AbstractBackgroundThe FDA’s statistical review for the recent aducanumab advisory committee included a Bayesian hierarchical analysis (BHA) combining CDR‐SB evidence across the ENGAGE and EMERGE studies resulting in a 62% probability of the treatment being efficacious. BHA can combine evidence across outcomes, trials within a drug development program, and trials for a specific mechanism of action, and provides an elegant solution to interpreting the totality of evidence. BHA is a comparable approach to composite scores and global statistical tests, but key differences exist.MethodUsing summary results from the aducanumab ENGAGE and EMERGE studies, solanezumab Expedition 1, 2, and 3 and the BAN2401 PRIME study, we combined evidence from ADAS‐Cog, ADCS‐ADL, and CDR‐SB using a BHA with hierarchies at the study, program, and three program level to assess the amyloid hypothesis, using the pre‐specified primary analysis populations. We compared these results to GSTs.ResultsThe aducanumab program combined across EMERGE and ENGAGE with all 3 outcomes has a 0.92 probability (>99.9% with GST), the solanezumab program combined across Expedition 1, Expedition 2 and Expedition 3 has a 0.92 probability (>99.9% with GST), and the BAN2401 program has a 0.95 probability (99.2% with GST) of treatment efficacy. We present BHA and GST results for individual studies compared to the original results. We also compare the study‐level BHA results to the global statistical test (GST) approach. We combine evidence across all 3 programs to get an overall probability of efficacy for the amyloid hypothesis with these 3 programs using BHA and GST.ConclusionBHA and GST both assess the totality of evidence within a study or development program, providing a natural correction for multiplicity, but results differ. BHA penalizes for divergence of outcomes or studies, and GST does not. This may be appropriate in some settings, but not in others. It allows an assessment of convergence of evidence, weakening of evidence, or elimination of evidence when a negative study “cancels out” a positive study. On a larger scale, it sheds light on how much evidence might exist for theories like the amyloid hypothesis when combining evidence across programs.
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