基于加权信息测量的连续终点反应自适应多臂设计

Gianmarco Caruso, Pavel Mozgunov
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引用次数: 0

摘要

鉴于多臂试验在统计和后勤方面的优势,多臂试验在实践中越来越受到关注。标准的方法是使用固定的(整个试验期间)分配比例,但也有人呼吁使其具有适应性,并将患者的分配向表现更好的病区倾斜。然而,众所周知,除其他挑战外,这些方法可能会降低统计功率。我们提出了一种针对连续终点的反应适应性设计,它明确允许控制分配到 "最佳 "臂的患者人数与统计功率之间的权衡。这种平衡是通过校准调谐参数来实现的,我们还探讨了有效选择调谐参数的各种策略。我们提出的标准是基于与上下文相关的信息度量,它赋予那些特征接近预先指定的临床目标的治疗臂更大的权重。我们还介绍了一种基于模拟的假设检验程序,该程序侧重于选择目标臂,并讨论了有效控制 I 类错误率的策略。我们通过模拟评估了所提出的标准相对于目前使用的替代标准的潜在优势,并结合早期 IIa 期概念验证肿瘤临床试验说明了该标准的实际应用情况。
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A response-adaptive multi-arm design for continuous endpoints based on a weighted information measure
Multi-arm trials are gaining interest in practice given the statistical and logistical advantages that they can offer. The standard approach is to use a fixed (throughout the trial) allocation ratio, but there is a call for making it adaptive and skewing the allocation of patients towards better performing arms. However, among other challenges, it is well-known that these approaches might suffer from lower statistical power. We present a response-adaptive design for continuous endpoints which explicitly allows to control the trade-off between the number of patients allocated to the 'optimal' arm and the statistical power. Such a balance is achieved through the calibration of a tuning parameter, and we explore various strategies to effectively select it. The proposed criterion is based on a context-dependent information measure which gives a greater weight to those treatment arms which have characteristics close to a pre-specified clinical target. We also introduce a simulation-based hypothesis testing procedure which focuses on selecting the target arm, discussing strategies to effectively control the type-I error rate. The potential advantage of the proposed criterion over currently used alternatives is evaluated in simulations, and its practical implementation is illustrated in the context of early Phase IIa proof-of-concept oncology clinical trials.
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