Clinical Trials Commons^™

Multiple Imputation Methods For Treatment Noncompliance And Nonresponse In Randomized Clinical Trials, Leslie Taylor, Xiao-Hua (Andrew) Zhou

UW Biostatistics Working Paper Series

Summary: Randomized clinical trials are a powerful tool for investigating causal treatment effects, but in human trials there are oftentimes problems of noncompliance which standard analyses, such as the intention-to-treat or as-treated analysis, either ignore or incorporate in such a way that the resulting estimand is no longer a causal effect. One alternative to these analyses is the complier average causal effect (CACE) which estimates the average causal treatment effect among a subpopulation that would comply under any treatment assigned. We focus on the setting of a randomized clinical trial with crossover treatment noncompliance (e.g., control subjects could receive the …

Selecting Optimal Treatments Based On Predictive Factors, Eric C. Polley, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

No abstract provided.

The Calculation Of The 97.5% Upper Confidence Bound: Application To Clustered Binary Data In A Binomial Non-Inferiority Two-Sample Trial., William F. Mccarthy

COBRA Preprint Series

This paper will discuss the analysis of a cluster randomized binomial non-inferiority two-sample trial. The determination of the intra-cluster correlation coefficient (ICC) and its use in the calculation of the 97.5% upper confidence bound for delta, the true difference in binomial proportions between the active control and the experimental treatment groups, will be outlined.

The Design And Sample Size Requirement For A Cluster Randomized Non-Inferiority Trial With Two Binary Co-Primary Outcomes., William F. Mccarthy

COBRA Preprint Series

This paper will discuss the design and sample size requirement for a cluster randomized non-inferiority trial with two binary co-primary outcomes. A hypothetical study (the EXAMPLE Trial) will be considered.

Lets assume the EXAMPLE Trial will consist of two separate binomial non-inferiority two-sample trials. Trial 1: the Coronary Artery Disease known population (co-primary 1) and Trial 2: the Coronary Artery Disease unknown population (co-primary 2). A physician-month cluster randomization scheme will be used. That is, for each trial (trial 1 and trial 2) every month for a 12-month period, each physician participating in the EXAMPLE Trial will be allocated a …

A Comparison Of Methods For Estimating The Causal Effect Of A Treatment In Randomized Clinical Trials Subject To Noncompliance, Rod Little, Qi Long, Xihong Lin

Harvard University Biostatistics Working Paper Series

No abstract provided.

Analysis Of Subgroup Effects In Randomized Trials When Subgroup Membership Is Informatively Missing: Application To The Madit Ii Study, Daniel O. Scharfstein, Georgiana Onicescu, Steven Goodman

Johns Hopkins University, Dept. of Biostatistics Working Papers

In this paper, we develop and implement a general sensitivity analysis methodology for drawing inference about subgroup effects in a two-arm randomized trial when subgroup status is only known for a non-random sample in one of the trial arms. The methodology is developed in the context of the MADIT II study, a randomized trial designed to evaluate the effectiveness of implantable defibrillators on survival.

Causal Inference In Observational Studies With Outcome-Dependent Sampling, Weiwei Wang, Daniel Scharfstein, Zhiqiang Tan, Ellen J. Mackenzie

Johns Hopkins University, Dept. of Biostatistics Working Papers

In this paper, we consider estimation of the causal effect of a treatment on an outcome from observational data collected in two phases. In the first phase, a simple random sample of individuals are drawn from a population. On these individuals, information is obtained on treatment, outcome, and a few low-dimensional confounders. These individuals are then stratified according to these factors. In the second phase, a random sub-sample of individuals are drawn from each stratum, with known, stratum-specific selection probabilities. On these individuals, a rich set of confounding factors are collected. In this setting, we introduce four estimators: (1) simple …

Nonparametric Inference Procedure For Percentiles Of The Random Effect Distribution In Meta Analysis, Rui Wang, Lu Tian, Tianxi Cai, L. J. Wei

Harvard University Biostatistics Working Paper Series

No abstract provided.

