Balanced covariates with response adaptive randomization

Response adaptive randomization (RAR) methods for clinical trials are susceptible to imbalance in the distribution of influential covariates across treatment arms. This can make the interpretation of trial results difficult, because observed differences between treatment groups may be a function of the covariates and not necessarily because of the treatments themselves. We propose a method for balancing the distribution of covariate strata across treatment arms within RAR. The method uses odds ratios to modify global RAR probabilities to obtain stratum‐specific modified RAR probabilities. We provide illustrative examples and a simple simulation study to demonstrate the effectiveness of the strategy for maintaining covariate balance. The proposed method is straightforward to implement and applicable to any type of RAR method or outcome.     

Weighted re‐randomization tests for minimization with unbalanced allocation

Re‐randomization test has been considered as a robust alternative to the traditional population model‐based methods for analyzing randomized clinical trials. This is especially so when the clinical trials are randomized according to minimization, which is a popular covariate‐adaptive randomization method for ensuring balance among prognostic factors. Among various re‐randomization tests, fixed‐entry‐order re‐randomization is advocated as an effective strategy when a temporal trend is suspected. Yet when the minimization is applied to trials with unequal allocation, fixed‐entry‐order re‐randomization test is biased and thus compromised in power. We find that the bias is due to non‐uniform re‐allocation probabilities incurred by the re‐randomization in this case. We therefore propose a weighted fixed‐entry‐order re‐randomization test to overcome the bias. The performance of the new test was investigated in simulation studies that mimic the settings of a real clinical trial. The weighted re‐randomization test was found to work well in the scenarios investigated including the presence of a strong temporal trend. Copyright © 2013 John Wiley & Sons, Ltd.     

Implementing optimal allocation for sequential continuous responses with multiple treatments

In practice, it is important to find optimal allocation strategies for continuous response with multiple treatments under some optimization criteria. In this article, we focus on exponential responses. For a multivariate test of homogeneity, we obtain the optimal allocation strategies to maximize power while (1) fixing sample size and (2) fixing expected total responses. Then the doubly adaptive biased coin design [Hu, F., Zhang, L.-X., 2004. Asymptotic properties of doubly adaptive biased coin designs for multi-treatment clinical trials. The Annals of Statistics 21, 268–301] is used to implement the optimal allocation strategies. Simulation results show that the proposed procedures have advantages over complete randomization with respect to both inferential (power) and ethical standpoints on average. It is important to note that one can usually implement optimal allocation strategies numerically for other continuous responses, though it is usually not easy to get the closed form of the optimal allocation theoretically.     

Shift in re‐randomization distribution with conditional randomization test

Proschan, Brittain, and Kammerman made a very interesting observation that for some examples of the unequal allocation minimization, the mean of the unconditional randomization distribution is shifted away from 0. Kuznetsova and Tymofyeyev linked this phenomenon to the variations in the allocation ratio from allocation to allocation in the examples considered in the paper by Proschan et al. and advocated the use of unequal allocation procedures that preserve the allocation ratio at every step. In this paper, we show that the shift phenomenon extends to very common settings: using conditional randomization test in a study with equal allocation. This phenomenon has the same cause: variations in the allocation ratio among the allocation sequences in the conditional reference set, not previously noted. We consider two kinds of conditional randomization tests. The first kind is the often used randomization test that conditions on the treatment group totals; we describe the variations in the conditional allocation ratio with this test on examples of permuted block randomization and biased coin randomization. The second kind is the randomization test proposed by Zheng and Zelen for a multicenter trial with permuted block central allocation that conditions on the within‐center treatment totals. On the basis of the sequence of conditional allocation ratios, we derive the value of the shift in the conditional randomization distribution for specific vector of responses and the expected value of the shift when responses are independent identically distributed random variables. We discuss the asymptotic behavior of the shift for the two types of tests. Copyright © 2013 John Wiley & Sons, Ltd.     

A Bayesian sequential design with adaptive randomization for 2‐sided hypothesis test

Bayesian sequential and adaptive randomization designs are gaining popularity in clinical trials thanks to their potentials to reduce the number of required participants and save resources. We propose a Bayesian sequential design with adaptive randomization rates so as to more efficiently attribute newly recruited patients to different treatment arms. In this paper, we consider 2‐arm clinical trials. Patients are allocated to the 2 arms with a randomization rate to achieve minimum variance for the test statistic. Algorithms are presented to calculate the optimal randomization rate, critical values, and power for the proposed design. Sensitivity analysis is implemented to check the influence on design by changing the prior distributions. Simulation studies are applied to compare the proposed method and traditional methods in terms of power and actual sample sizes. Simulations show that, when total sample size is fixed, the proposed design can obtain greater power and/or cost smaller actual sample size than the traditional Bayesian sequential design. Finally, we apply the proposed method to a real data set and compare the results with the Bayesian sequential design without adaptive randomization in terms of sample sizes. The proposed method can further reduce required sample size.     

