Covariate-adjusted Response-adaptive Randomization Research Articles

Covariate-adjusted response-adaptive designs based on semiparametric approaches.

We consider theoretical and practical issues for innovatively using a large number of covariates in clinical trials to achieve various design objectives without model misspecification. Specifically, we propose a new family of semiparametric covariate-adjusted response-adaptive randomization (CARA) designs and we use the target maximum likelihood estimation (TMLE) to analyze the correlated data from CARA designs. Our approach can flexibly achieve multiple objectives and correctly incorporate the effect of a large number of covariates on the responses without model misspecification. We also obtain the consistency and asymptotic normality of the target parameters, allocation probabilities, and allocation proportions. Numerical studies demonstrate that our approach has advantages over existing approaches, even when the data-generating distribution iscomplicated.

Personalized Risk-Based Screening Design for Comparative Two-Arm Group Sequential Clinical Trials.

Personalized medicine has been emerging to take into account individual variability in genes and environment. In the era of personalized medicine, it is critical to incorporate the patients’ characteristics and improve the clinical benefit for patients. The patients’ characteristics are incorporated in adaptive randomization to identify patients who are expected to get more benefit from the treatment and optimize the treatment allocation. However, it is challenging to control potential selection bias from using observed efficacy data and the effect of prognostic covariates in adaptive randomization. This paper proposes a personalized risk-based screening design using Bayesian covariate-adjusted response-adaptive randomization that compares the experimental screening method to a standard screening method based on indicators of having a disease. Personalized risk-based allocation probability is built for adaptive randomization, and Bayesian adaptive decision rules are calibrated to preserve error rates. A simulation study shows that the proposed design controls error rates and yields a much smaller number of failures and a larger number of patients allocated to a better intervention compared to existing randomized controlled trial designs. Therefore, the proposed design performs well for randomized controlled clinical trials under personalized medicine.

A novel statistical test for treatment differences in clinical trials using a response-adaptive forward-looking Gittins Index Rule.

The most common objective for response-adaptive clinical trials is to seek to ensure that patients within a trial have a high chance of receiving the best treatment available by altering the chance of allocation on the basis of accumulating data. Approaches that yield good patient benefit properties suffer from low power from a frequentist perspective when testing for a treatment difference at the end of the study due to the high imbalance in treatment allocations. In this work we develop an alternative pairwise test for treatment difference on the basis of allocation probabilities of the covariate-adjusted response-adaptive randomization with forward-looking Gittins Index (CARA-FLGI) Rule for binary responses. The performance of the novel test is evaluated in simulations for two-armed studies and then its applications to multiarmed studies are illustrated. The proposed test has markedly improved power over the traditional Fisher exact test when this class of nonmyopic response adaptation is used. We also find that the test's power is close to the power of a Fisher exact test under equalrandomization.

A Clinical Trial Design With Covariate-Adjusted Response-Adaptive Randomization Using Superiority Confidence of Treatments

Adaptive randomization using response outcome or covariate is commonly used in the literature. However, the performance of these designs has not been thoroughly studied, especially when there are various interactions between the covariate and treatment. We have conducted simulations to evaluate the performance of commonly used designs under two-arm and multiple-arm situations. When a predictive factor exists, in the phase II trial conduction using adaptive designs, such as the BATTLE-1, BATTLE-2 trial, and ISPY-2 trials, researchers evaluate the operating characteristics using the traditional power assessment. In this article, new criteria are used in a general modeling frame work to incorporate the complicated interaction. Based on our evaluation, the covariate-adjusted and response-adaptive randomization (Sc-ca) results in a greater total number of responders. Additionally, the design can detect the treatment effect difference in subgroups, and consistently assign patients to the most beneficial treatment according to their covariate profiles. This translates into a higher proportion of individuals receiving optimized treatments compared with other commonly used designs. This adaptive design is a step toward personalized therapy to benefit each patient enrolled in a prospective clinical trial, when there is the strong evidence that predictive factors exist.

