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Pharmaceutical Statistics

Claire L Smith, Yan Jin, Eyas Raddad, Terry A McNearney, Xiao Ni, David Monteith, Roger Brown, Mark A Deeg, Thomas Schnitzer
Development of new pharmacological treatments for osteoarthritis that address unmet medical needs in a competitive market place is challenging. Bayesian approaches to trial design offer advantages in defining treatment benefits by addressing clinically relevant magnitude of effects relative to comparators and in optimizing efficiency in analysis. Such advantages are illustrated by a motivating case study, a proof of concept, and dose finding study in patients with osteoarthritis. Patients with osteoarthritis were randomized to receive placebo, celecoxib, or 1 of 4 doses of galcanezumab...
October 15, 2018: Pharmaceutical Statistics
Richard C Zink, Laura Castro-Schilo, Jianfeng Ding
Mahalanobis distance is often recommended to identify patients or clinical sites that are considered unusual in clinical trials. Patients extreme in one or more covariates may be considered outliers in that they reside some distance from the multivariate mean, which can be thought of as the center of the data cloud. Less often discussed, patients whose data are believed to be "too good to be true" are located near the centroid as inliers. In order to efficiently investigate these anomalies for potential lapses in data quality, it is important to understand how the individual variables contribute to each multivariate outlier...
September 26, 2018: Pharmaceutical Statistics
Helmut Petto, Ulrich Mrowietz, Stefan Wilhelm, Alexander Schacht
Assessment of severity is essential for the management of chronic diseases. Continuous variables like scores obtained from the Hamilton Rating Scale for Depression or the Psoriasis Area and Severity Index (PASI) are standard measures used in clinical trials of depression and psoriasis. In clinical trials of psoriasis, for example, the reduction of PASI from baseline in response to therapy, in particular the proportion of patients achieving at least 75%, 90%, or 100% improvement of disease (PASI 75, PASI 90, or PASI 100), is typically used to evaluate treatment efficacy...
September 26, 2018: Pharmaceutical Statistics
Ibrahim Turkoz, Marc Sobel, Larry Alphs
Disease modification is a primary therapeutic aim when developing treatments for most chronic progressive diseases. The best treatments do not simply affect disease symptoms but fundamentally improve disease course by slowing, halting, or reversing disease progression. One of many challenges for establishing disease modification relates to the identification of adequate analytic tools to show differences in a disease course following intervention. Traditional approaches rely on the comparisons of slopes or noninferiority margins...
September 16, 2018: Pharmaceutical Statistics
Hui Quan, Yi Xu, Yixin Chen, Lei Gao, Xun Chen
Patient recruitment is challenging in rare disease clinical trials. To save time and resources, an inferential seamless phase II/III clinical trial design is considered for a clinical trial in a rare disease area. In particular, 2 doses compared to a placebo control are evaluated at phase II (ie, stage I). Based on the results of a phase II intermediate endpoint, additional patients may be enrolled into the 2 doses and control, 1 selected dose and control, or none of the 3 treatment arms at stage II. All patients including those of unselected dose (s) will be followed for the measurements of the phase III (ie, stage II) primary and secondary endpoints and incorporated in the final analysis...
September 16, 2018: Pharmaceutical Statistics
Christian Holm Hansen, Pamela Warner, Allan Walker, Richard A Parker, Lucy Whitaker, Hilary O D Critchley, Christopher J Weir
It is often unclear what specific adaptive trial design features lead to an efficient design which is also feasible to implement. Before deciding on a particular design, it is generally advisable to carry out a simulation study to characterise the properties of candidate designs under a range of plausible assumptions. The implementation of such pre-trial simulation studies presents many challenges and requires considerable statistical programming effort and time. Despite the scale and complexity, there is little existing literature to guide the implementation of such projects using commonly available software...
September 14, 2018: Pharmaceutical Statistics
Saurabh Mukhopadhyay, Brian Waterhouse, Alan Hartford
Safety surveillance is a critical issue for ongoing clinical trials to actively identify and evaluate important safety information. With the new regulatory emphasis on aggregate review of safety, sponsors are faced with the challenge to develop systematic and sound quantitative methods to assess risk from blinded safety data during the pre-approval period of a new therapy. To address this challenge, a novel statistical method is proposed to monitor and detect safety signals with data from blinded ongoing clinical trials, specifically for adverse events of special interest (AESI) when historical data are available to provide background rates...
