Clinical Trials Commons^™

Application Of Time-To-Event Methods In The Assessment Of Safety In Clinical Trials, Kelly L. Moore, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

Since randomized controlled trials (RCT) are typically designed and powered for efficacy rather than safety, power is an important concern in the analysis of the effect of treatment on the occurrence of adverse events (AE). These outcomes are often time-to-event outcomes which will naturally be subject to right-censoring due to early patient withdrawals. In the analysis of the treatment effect on such an outcome, gains in efficiency, and thus power, can be achieved by exploiting covariate information. We apply the targeted maximum likelihood methodology to the estimation of treatment specific survival at a fixed end point for right-censored survival outcomes. …

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.

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 …

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 …

Estimation Of Treatment Effects In Randomized Trials With Noncompliance And A Dichotomous Outcome , Mark J. Van Der Laan, Alan E. Hubbard, Nicholas P. Jewell

U.C. Berkeley Division of Biostatistics Working Paper Series

We propose a class of estimators of the treatment effect on a dichotomous outcome among the treated subjects within covariate and treatment arm strata in randomized trials with non-compliance. Recent articles by Vansteelandt and Goethebeur (2003) and Robins and Rotnitzky (2004) have presented consistent and asymptotically linear estimators of a causal odds ratio, which rely, beyond correct specification of a model for the causal odds ratio, on a correctly specified model for a potentially high dimensional nuisance parameter. In this article we propose consistent, asymptotically linear and locally efficient estimators of a causal relative risk and a new parameter -- …

Estimation Of Direct And Indirect Causal Effects In Longitudinal Studies, Mark J. Van Der Laan, Maya L. Petersen

U.C. Berkeley Division of Biostatistics Working Paper Series

The causal effect of a treatment on an outcome is generally mediated by several intermediate variables. Estimation of the component of the causal effect of a treatment that is mediated by a given intermediate variable (the indirect effect of the treatment), and the component that is not mediated by that intermediate variable (the direct effect of the treatment) is often relevant to mechanistic understanding and to the design of clinical and public health interventions. Under the assumption of no-unmeasured confounders, Robins & Greenland (1992) and Pearl (2000), develop two identifiability results for direct and indirect causal effects. They define an …

Mean Response Models Of Repeated Measurements In Presence Of Varying Effectiveness Onset, Ying Qing Chen, Su-Chun Cheng

U.C. Berkeley Division of Biostatistics Working Paper Series

Repeated measurements are often collected over time to evaluate treatment efficacy in clinical trials. Most of the statistical models of the repeated measurements have been focusing on their mean response as function of time. These models usually assume that the treatment has persistent effect of constant additivity or multiplicity on the mean response functions throughout the observation period of time. In reality, however, such assumption may be confounded by the potential existence of the so-called effectiveness action onset, although they are often unobserved or difficult to obtain. Instead of including nonparametric time-varying coefficients in the mean response models, we propose …

Comparison Of The Inverse Probability Of Treatment Weighted (Iptw) Estimator With A Naïve Estimator In The Analysis Of Longitudinal Data With Time-Dependent Confounding: A Simulation Study, Thaddeus Haight, Romain Neugebauer, Ira B. Tager, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

A simulation study was conducted to compare estimates from a naïve estimator, using standard conditional regression, and an IPTW (Inverse Probability of Treatment Weighted) estimator, to true causal parameters for a given MSM (Marginal Structural Model). The study was extracted from a larger epidemiological study (Longitudinal Study of Effects of Physical Activity and Body Composition on Functional Limitation in the Elderly, by Tager et. al [accepted, Epidemiology, September 2003]), which examined the causal effects of physical activity and body composition on functional limitation. The simulation emulated the larger study in terms of the exposure and outcome variables of interest-- physical …

Measuring Treatment Effects Using Semiparametric Models, Zhuo Yu, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

In order to estimate the causal effect of treatments on an outcome of interest, one has to account for the effect of confounding factors which covary with the treatments and also contribute to the outcome of interest. In this paper, we use the semiparametric regression model to estimate the causal parameters. We assume the causal effect of the treatments can be described by the parametric component of the semiparametric regression model. Following the general methodology which was developed in van der Laan and Robins (2002) we give the orthogonal complement of the nuisance tangent space which identifies all the estimating …

Estimating Causal Parameters In Marginal Structural Models With Unmeasured Confounders Using Instrumental Variables, Tanya A. Henneman, Mark Johannes Van Der Laan, Alan E. Hubbard

U.C. Berkeley Division of Biostatistics Working Paper Series

For statisticians analyzing medical data, a significant problem in determining the causal effect of a treatment on a particular outcome of interest, is how to control for unmeasured confounders. Techniques using instrumental variables (IV) have been developed to estimate causal parameters in the presence of unmeasured confounders. In this paper we apply IV methods to both linear and non-linear marginal structural models. We study a specific class of generalized estimating equations that is appropriate to these data, and compare the performance of the resulting estimator to the standard IV method, a two-stage least squares procedure. Our results are applied to …

Mixture Hazards Models With Additive Random Effects Accounting For Treatment Effectiveness Lag Time, Ying Qing Chen, C. A. Rohde, M.-C. Wang

U.C. Berkeley Division of Biostatistics Working Paper Series

In many clinical trials to evaluate treatment efficacy, it is believed that there may exist latent treatment effectiveness lag times after which medical treatment procedure or chemical compound would be in full effect. In this article, semiparametric regression models are proposed and studied for estimating the treatment effect accounting for such latent lag times. The new models take advantage of the invariance property of the additive hazards model in marginalising over an additive latent variable; parameters in the models are thus easily estimated and interpreted, while the flexibility of not having to specify the baseline hazard function is preserved. Monte …

A Class Of Semiparametric Scale-Change Hazards Regression Models And Its Adequacy For Censored Survival Data, Ying Qing Chen

U.C. Berkeley Division of Biostatistics Working Paper Series

A class of semiparametric hazards regression models called the accelerated hazards models was introduced to identify the covariate effect characterized by the scale-change between hazard functions. In this article, we compare the accelerated hazards models with several other popular classes of regression models in statistical literature for censored survival data. We also propose and study some test statistics to assess the models' adequacy. Simulation studies are conducted to evaluate the performance of the test statistics. Actual clinical trials data are analyzed to demonstrate the proposed models and test statistics.