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Register a new userTesting for Treatment Effect in Covariate-Adaptive Randomized Clinical Trials with Generalized Linear Models and Omitted Covariates
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Wei Ma
Publication date
2020
fields
Mathematical Statistics
and research's language is
English
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Concerns have been expressed over the validity of statistical inference under covariate-adaptive randomization despite the extensive use in clinical trials. In the literature, the inferential properties under covariate-adaptive randomization have been mainly studied for continuous responses; in particular, it is well known that the usual two sample t-test for treatment effect is typically conservative, in the sense that the actual test size is smaller than the nominal level. This phenomenon of invalid tests has also been found for generalized linear models without adjusting for the covariates and are sometimes more worrisome due to inflated Type I error. The purpose of this study is to examine the unadjusted test for treatment effect under generalized linear models and covariate-adaptive randomization. For a large class of covariate-adaptive randomization methods, we obtain the asymptotic distribution of the test statistic under the null hypothesis and derive the conditions under which the test is conservative, valid, or anti-conservative. Several commonly used generalized linear models, such as logistic regression and Poisson regression, are discussed in detail. An adjustment method is also proposed to achieve a valid size based on the asymptotic results. Numerical studies confirm the theoretical findings and demonstrate the effectiveness of the proposed adjustment method.
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A central goal in designing clinical trials is to find the test that maximizes power (or equivalently minimizes required sample size) for finding a true research hypothesis subject to the constraint of type I error. When there is more than one test, such as in clinical trials with multiple endpoints, the issues of optimal design and optimal policies become more complex. In this paper we address the question of how such optimal tests should be defined and how they can be found. We review different notions of power and how they relate to study goals, and also consider the requirements of type I error control and the nature of the policies. This leads us to formulate the optimal policy problem as an explicit optimization problem with objective and constraints which describe its specific desiderata. We describe a complete solution for deriving optimal policies for two hypotheses, which have desired monotonicity properties, and are computationally simple. For some of the optimization formulations this yields optimal policies that are identical to existing policies, such as Hommels procedure or the procedure of Bittman et al. (2009), while for others it yields completely novel and more powerful policies than existing ones. We demonstrate the nature of our novel policies and their improved power extensively in simulation and on the APEX study (Cohen et al., 2016).
In randomized clinical trials, adjustments for baseline covariates at both design and analysis stages are highly encouraged by regulatory agencies. A recent trend is to use a model-assisted approach for covariate adjustment to gain credibility and efficiency while producing asymptotically valid inference even when the model is incorrect. In this article we present three considerations for better practice when model-assisted inference is applied to adjust for covariates under simple or covariate-adaptive randomized trials: (1) guaranteed efficiency gain: a model-assisted method should often gain but never hurt efficiency; (2) wide applicability: a valid procedure should be applicable, and preferably universally applicable, to all commonly used randomization schemes; (3) robust standard error: variance estimation should be robust to model misspecification and heteroscedasticity. To achieve these, we recommend a model-assisted estimator under an analysis of heterogeneous covariance working model including all covariates utilized in randomization. Our conclusions are based on an asymptotic theory that provides a clear picture of how covariate-adaptive randomization and regression adjustment alter statistical efficiency. Our theory is more general than the existing ones in terms of studying arbitrary functions of response means (including linear contrasts, ratios, and odds ratios), multiple arms, guaranteed efficiency gain, optimality, and universal applicability.
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Modeling of longitudinal data often requires diffusion models that incorporate overall time-dependent, nonlinear dynamics of multiple components and provide sufficient flexibility for subject-specific modeling. This complexity challenges parameter inference and approximations are inevitable. We propose a method for approximate maximum-likelihood parameter estimation in multivariate time-inhomogeneous diffusions, where subject-specific flexibility is accounted for by incorporation of multidimensional mixed effects and covariates. We consider $N$ multidimensional independent diffusions $X^i = (X^i_t)_{0leq tleq T^i}, 1leq ileq N$, with common overall model structure and unknown fixed-effects parameter $mu$. Their dynamics differ by the subject-specific random effect $phi^i$ in the drift and possibly by (known) covariate information, different initial conditions and observation times and duration. The distribution of $phi^i$ is parametrized by an unknown $vartheta$ and $theta = (mu, vartheta)$ is the target of statistical inference. Its maximum likelihood estimator is derived from the continuous-time likelihood. We prove consistency and asymptotic normality of $hat{theta}_N$ when the number $N$ of subjects goes to infinity using standard techniques and consider the more general concept of local asymptotic normality for less regular models. The bias induced by time-discretization of sufficient statistics is investigated. We discuss verification of conditions and investigate parameter estimation and hypothesis testing in simulations.
We propose a novel adaptive design for clinical trials with time-to-event outcomes and covariates (which may consist of or include biomarkers). Our method is based on the expected entropy of the posterior distribution of a proportional hazards model. The expected entropy is evaluated as a function of a patients covariates, and the information gained due to a patient is defined as the decrease in the corresponding entropy. Candidate patients are only recruited onto the trial if they are likely to provide sufficient information. Patients with covariates that are deemed uninformative are filtered out. A special case is where all patients are recruited, and we determine the optimal treatment arm allocation. This adaptive design has the advantage of potentially elucidating the relationship between covariates, treatments, and survival probabilities using fewer patients, albeit at the cost of rejecting some candidates. We assess the performance of our adaptive design using data from the German Breast Cancer Study group and numerical simulations of a biomarker validation trial.
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