August 30, 2018: Pharmaceutical Statistics
Kosuke Kashiwabara, Yutaka Matsuyama
In cancer phase II trials, determining the sample size of a single-arm two-stage design remains a challenge. To overcome this problem, Simon's two-stage design was extended to an adaptive design: at the interim analysis, the total sample size can be set to either of the two preplanned values. However, without any restriction on design construction, an optimal or suboptimal design derived may have counter-intuitive or unreasonable design features, which make the chosen design less persuasive and inefficient...
August 30, 2018: Pharmaceutical Statistics
Zhongqiang Liu, Feifang Hu, Li-Xin Zhang
Many response-adaptive randomization procedures have been proposed and studied over the past few decades. However, most of these procedures are based on parametric structure and do not directly apply to nonparametric models. In this paper, we propose a response-adaptive randomization procedure based on Mann-Whitney U test statistic. Under widely satisfied conditions, we derive asymptotic properties of the randomization procedure and further obtain power functions in form under Mann-Whitney U test. Simulations show the proposed procedure is more robust and more ethical than classical response-adaptive randomization procedures in some circumstances...
August 27, 2018: Pharmaceutical Statistics
Kert Viele, Linda M Mundy, Robert B Noble, Gang Li, Kristine Broglio, Jeffrey D Wetherington
New antimicrobial drugs for treatment of complicated urinary tract infection (cUTI) are generally assessed in randomized, double-blind, noninferiority clinical trials. Robust historical data for the active comparator inform on treatment effect estimation, yet typically do not substitute for the active comparator data in the proposed trial. We report design options for a phase 3 trial of cUTI using a Bayesian hierarchical model and historical data from 2 well-executed phase 3 registrational trials of doripenem...
August 27, 2018: Pharmaceutical Statistics
Kung-Jong Lui
When one studies treatments for psychological or mental diseases in a double-blind placebo-controlled trial with a high placebo response rate, the sequential parallel comparison design (SPCD) has been proposed elsewhere to improve power. All procedures for testing equality of treatments under the SPCD have been so far derived from large sample theory. If the trial size is small, asymptotic test procedures can be theoretically invalid. Thus, the development of an exact test procedure assuring type I error rate to be less than or equal to the nominal α-level is of use and interest...
August 23, 2018: Pharmaceutical Statistics
Shinjo Yada, Chikuma Hamada
In phase I/II anticancer drug-combination trials, trial design to evaluate toxicity and efficacy has been studied by dividing the trial into 2 stages, followed by seamless execution of the 2 stages. In the first stage, admissible dose combinations in toxicity are identified, followed by patient assignment among the identified admissible dose combinations using adaptive randomization in the second stage. When patients are assigned using adaptive randomization, it is desirable to determine a more appropriate dose combination by taking into consideration both drug efficacy and toxicity; however, during the course of this determination and evaluation of toxicity and efficacy, there remains a concern that the trial duration might be prolonged...
August 15, 2018: Pharmaceutical Statistics
P Dutton, J Holmes
Mechanistic understanding of cancers and their potential interactions with molecularly targeted agents is driving the need for stratified medicine to ensure each participant receives the best possible care. This understanding, backed by scientific research, should be used to guide the design of clinical trials for these agents. The mechanism of action of a molecularly targeted agent often suggests that a biomarker can be used as a predictor of activity of the agent on the targeted disease. A biomarker driven trial is needed to confirm that the molecularly targeted agent stratifies the participant population with disease into high and low responder groups...
