This article aims to study efficient/trace optimal designs for crossover trials with multiple responses recorded from each subject in the time periods. A multivariate fixed effects model is proposed with direct and carryover effects corresponding to the multiple responses. The corresponding error dispersion matrix is chosen to be either of the proportional or the generalized Markov covariance type, permitting the existence of direct and cross-correlations within and between the multiple responses. The corresponding information matrices for direct effects under the two types of dispersions are used to determine efficient designs. The efficiency of orthogonal array designs of Type $I$ and strength $2$ is investigated for a wide choice of covariance functions, namely, Mat($0.5$), Mat($1.5$) and Mat($\infty$). To motivate these multivariate crossover designs, a gene expression dataset in a $3 \times 3$ framework is utilized.
Crossover designs are an extremely useful tool to investigators, whilst group sequential methods have proven highly proficient at improving the efficiency of parallel group trials. Yet, group sequential methods and crossover designs have rarely been paired together. One possible explanation for this could be the absence of a formal proof of how to strongly control the familywise error rate in the case when multiple comparisons will be made. Here, we provide this proof, valid for any number of initial experimental treatments and any number of stages, when results are analysed using a linear mix…
The determination of the sample size required by a crossover trial typically depends on the specification of one or more variance components. Uncertainty about the value of these parameters at the design stage means that there is often a risk a trial may be under- or over-powered. For many study designs, this problem has been addressed by considering adaptive design methodology that allows for the re-estimation of the required sample size during a trial. Here, we propose and compare several approaches for this in multi-treatment crossover trials. Specifically, regulators favour re-estimation p…
An efficient monotone data augmentation (MDA) algorithm is proposed for missing data imputation for incomplete multivariate nonnormal data that may contain variables of different types, and are modeled by a sequence of regression models including the linear, binary logistic, multinomial logistic, proportional odds, Poisson, negative binomial, skew-normal, skew-t regressions or a mixture of these models. The MDA algorithm is applied to the sensitivity analyses of longitudinal trials with nonignorable dropout using the controlled pattern imputations that assume the treatment effect reduces or di…
Consider a two-treatment, two-period crossover trial, with responses that are continuous random variables. We find a large-sample frequentist 1-alpha confidence interval for the treatment difference that utilizes the uncertain prior information that there is no differential carryover effect.
Cluster randomized crossover trials with very few clusters but multiple periods: which analyses for continuous outcomes should be used?
Yale School of Medicine（耶鲁医学院）；Yale School of Public Health（耶鲁公共卫生学院）；Monash University（蒙纳士大学）；The Ottawa Hospital Research Institute（渥太华医院研究所）；University of Ottawa（渥太华大学）
This article discusses D-optimal Bayesian crossover designs for generalized linear models. Crossover trials with t treatments and p periods, for $t <= p$, are considered. The designs proposed in this paper minimize the log determinant of the variance of the estimated treatment effects over all possible allocation of the n subjects to the treatment sequences. It is assumed that the p observations from each subject are mutually correlated while the observations from different subjects are uncorrelated. Since main interest is in estimating the treatment effects, the subject effect is assumed to b…
What is estimated in cluster randomized crossover trials with informative sizes? -- A survey of estimands and common estimators
University of Pennsylvania（宾夕法尼亚大学）；Monash University（莫纳什大学）；MRC Clinical Trials Unit at UCL（伦敦大学学院医学研究委员会临床试验单元）；Wellington Hospital（惠灵顿医院）；Medical Research Institute of New Zealand（新西兰医学研究所）；Australian and New Zealand Intensive Care Research Centre, Monash University（莫纳什大学澳新重症监护研究中心）；University of Melbourne（墨尔本大学）；Perelman School of Medicine, University of Pennsylvania（宾夕法尼亚大学佩雷尔曼医学院）；Yale School of Public Health（耶鲁公共卫生学院）