Parametric Non-Mixture Cure Models For Schedule-Finding Of Therapeutic Agents, Thomas M. Braun, Changying A. Liu

The University of Michigan Department of Biostatistics Working Paper Series

We propose a Phase I clinical trial design that seeks to determine the cumulative safety of a series of administrations of a fixed dose of an investigational agent. In contrast to traditional Phase I trials that are designed to solely find the maximum tolerated dose (MTD) of the agent, our design instead identifies a maximum tolerated schedule (MTS) that includes an MTD as well as a vector of recommended administration times. Our model is based upon a non-mixture cure model that constrains the probability of toxicity for all subjects to monotonically increase with both dose and the number of administrations …

Targeted Methods For Biomarker Discovery, The Search For A Standard, Catherine Tuglus, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

More often than not biomarker studies analyze large quantities of variables with complicated and generally unknown correlation structure. There are numerous statistical methods which attempt to unravel these variables and determine the underlying mechanism through identification of causally related biomarkers. Results from these methods are generally difficult to interpret and nearly impossible to compare across studies. The FDA has currently called for a standardization of methods and protocol for biomarker detection. In response, we propose targeted variable importance (tVIM) as a standardized method for biomarker discovery. Through the use of targeted Maximum Likelihood, tVIM provides double robust estimates of variable …

Covariate Adjustment For The Intention-To-Treat Parameter With Empirical Efficiency Maximization, Daniel B. Rubin, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

In randomized experiments, the intention-to-treat parameter is defined as the difference in expected outcomes between groups assigned to treatment and control arms. There is a large literature focusing on how (possibly misspecified) working models can sometimes exploit baseline covariate measurements to gain precision, although covariate adjustment is not strictly necessary. In Rubin and van der Laan (2008), we proposed the technique of empirical efficiency maximization for improving estimation by forming nonstandard fits of such working models. Considering a more realistic randomization scheme than in our original article, we suggest a new class of working models for utilizing covariate information, show …

Estimation Of Controlled Direct Effects, Sylvie Goetgeluk, Stijn Vansteelandt, Els Goetghebeur

Harvard University Biostatistics Working Paper Series

No abstract provided.

Correcting Instrumental Variables Estimators For Systematic Measurement Error, Stijn Vansteelandt, Manoochehr Babanezhad, Els Goetghebeur

Harvard University Biostatistics Working Paper Series

No abstract provided.

Effectively Combining Independent 2 X 2 Tables For Valid Inferences In Meta Analysis With All Available Data But No Artificial Continuity Corrections For Studies With Zero Events And Its Application To The Analysis Of Rosiglitazone's Cardiovascular Disease Related Event Data, Lu Tian, Tianxi Cai, Nikita Piankov, Pierre-Yves Cremieux, L. J. Wei

Harvard University Biostatistics Working Paper Series

No abstract provided.

A Censored Multinomial Regression Model For Perinatal Mother To Child Transmission Of Hiv, Charlotte C. Gard, Elizabeth R. Brown

UW Biostatistics Working Paper Series

In studies designed to estimate rates of perinatal mother to child transmission of HIV, HIV assays are scheduled at multiple points in time. Still infection status for some infants at some time points is often unknown, particularly when interim analyses are conducted. Logistic regression and Cox proportional hazards regression are commonly used to estimate covariate-adjusted transmission rates, but their methods for handling missing data may be inadequate. Here, we propose using censored multinomial regression models to estimate cumulative and conditional rates of HIV transmission. Through simulation, we show that the proposed methods perform better than standard logistic models in terms …

Empirical Efficiency Maximization, Daniel B. Rubin, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

It has long been recognized that covariate adjustment can increase precision, even when it is not strictly necessary. The phenomenon is particularly emphasized in clinical trials, whether using continuous, categorical, or censored time-to-event outcomes. Adjustment is often straightforward when a discrete covariate partitions the sample into a handful of strata, but becomes more involved when modern studies collect copious amounts of baseline information on each subject.

The dilemma helped motivate locally efficient estimation for coarsened data structures, as surveyed in the books of van der Laan and Robins (2003) and Tsiatis (2006). Here one fits a relatively small working model …

Identifying Patients Who Need Additional Biomarkers For Better Prediction Of Health Outcome Or Diagnosis Of Clinical Phenotype, Lu Tian, Tianxi Cai, L. J. Wei

Harvard University Biostatistics Working Paper Series

No abstract provided.

Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography: Statistical Design And Analysis, William F. Mccarthy, Douglas R. Thompson, Bruce A. Barton

COBRA Preprint Series

Contrast-enhanced multi-detector row spiral computed tomography (MDCT) has been introduced as a method for non-invasive visualization of coronary artery stenosis. To determine the diagnostic accuracy of MDCT coronary angiography, as compared to the “gold standard” invasive coronary angiography, sensitivity and specificity are estimated (95% Confidence Intervals). Three separate levels of estimation are computed: at the patient level, at the coronary artery level, and at the coronary artery segment level. We review the methodology for the estimation of sensitivity and specificity of non-clustered binary data (patient level analysis) and present a methodology for the estimation of sensitivity and specificity that considers …

Evaluating A Group Sequential Design In The Setting Of Nonproportional Hazards, Daniel L. Gillen, Scott S. Emerson

UW Biostatistics Working Paper Series

Group sequential methods have been widely described and implemented in a clinical trial setting where parametric and semiparametric models are deemed suitable. In these situations, the evaluation of the operating characteristics of a group sequential stopping rule remains relatively straightforward. However, in the presence of nonproportional hazards survival data nonparametric methods are often used, and the evaluation of stopping rules is no longer a trivial task. Specifically, nonparametric test statistics do not necessarily correspond to a parameter of clinical interest, thus making it difficult to characterize alternatives at which operating characteristics are to be computed. We describe an approach for …

Simultaneously Optimizing Dose And Schedule Of A New Cytotoxic Agent, Thomas M. Braun, Peter F. Thall, Hoang Nguyen, Marcos De Lima

The University of Michigan Department of Biostatistics Working Paper Series

Traditionally, phase I clinical trial designs determine a maximum tolerated dose of an experimental cytotoxic agent based on a fixed schedule, usually one course consisting of multiple administrations, while varying the dose per administration between patients. However, in actual medical practice patients often receive several courses of treatment, and some patients may receive one or more dose reductions due to low-grade (non-dose limiting) toxicity in previous courses. As a result, the overall risk of toxicity for each patient is a function of both the schedule and the dose used at each adminstration. We propose a new paradigm for Phase I …

Nested Markov Compliance Class Model In The Presence Of Time-Varying Noncompliance, Julia Y. Lin, Thomas R. Tenhave, Michael R. Elliott

UPenn Biostatistics Working Papers

We consider a Markov structure for partially unobserved time-varying compliance classes in the Imbens-Rubin (1997) compliance model framework. The context is a longitudinal randomized intervention study where subjects are randomized once at baseline, outcomes and patient adherence are measured at multiple follow-ups, and patient adherence to their randomized treatment could vary over time. We propose a nested latent compliance class model where we use time-invariant subject-specific compliance principal strata to summarize longtudinal trends of subject-specific time-varying compliance patterns. The principal strata are formed using Markov models that related current compliance behavior to compliance history. Treatment effects are estimated as intent-to …

Causal Comparisons In Randomized Trials Of Two Active Treatments: The Effect Of Supervised Exercise To Promote Smoking Cessation, Jason Roy, Joseph W. Hogan

COBRA Preprint Series

In behavioral medicine trials, such as smoking cessation trials, two or more active treatments are often compared. Noncompliance by some subjects with their assigned treatment poses a challenge to the data analyst. Causal parameters of interest might include those defined by subpopulations based on their potential compliance status under each assignment, using the principal stratification framework (e.g., causal effect of new therapy compared to standard therapy among subjects that would comply with either intervention). Even if subjects in one arm do not have access to the other treatment(s), the causal effect of each treatment typically can only be identified from …

Longitudinal Nested Compliance Class Model In The Presence Of Time-Varying Noncompliance, Julia Y. Lin, Thomas R. Tenhave, Michael R. Elliott

UPenn Biostatistics Working Papers

This article discusses a nested latent class model for analyzing longitudinal randomized trials when subjects do not always adhere to the treatment to which they are randomized. In the "Prevention of Suicide in Primary Care Elderly: Collaborative Trial" (PROSPECT) study, subjects were randomized to either the control treatment, where they received standard care, or to the intervention, where they received standard care in addition to meeting with depression health specialists. The health specialists educate patients, their families, and physicians about depression and monitor their treatment. Those randomized to the control treatment have no access to the health specialists; however, those …

Semiparametric Bayesian Modeling Of Multivariate Average Bioequivalence, Pulak Ghosh Dr., Mithat Gonen

Memorial Sloan-Kettering Cancer Center, Dept. of Epidemiology & Biostatistics Working Paper Series