Stratification of randomization is not required for a pre‐specified subgroup analysis

Published literature and regulatory agency guidance documents provide conflicting recommendations as to whether a pre‐specified subgroup analysis also requires for its validity that the study employ randomization that is stratified on subgroup membership. This is an important issue, as subgroup analyses are often required to demonstrate efficacy in the development of drugs with a companion diagnostic. Here, it is shown, for typical randomization methods, that the fraction of patients in the subgroup given experimental treatment matches, on average, the target fraction in the entire study. Also, mean covariate values are balanced, on average, between treatment arms in the subgroup, and it is argued that the variance in covariate imbalance between treatment arms in the subgroup is at worst only slightly increased versus a subgroup‐stratified randomization method. Finally, in an analysis of variance setting, a least‐squares treatment effect estimator within the subgroup is shown to be unbiased whether or not the randomization is stratified on subgroup membership. Thus, a requirement that a study be stratified on subgroup membership would place an artificial roadblock to innovation and the goals of personalized healthcare. Copyright © 2012 John Wiley & Sons, Ltd.     

Doubly adaptive biased coin designs with heterogeneous responses

Doubly adaptive biased coin design (DBCD) is an important family of response-adaptive randomization procedures for clinical trials. It uses sequentially updated estimation to skew the allocation probability to favor the treatment that has performed better thus far. An important assumption for the DBCD is the homogeneity assumption for the patient responses. However, this assumption may be violated in many sequential experiments. Here we prove the robustness of the DBCD against certain time trends in patient responses. Strong consistency and asymptotic normality of the design are obtained under some widely satisfied conditions. Also, we propose a general weighted likelihood method to reduce the bias caused by the heterogeneity in the inference after a trial. Some numerical studies are also presented to illustrate the finite sample properties of DBCD.     

Effects of unstratified and centre‐stratified randomization in multi‐centre clinical trials

This paper deals with the analysis of randomization effects in multi‐centre clinical trials. The two randomization schemes most often used in clinical trials are considered: unstratified and centre‐stratified block‐permuted randomization. The prediction of the number of patients randomized to different treatment arms in different regions during the recruitment period accounting for the stochastic nature of the recruitment and effects of multiple centres is investigated. A new analytic approach using a Poisson‐gamma patient recruitment model (patients arrive at different centres according to Poisson processes with rates sampled from a gamma distributed population) and its further extensions is proposed. Closed‐form expressions for corresponding distributions of the predicted number of the patients randomized in different regions are derived. In the case of two treatments, the properties of the total imbalance in the number of patients on treatment arms caused by using centre‐stratified randomization are investigated and for a large number of centres a normal approximation of imbalance is proved. The impact of imbalance on the power of the study is considered. It is shown that the loss of statistical power is practically negligible and can be compensated by a minor increase in sample size. The influence of patient dropout is also investigated. The impact of randomization on predicted drug supply overage is discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Two-sample post-stratified or subgroup analysis with restricted randomization rules

In a clinical trial to compare two treatments, subjects may be allocated sequentially to treatment groups by a restricted randomization rule. Suppose that at the end of the trial, the investigator is interested in a post-stratified or subgroup analysis with respect to a particular demographic or clinical factor which was not selected prior to the trial for stratified randomization. Under a randomization model, large sample theory of two-sample post-stratified permutational tests is developed with a broad class of restricted randomization treatment allocation rules. The test procedures proposed here are illustrated with a real-life example. The results of this example indicate that it is not always possible to ignore the treatment rule used in the trial in the design-based analysis.     

The use of covariate information in the sequential analysis of dichotomous response experiments

A method is presented for the sequential analysis of experiments involving two treatments to which response is dichotomous. Composite hypotheses about the difference in success probabilities are tested, and covariate information is utilized in the analysis. The method is based upon a generalization of Bartlett’s (1946) procedure for using the maximum likelihood estimate of a nuisance parameter in a Sequential Probability Ratio Test (SPRT). Treatment assignment rules studied include pure randomization, randomized blocks, and an adaptive rule which tends to assign the superior treatment to the majority of subjects. It is shown that the use of covariate information can result in important reductions in the expected sample size for specified error probabilities, and that the use of covariate information is essential for the elimination of bias when adaptive assignment rules are employed. Designs of the type presented are easily generated, as the termination criterion is the same as for a Wald SPRT of simple hypotheses.     

Quantitative comparison of randomization designs in sequential clinical trials based on treatment balance and allocation randomness

To evaluate the performance of randomization designs under various parameter settings and trial sample sizes, and identify optimal designs with respect to both treatment imbalance and allocation randomness, we evaluate 260 design scenarios from 14 randomization designs under 15 sample sizes range from 10 to 300, using three measures for imbalance and three measures for randomness. The maximum absolute imbalance and the correct guess (CG) probability are selected to assess the trade-off performance of each randomization design. As measured by the maximum absolute imbalance and the CG probability, we found that performances of the 14 randomization designs are located in a closed region with the upper boundary (worst case) given by Efron's biased coin design (BCD) and the lower boundary (best case) from the Soares and Wu's big stick design (BSD). Designs close to the lower boundary provide a smaller imbalance and a higher randomness than designs close to the upper boundary. Our research suggested that optimization of randomization design is possible based on quantified evaluation of imbalance and randomness. Based on the maximum imbalance and CG probability, the BSD, Chen's biased coin design with imbalance tolerance method, and Chen's Ehrenfest urn design perform better than popularly used permuted block design, EBCD, and Wei's urn design.     