August 15, 2018: Pharmaceutical Statistics
Andrew G Chapple, Peter F Thall
A Bayesian design is presented that does precision dose finding based on time to toxicity in a phase I clinical trial with two or more patient subgroups. The design, called Sub-TITE, makes sequentially adaptive subgroup-specific decisions while possibly combining subgroups that have similar estimated dose-toxicity curves. Decisions are based on posterior quantities computed under a logistic regression model for the probability of toxicity within a fixed follow-up period, as a function of dose and subgroup. Similarly to the time-to-event continual reassessment method (TITE-CRM, Cheung and Chappell), the Sub-TITE design downweights each patient's likelihood contribution using a function of follow-up time...
August 15, 2018: Pharmaceutical Statistics
Perceval Sondag, Lingmin Zeng, Binbing Yu, Réjane Rousseau, Bruno Boulanger, Harry Yang, Steven Novick
The USP<1032> guidelines recommend the screening of bioassay data for outliers prior to performing a relative potency (RP) analysis. The guidelines, however, do not offer advice on the size or type of outlier that should be removed prior to model fitting and calculation of RP. Computer simulation was used to investigate the consequences of ignoring the USP<1032> guidance to remove outliers. For biotherapeutics and vaccines, outliers in potency data may result in the false acceptance/rejection of a bad/good lot of drug product...
August 15, 2018: Pharmaceutical Statistics
Ruitao Lin, Guosheng Yin
Interval designs have recently attracted much attention in phase I clinical trials because of their simplicity and desirable finite-sample performance. However, existing interval designs typically cannot converge to the optimal dose level since their intervals do not shrink to the target toxicity probability as the sample size increases. The uniformly most powerful Bayesian test (UMPBT) is an objective Bayesian hypothesis testing procedure, which results in the largest probability that the Bayes factor against null hypothesis exceeds the evidence threshold for all possible values of the data generating parameter...
July 31, 2018: Pharmaceutical Statistics
Kentaro Takeda, Kanji Komatsu, Satoshi Morita
The main purpose of a phase I dose-finding study in the field of oncology is to evaluate toxicity and pharmacokinetic (PK) data and to estimate the optimal dose (OD) for subsequent clinical trials. From a pharmacological perspective, PK information is considered as an appropriate indicator for evaluating the degree of drug intervention in humans. Dose proportionality is typically assessed to investigate the PK properties of a drug. If we rely solely on the dose-exposure relationship, then when this relationship is not proportional, eg, if there is saturation of drug elimination or absorption, the performance of OD selection may be affected...
July 31, 2018: Pharmaceutical Statistics
Bohdana Ratitch, Ilya Lipkovich, Janelle Shannon Erickson, Lu Zhang, Craig H Mallinckrodt
This article focuses on 2 objectives in the analysis of efficacy in long-term extension studies of chronic diseases: (1) defining and discussing estimands of interest in such studies and (2) evaluating the performance of several multiple imputation methods that may be useful in estimating some of these estimands. Specifically, 4 estimands are defined and their clinical utility and inferential ramifications discussed. The performance of several multiple imputation methods and approaches were evaluated using simulated data...
July 26, 2018: Pharmaceutical Statistics
Junjing Lin, Margaret Gamalo-Siebers, Ram Tiwari
Existing statutes in the United States and Europe require manufacturers to demonstrate evidence of effectiveness through the conduct of adequate and well-controlled studies to obtain marketing approval of a therapeutic product. What constitutes adequate and well-controlled studies is usually interpreted as randomized controlled trials (RCTs). However, these trials are sometimes unfeasible because of their size, duration, cost, patient preference, or in some cases, ethical concerns. For example, RCTs may not be fully powered in rare diseases or in infections caused by multidrug resistant pathogens because of the low number of enrollable patients...
September 2018: Pharmaceutical Statistics
Shufang Liu, Chenghao Chu, Alan Rong
A cancer clinical trial with an immunotherapy often has 2 special features, which are patients being potentially cured from the cancer and the immunotherapy starting to take clinical effect after a certain delay time. Existing testing methods may be inadequate for immunotherapy clinical trials, because they do not appropriately take the 2 features into consideration at the same time, hence have low power to detect the true treatment effect. In this paper, we proposed a piece-wise proportional hazards cure rate model with a random delay time to fit data, and a new weighted log-rank test to detect the treatment effect of an immunotherapy over a chemotherapy control...
September 2018: Pharmaceutical Statistics
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