Bioequivalence trials are usually conducted to compare two or more formulations of a drug. Simultaneous assessment of bioequivalence on multiple endpoints is called multivariate bioequivalence. Despite the fact that some tests for multivariate bioequivalence are suggested, current practice usually involves univariate bioequivalence assessments ignoring the correlations between the endpoints such as AUC and Cmax. In this paper we develop a semiparametric Bayesian test for bioequivalence under multiple endpoints. Specifically, we show how the correlation between the endpoints can be incorporated in the analysis and how this correlation affects the inference. Resulting estimates and posterior probabilities ``borrow strength'' from one another …

Estimating A Treatment Effect With Repeated Measurements Accounting For Varying Effectiveness Duration, Ying Qing Chen, Jingrong Yang, Su-Chun Cheng

UW Biostatistics Working Paper Series

To assess treatment efficacy in clinical trials, certain clinical outcomes are repeatedly measured for same subject over time. They can be regarded as function of time. The difference in their mean functions between the treatment arms usually characterises a treatment effect. Due to the potential existence of subject-specific treatment effectiveness lag and saturation times, erosion of treatment effect in the difference may occur during the observation period of time. Instead of using ad hoc parametric or purely nonparametric time-varying coefficients in statistical modeling, we first propose to model the treatment effectiveness durations, which are the varying time intervals between the …

Designed Extension Of Survival Studies: Application To Clinical Trials With Unrecognized Heterogeneity, Yi Li, Mei-Chiung Shih, Rebecca A. Betensky

Harvard University Biostatistics Working Paper Series

It is well known that unrecognized heterogeneity among patients, such as is conferred by genetic subtype, can undermine the power of randomized trial, designed under the assumption of homogeneity, to detect a truly beneficial treatment. We consider the conditional power approach to allow for recovery of power under unexplained heterogeneity. While Proschan and Hunsberger (1995) confined the application of conditional power design to normally distributed observations, we consider more general and difficult settings in which the data are in the framework of continuous time and are subject to censoring. In particular, we derive a procedure appropriate for the analysis of …

Computing The Total Sample Size When Group Sizes Are Not Fixed, Mithat Gonen

Memorial Sloan-Kettering Cancer Center, Dept. of Epidemiology & Biostatistics Working Paper Series

This article is concerned with computing the total sample size required for a two-sample comparison when the sizes of the two groups to be compared cannot be fixed in advance. This is frequently encountered when group membership depends on a variable which is observable only after the subject is enrolled to the study, such as a genetic or a biological marker. The most common way of circumventing this problem is assuming a fixed number for the prevalence of the condition that will determine the group membership and compute the required sample size conditionally. In this article this practice is formalized …

New Statistical Paradigms Leading To Web-Based Tools For Clinical/Translational Science, Knut M. Wittkowski

COBRA Preprint Series

As the field of functional genetics and genomics is beginning to mature, we become confronted with new challenges. The constant drop in price for sequencing and gene expression profiling as well as the increasing number of genetic and genomic variables that can be measured makes it feasible to address more complex questions. The success with rare diseases caused by single loci or genes has provided us with a proof-of-concept that new therapies can be developed based on functional genomics and genetics.

Common diseases, however, typically involve genetic epistasis, genomic pathways, and proteomic pattern. Moreover, to better understand the underlying biologi-cal …

Frequentist Evaluation Of Group Sequential Clinical Trial Designs, Scott S. Emerson, John M. Kittelson, Daniel L. Gillen

UW Biostatistics Working Paper Series

Group sequential stopping rules are often used as guidelines in the monitoring of clinical trials in order to address the ethical and efficiency issues inherent in human testing of a new treatment or preventive agent for disease. Such stopping rules have been proposed based on a variety of different criteria, both scientific (e.g., estimates of treatment effect) and statistical (e.g., frequentist type I error, Bayesian posterior probabilities, stochastic curtailment). It is easily shown, however, that a stopping rule based on one of those criteria induces a stopping rule on all other criteria. Thus the basis used to initially define a …

On The Use Of Stochastic Curtailment In Group Sequential Clinical Trials, Scott S. Emerson, John M. Kittelson, Daniel L. Gillen

UW Biostatistics Working Paper Series

Many different criteria have been proposed for the selection of a stopping rule for group sequen- tial trials. These include both scientific (e.g., estimates of treatment effect) and statistical (e.g., frequentist type I error, Bayesian posterior probabilities, stochastic curtailment) measures of the evidence for or against beneficial treatment effects. Because a stopping rule based on one of those criteria induces a stopping rule on all other criteria, the utility of any particular scale relates to the ease with which it allows a clinical trialist to search for sequential sampling plans having de- sirable operating characteristics. In this paper we examine …