access to the confidential marketing authorisation application dossiers. In addition, several of the authors (IMMS, LW, MC and HE) are directly involved in the regulatory assessment of COVID-19 treatments and vaccines.

Figures

Figure 1
Figure 1
Participation to prevalence ratios (PPR) of the data sets used for treatments remdesivir and dexamethasone, and vaccines BNT162b2 mRNA (BioNTech/Pfizer), mRNA-1273 (Moderna), ChAdOx1-S (AstraZeneca) and Ad26.COV2-S (Janssen).
Figure 2
Figure 2
Sex-specific efficacy results of (A) treatment remdesivir, (B) treatment dexamethasone, and (C) vaccines BNT162b2 mRNA (BioNTech/Pfizer), mRNA-1273 (Moderna) and Ad26.COV2-S (Janssen). CI, confidence interval; RR, rate ratio; RRR, recovery rate ratio; VE, Vaccine effectiveness.
See this image and copyright information in PMC

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