Multivariate outcomes are common in pragmatic cluster randomized trials. While sample size calculation procedures for multivariate outcomes exist under parallel assignment, none have been developed for a stepped wedge design. In this article, we present computationally efficient power and sample size procedures for stepped wedge cluster randomized trials (SW-CRTs) with multivariate outcomes that differentiate the within-period and between-period intracluster correlation coefficients (ICCs). Under a multivariate linear mixed model, we derive the joint distribution of the intervention test stati…
In many clinical trials, outcomes of interest include binary-valued endpoints. It is not uncommon that a binary-valued outcome is dichotomized from a continuous outcome at a threshold of clinical interest. To reach the objective, common approaches include (a) fitting the generalized linear mixed model (GLMM) to the dichotomized longitudinal binary outcome and (b) imputation method (MI): imputing the missing values in the continuous outcome, dichotomizing it into a binary outcome, and then fitting the generalized linear model for the "complete" data. We conducted comprehensive simulation studie…
Data collected in clinical trials are often composed of multiple types of variables. For example, laboratory measurements and vital signs are longitudinal data of continuous or categorical variables, adverse events may be recurrent events, and death is a time-to-event variable. Missing data due to patients' discontinuation from the study or as a result of handling intercurrent events using a hypothetical strategy almost always occur during any clinical trial. Imputing these data with mixed types of variables simultaneously is a challenge that has not been studied extensively. In this article, …
Pragmatic trials evaluating health care interventions often adopt cluster randomization due to scientific or logistical considerations. Previous reviews have shown that co-primary endpoints are common in pragmatic trials but infrequently recognized in sample size or power calculations. While methods for power analysis based on $K$ ($K\geq 2$) binary co-primary endpoints are available for CRTs, to our knowledge, methods for continuous co-primary endpoints are not yet available. Assuming a multivariate linear mixed model that accounts for multiple types of intraclass correlation coefficients (en…
A sequential multiple assignment randomized trial (SMART) facilitates comparison of multiple adaptive treatment strategies (ATSs) simultaneously. Previous studies have established a framework to test the homogeneity of multiple ATSs by a global Wald test through inverse probability weighting. SMARTs are generally lengthier than classical clinical trials due to the sequential nature of treatment randomization in multiple stages. Thus, it would be beneficial to add interim analyses allowing for early stop if overwhelming efficacy is observed. We introduce group sequential methods to SMARTs to fa…
Hasso Plattner Institute for Digital Engineering（数字工程哈索·普拉特纳研究所）；University of Potsdam（波茨坦大学）；École Polytechnique Fédérale de Lausanne（洛桑联邦理工学院）；CUNY Graduate School of Public Health and Health Policy（纽约市立大学研究生院公共卫生与健康政策学院）
Mediation analysis is appealing for its ability to improve understanding of the mechanistic drivers of causal effects, but real-world data complexities challenge its successful implementation, including: 1) the existence of post-exposure variables that also affect mediators and outcomes (thus, confounding the mediator-outcome relationship), that may also be 2) multivariate, and 3) the existence of multivariate mediators. Interventional direct and indirect effects (IDE/IIE) accommodate post-exposure variables that confound the mediator-outcome relationship, but currently, no estimator for IDE/I…
Given the cost and duration of phase III and phase IV clinical trials, the development of statistical methods for go/no-go decisions is vital. In this paper, we introduce a Bayesian methodology to compute the probability of success based on the current data of a treatment regimen for the multivariate linear model. Our approach utilizes a Bayesian seemingly unrelated regression model, which allows for multiple endpoints to be modeled jointly even if the covariates between the endpoints are different. Correlations between endpoints are explicitly modeled. This Bayesian joint modeling approach un…
We propose a novel personalized concept for the optimal treatment selection for a situation where the response is a multivariate vector, that could contain right-censored variables such as survival time. The proposed method can be applied with any number of treatments and outcome variables, under a broad set of models. Following a working semiparametric Single Index Model that relates covariates and responses, we first define a patient-specific composite score, constructed from individual covariates. We then estimate conditional means of each response, given the patient score, correspond to ea…