A class of Covariate-Adjusted Response-Adaptive Allocation Designs for Multitreatment Binary Response Trials

ABSTRACTA class of covariate-adjusted response-adaptive randomization procedures is developed for binary treatment outcomes in a phase III clinical trial set up involving multiple treatments. The target allocation is developed by combining the ethical aspects with statistical precision under the existence of treatment covariate interaction. Relevant measures of the performance for the proposed allocation designs are studied and compared.

Multi-treatment covariate-adjusted adaptive design under informative censoring

In the present work, we find a set of reliability functionals to fix up an allocation strategy among K(≥2) treatments when the response distributions, conditionally dependent on some continuous prognostic variable, are exponential with unknown linear regression functions as the means of the respective conditional distributions. Targeting such reliability functionals, we propose a covariate-adjusted response-adaptive randomization procedure for the multi-treatment single-period clinical trial under the Koziol–Green model for informative censoring. We compare the proposed procedure with its competitive covariate-eliminated procedure.

Longitudinal covariate-adjusted response-adaptive randomized designs

Clinical trials often involve longitudinal data set which has two important characteristics: repeated and correlated measurements and time-varying covariates. In this paper, we propose a general framework of longitudinal covariate-adjusted response-adaptive (LCARA) randomization procedures. We study their properties under widely satisfied conditions. This design skews the allocation probabilities which depend on both patients' first observed covariates and sequentially estimated parameters based on the accrued longitudinal responses and covariates. The asymptotic properties of estimators for the unknown parameters and allocation proportions are established. The special case of binary treatment and continuous responses is studied in detail. Simulation studies and an analysis of the National Cooperative Gallstone Study (NCGS) data are carried out to illustrate the advantages of the proposed LCARA randomization procedure.

Utility of Covariate-Adjusted Response-Adaptive Randomization in Survival Trials

Covariate-adjusted response-adaptive (CARA) randomization is used in clinical trials to balance the competing goals of assigning a greater number of study subjects to the better treatment and achieving high statistical efficiency in estimating treatment effects in the presence of covariates, while maintaining randomness in treatment assignments. In this article, we propose CARA randomization procedures for survival intervention trials with two treatment arms when the primary outcomes follow an exponential regression model. We demonstrate, through extensive simulation, that our CARA procedures can achieve some reduction in the number of events in the study without compromising power and Type I error, compared with balanced randomization designs, including in situations when the exponential model is misspecified. We conclude that the proposed CARA procedures can be suitable alternatives to the traditional balanced randomization designs in survival trials, provided response data are available during the recruitment phase to enable adaptations in the design. We illustrate the proposed methodology by redesigning two survival trials from the literature.

A Bayesian adaptive design with biomarkers for targeted therapies.

Targeted therapies are becoming increasingly important for the treatment of various diseases. Biomarkers are a critical component of a targeted therapy as they can be used to identify patients who are more likely to benefit from a treatment. Targeted therapies, however, have created major challenges in the design, conduct, and analysis of clinical trials. In traditional clinical trials, treatment effects for various biomarkers are typically evaluated in an exploratory fashion and only limited information about the predictive values of biomarkers obtained. New study designs are required, which effectively evaluate both the diagnostic and the therapeutic implication of biomarkers. The Bayesian approach provides a useful framework for optimizing the clinical trial design by directly integrating information about biomarkers and clinical outcomes as they become available. We propose a Bayesian covariate-adjusted response-adaptive randomization design, which utilizes individual biomarker profiles and patient's clinical outcomes as they become available during the course of the trial, to assign the most efficacious treatment to individual patients. Predictive biomarker subgroups are determined adaptively using a partial least squares regression approach. A series of simulation studies were conducted to examine the operating characteristics of the proposed study design. The simulation studies show that the proposed design efficiently identifies patients who benefit most from a targeted therapy and that there are substantial savings in the sample size requirements when compared to alternative designs. The design does not control for the type I error in the traditional sense and a positive result should be confirmed by conducting an independent phase III study focusing on the selected biomarker profile groups. We conclude that the proposed design may serve a useful role in the early efficacy phase of targeted therapy development.