Clinical Trials Commons^™

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 …

Estimating Percentile-Specific Causal Effects: A Case Study Of Micronutrient Supplementation, Birth Weight, And Infant Mortality, Francesca Dominici, Scott L. Zeger, Giovanni Parmigiani, Joanne Katz, Parul Christian

Johns Hopkins University, Dept. of Biostatistics Working Papers

In developing countries, higher infant mortality is partially caused by poor maternal and fetal nutrition. Clinical trials of micronutrient supplementation are aimed at reducing the risk of infant mortality by increasing birth weight. Because infant mortality is greatest among the low birth weight infants (LBW) (• 2500 grams), an effective intervention may need to increase the birth weight among the smallest babies. Although it has been demonstrated that supplementation increases the birth weight in a trial conducted in Nepal, there is inconclusive evidence that the supplementation improves their survival. It has been hypothesized that a potential benefit of the treatment …

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 …

The Optimal Confidence Region For A Random Parameter, Hajime Uno, Lu Tian, L.J. Wei

Harvard University Biostatistics Working Paper Series

Under a two-level hierarchical model, suppose that the distribution of the random parameter is known or can be estimated well. Data are generated via a fixed, but unobservable realization of this parameter. In this paper, we derive the smallest confidence region of the random parameter under a joint Bayesian/frequentist paradigm. On average this optimal region can be much smaller than the corresponding Bayesian highest posterior density region. The new estimation procedure is appealing when one deals with data generated under a highly parallel structure, for example, data from a trial with a large number of clinical centers involved or genome-wide …

New Estimating Methods For Surrogate Outcome Data, Bin Nan

The University of Michigan Department of Biostatistics Working Paper Series

Surrogate outcome data arise frequently in medical research. The true outcomes of interest are expensive or hard to ascertain, but measurements of surrogate outcomes (or more generally speaking, the correlates of the true outcomes) are usually available. In this paper we assume that the conditional expectation of the true outcome given covariates is known up to a finite dimensional parameter. When the true outcome is missing at random, the e±cient score function for the parameter in the conditional mean model has a simple form, which is similar to the generalized estimating functions. There is no integral equation involved as in …

Asymptotic Results For Simultaneous Group Sequential Analysis Of Rank-Based And Weighted Kaplan-Meier Tests With Paired Survival Data In The Presence Of Censoring. Technical Report, Adin-Cristian Andrei, Susan Murray

The University of Michigan Department of Biostatistics Working Paper Series

This research sequentially monitors paired survival differences using a new class of non-parametric tests based on functionals of standardized paired weighted log-rank (PWLR) and standardized paired weighted Kaplan-Meier (PWKM) tests. During a trial these tests may alternately assume the role of the more extreme statistic. By monitoring PEMAX, the maximum between the absolute values of the standardized PWLR and PWKM, one combines advantages of rank-based and non rank-based paired testing paradigms. Simulations show that monitoring treatment differences using PEMAX maintains type I error and is nearly as powerful as using the more advantageous of the two tests, in proportional hazards …

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 …

Causal Inference In Hybrid Intervention Trials Involving Treatment Choice, Qi Long, Rod Little, Xihong Lin

The University of Michigan Department of Biostatistics Working Paper Series

Randomized allocation of treatments is a cornerstone of experimental design, but has drawbacks when a limited set of individuals are willing to be randomized, or the act of randomization undermines the success of the treatment. Choice-based experimental designs allow a subset of the participants to choose their treatments. We discuss here causal inferences for experimental designs where some participants are randomly allocated to treatments and others receive their treatment preference. This paper was motivated by the “Women Take Pride” (WTP) study (Janevic et al., 2001), a doubly randomized preference trail (DRPT) to assess behavioral interventions for women with heart disease. …

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 …

A Nonparametric Comparison Of Conditional Distributions With Nonnegligible Cure Fractions, Yi Li, Jin Feng

Harvard University Biostatistics Working Paper Series

No abstract provided.

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 …