Clinical Trials Commons^™

An Improved Bayesian Pick-The-Winner (Ibpw) Design For Randomized Phase Ii Clinical Trials, Wanni Lei, Maosen Peng, Xi K. Zhou

COBRA Preprint Series

Phase II clinical trials play a pivotal role in drug development by screening a large number of drug candidates to identify those with promising preliminary efficacy for phase III testing. Trial designs that enable efficient decision-making with small sample sizes and early futility stopping while controlling for type I and II errors in hypothesis testing, such as Simon’s two-stage design, are preferred. Randomized multi-arm trials are increasingly used in phase II settings to overcome the limitations associated with using historical controls as the reference. However, how to effectively balance efficiency and accurate decision-making continues to be an important research topic. …

Unified Methods For Feature Selection In Large-Scale Genomic Studies With Censored Survival Outcomes, Lauren Spirko-Burns, Karthik Devarajan

COBRA Preprint Series

One of the major goals in large-scale genomic studies is to identify genes with a prognostic impact on time-to-event outcomes which provide insight into the disease's process. With rapid developments in high-throughput genomic technologies in the past two decades, the scientific community is able to monitor the expression levels of tens of thousands of genes and proteins resulting in enormous data sets where the number of genomic features is far greater than the number of subjects. Methods based on univariate Cox regression are often used to select genomic features related to survival outcome; however, the Cox model assumes proportional hazards …

Improving Statistical Analysis Of Prospective Clinical Trials In Stem Cell Transplantation. An Inventory Of New Approaches In Survival Analysis, Aurelien Latouche

COBRA Preprint Series

The CLINT project is an European Union funded project, run as a specific support action, under the sixth framework programme. It is a 2 year project aimed at supporting the European Group for Blood and Marrow Transplantation (EBMT) to develop its infrastructure for the conduct of trans-European clinical trials in accordance with the EU Clinical Trials Directive, and to facilitate International prospective clinical trials in stem cell transplantation. The initial task is to create an inventory of the existing biostatistical literature on new approaches to survival analyses that are not currently widely utilised. The estimation of survival endpoints is introduced, …

Efficient Design And Inference For Multi-Stage Randomized Trials Of Individualized Treatment Policies, Ree Dawson, Philip W. Lavori

COBRA Preprint Series

Increased clinical interest in individualized ‘adaptive’ treatment policies has shifted the methodological focus for their development from the analysis of naturalistically observed strategies to experimental evaluation of a pre-selected set of strategies via multi-stage designs. Because multi-stage studies often avoid the ‘curse of dimensionality’ inherent in uncontrolled studies, and hence the need to parametrically smooth trial data, it is not surprising in this context to find direct connections among different methodological approaches. We show by asymptotic and algebraic proof that the maximum likelihood (ML) and optimal semi-parametric estimators of the mean of a treatment policy and its standard error are …

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 …

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 …

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 …

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 …