{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T15:50:00Z","timestamp":1767109800026,"version":"3.48.0"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia Open"],"published-print":{"date-parts":[[2025,8]]},"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n \n Clinical trials on drug safety and efficacy are understood to be valid for all humans, but are not equally distributed worldwide. We aimed to analyze the global distribution of clinical drug trials (phase I\u2013\n IV<\/jats:styled-content>\n ) in epilepsy and its correlation with key demographical and epidemiological factors.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We combined data on industry\u2010funded interventional drug trials in epilepsy from\n clinicaltrials.gov<\/jats:ext-link>\n with epidemiological, geographical, socioeconomic, and human development data. This allowed us to analyze the distribution of trials and trial sites in relation to population, epilepsy incidence, and prevalence.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 459 trials conducted in 69 countries, a vast majority of sites were situated in high\u2010income regions and countries with very high Human Development Index (\n HDI<\/jats:styled-content>\n ). There was a striking underrepresentation of low\u2010income countries and those with low\n HDI<\/jats:styled-content>\n . Specifically, we found a 40\u2010 to 145\u2010fold underrepresentation of trial sites in the\n WHO<\/jats:styled-content>\n regions of Africa and the Eastern Mediterranean when comparing the actual number of sites to the expected number, assuming an even distribution by population, incidence, or prevalence.\n <\/jats:p>\n <\/jats:sec>\n \n Significance<\/jats:title>\n Our findings highlight inequalities in the distribution of epilepsy trial sites based on population size and disease burden. They underscore the need for more equitable trial placement strategies that consider both disease epidemiology and demographic diversity to ensure adequate representation of all affected populations.<\/jats:p>\n <\/jats:sec>\n \n Plain Language Summary<\/jats:title>\n This study looked at where clinical trials for epilepsy medications are being done around the world. We found that most trials take place in high\u2010income countries, while many areas with a high number of people living with epilepsy\u2014especially in Africa and the Eastern Mediterranean\u2014are left out. This shows a big gap between where the disease is most common and where research happens. Highlighting this mismatch can help guide future efforts to make clinical research more inclusive and globally relevant.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/epi4.70076","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T02:54:47Z","timestamp":1750388087000},"page":"1161-1166","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inequalities in access to industry\u2010funded interventional phase I\u2013\n IV<\/scp>\n drug trials in epilepsy"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0115-7021","authenticated-orcid":false,"given":"Robert","family":"Hoepner","sequence":"first","affiliation":[{"name":"Department of Neurology, Inselspital Bern University Hospital Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8375-9810","authenticated-orcid":false,"given":"Alejandro Xavier Le\u00f3n","family":"Betancourt","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital Bern University Hospital Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8237-6965","authenticated-orcid":false,"given":"Stefanie","family":"Marti","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital Bern University Hospital Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6702-5622","authenticated-orcid":false,"given":"Andrea","family":"Seiler","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital Bern University Hospital Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2023.120645"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.45619"},{"key":"e_1_2_12_4_1","unstructured":"United Nations Development Programme (UNDP).United Nations Development Programme. 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