University of North Carolina（北卡罗来纳大学）；University of Southern California（南加利福尼亚大学）；University of Texas at Austin（得克萨斯大学奥斯汀分校）
The field of precision medicine aims to tailor treatment based on patient-specific factors in a reproducible way. To this end, estimating an optimal individualized treatment regime (ITR) that recommends treatment decisions based on patient characteristics to maximize the mean of a pre-specified outcome is of particular interest. Several methods have been proposed for estimating an optimal ITR from clinical trial data in the parallel group setting where each subject is randomized to a single intervention. However, little work has been done in the area of estimating the optimal ITR from crossove…
Suppose one wishes to estimate the effect of a binary treatment on a binary endpoint conditional on a post-randomization quantity in a counterfactual world in which all subjects received treatment. It is generally difficult to identify this parameter without strong, untestable assumptions. It has been shown that identifiability assumptions become much weaker under a crossover design in which subjects not receiving treatment are later given treatment. Under the assumption that the post-treatment biomarker observed in these crossover subjects is the same as would have been observed had they rece…
The increasing interest in subpopulation analysis has led to the development of various new trial designs and analysis methods in the fields of personalized medicine and targeted therapies. In this paper, subpopulations are defined in terms of an accumulation of disjoint population subsets and will therefore be called composite populations. The proposed trial design is applicable to any set of composite populations, considering normally distributed endpoints and random baseline covariates. Treatment effects for composite populations are tested by combining $p$-values, calculated on the subset …
A Framework for Parametric Time-Varying Treatment Effects in Multiple Intervention Stepped Wedge Design Clinical Trials in the Presence of Non-Uniform Cluster-Period Correlation Structures
The Johns Hopkins University Applied Physics Laboratory（约翰斯·霍普金斯大学应用物理实验室）；UTHealth Houston School of Public Health, The University of Texas Health Science Center at Houston（休斯顿德克萨斯大学健康科学中心休斯顿公共卫生学院）
Randomized experiments play a major role in data-driven decision making across many different fields and disciplines. In medicine, for example, randomized controlled trials (RCTs) are the backbone of clinical trial methodology for testing the efficacy of new drugs and therapies versus existing treatments or placebo. In business and marketing, randomized experiments are typically referred to as A/B tests when there are only two arms, or variants, in the experiment, and as multivariate A/B tests when there are more than two arms. Typical applications of A/B tests include comparing the effectiven…
In many psychometric applications, the relationship between the mean of an outcome and a quantitative covariate is too complex to be described by simple parametric functions; instead, flexible nonlinear relationships can be incorporated using penalized splines. Penalized splines can be conveniently represented as a linear mixed effects model (LMM), where the coefficients of the spline basis functions are random effects. The LMM representation of penalized splines makes the extension to multivariate outcomes relatively straightforward. In the LMM, no effect of the quantitative covariate on the …
Cookstove replacement trials have found mixed results on their impact on respiratory health. The limited range of concentrations and small sample sizes of individual studies are important factors that may be limiting their statistical power. We present a hierarchical approach to modeling exposure concentrations and pooling data from multiple studies in order to estimate a common exposure-response curve. The exposure concentration model accommodates temporally sparse, clustered longitudinal observations. The exposure-response curve model provides a flexible, semi-parametric estimate of the expo…
Group sequential design (GSD) is widely used in clinical trials in which correlated tests of multiple hypotheses are used. Multiple primary objectives resulting in tests with known correlations include evaluating 1) multiple experimental treatment arms, 2) multiple populations, 3) the combination of multiple arms and multiple populations, or 4) any asymptotically multivariate normal tests. In this paper, we focus on the first 3 of these and extend the framework of the weighted parametric multiple test procedure from fixed designs with a single analysis per objective to a GSD setting where diff…