A signature enrichment design with Bayesian adaptive randomization

Clinical trials in the era of precision cancer medicine aim to identify and validate biomarker signatures which can guide the assignment of individually optimal treatments to patients. In this article, we propose a group sequential randomized phase II design, which updates the biomarker signature as the trial goes on, utilizes enrichment strategies for patient selection, and uses Bayesian response-adaptive randomization for treatment assignment. To evaluate the performance of the new design, in addition to the commonly considered criteria of Type I error and power, we propose four new criteria measuring the benefits and losses for individuals both inside and outside of the clinical trial. Compared with designs with equal randomization, the proposed design gives trial participants a better chance to receive their personalized optimal treatments and thus results in a higher response rate on the trial. This design increases the chance to discover a successful new drug by an adaptive enrichment strategy, i.e. identification and selective enrollment of a subset of patients who are sensitive to the experimental therapies. Simulation studies demonstrate these advantages of the proposed design. It is illustrated by an example based on an actual clinical trial in non-small-cell lung cancer.     

OPTIMAL EXPERIMENTAL DESIGNS FOR MULTILEVEL MODELS WITH COVARIATES

In this paper optimal experimental designs for multilevel models with covariates and two levels of nesting are considered. Multilevel models are used to describe the relationship between an outcome variable and a treatment condition and covariate. It is assumed that the outcome variable is measured on a continuous scale. As optimality criteria D-optimality, and L-optimality are chosen. It is shown that pre-stratification on the covariate leads to a more efficient design and that the person level is the optimal level of randomization. Furthermore, optimal sample sizes are given and it is shown that these do not depend on the optimality criterion when randomization is done at the group level.     

Inference for two-stage adaptive treatment strategies using mixture distributions

Summary.  Treatment of complex diseases such as cancer, leukaemia, acquired immune deficiency syndrome and depression usually follows complex treatment regimes consisting of time varying multiple courses of the same or different treatments. The goal is to achieve the largest overall benefit defined by a common end point such as survival. Adaptive treatment strategy refers to a sequence of treatments that are applied at different stages of therapy based on the individual's history of covariates and intermediate responses to the earlier treatments. However, in many cases treatment assignment depends only on intermediate response and prior treatments. Clinical trials are often designed to compare two or more adaptive treatment strategies. A common approach that is used in these trials is sequential randomization. Patients are randomized on entry into available first-stage treatments and then on the basis of the response to the initial treatments are randomized to second-stage treatments, and so on. The analysis often ignores this feature of randomization and frequently conducts separate analysis for each stage. Recent literature suggested several semiparametric and Bayesian methods for inference related to adaptive treatment strategies from sequentially randomized trials. We develop a parametric approach using mixture distributions to model the survival times under different adaptive treatment strategies. We show that the estimators proposed are asymptotically unbiased and can be easily implemented by using existing routines in statistical software packages.     

A distribution free test to detect general dependence between a response variable and a covariate in the presence of heteroscedastic treatment effects

In this paper, we present a test of independence between the response variable, which can be discrete or continuous, and a continuous covariate after adjusting for heteroscedastic treatment effects. The method involves first augmenting each pair of the data for all treatments with a fixed number of nearest neighbours as pseudo‐replicates. Then a test statistic is constructed by taking the difference of two quadratic forms. The statistic is equivalent to the average lagged correlations between the response and nearest neighbour local estimates of the conditional mean of response given the covariate for each treatment group. This approach effectively eliminates the need to estimate the nonlinear regression function. The asymptotic distribution of the proposed test statistic is obtained under the null and local alternatives. Although using a fixed number of nearest neighbours pose significant difficulty in the inference compared to that allowing the number of nearest neighbours to go to infinity, the parametric standardizing rate for our test statistics is obtained. Numerical studies show that the new test procedure has robust power to detect nonlinear dependency in the presence of outliers that might result from highly skewed distributions. The Canadian Journal of Statistics 38: 408–433; 2010 © 2010 Statistical Society of Canada     

Analyzing propensity matched zero-inflated count outcomes in observational studies

Determining the effectiveness of different treatments from observational data, which are characterized by imbalance between groups due to lack of randomization, is challenging. Propensity matching is often used to rectify imbalances among prognostic variables. However, there are no guidelines on how appropriately to analyze group matched data when the outcome is a zero-inflated count. In addition, there is debate over whether to account for correlation of responses induced by matching and/or whether to adjust for variables used in generating the propensity score in the final analysis. The aim of this research is to compare covariate unadjusted and adjusted zero-inflated Poisson models that do and do not account for the correlation. A simulation study is conducted, demonstrating that it is necessary to adjust for potential residual confounding, but that accounting for correlation is less important. The methods are applied to a biomedical research data set.     

Use of simulation to compare the performance of minimization with stratified blocked randomization

Minimization is an alternative method to stratified permuted block randomization, which may be more effective at balancing treatments when there are many strata. However, its use in the regulatory setting for industry trials remains controversial, primarily due to the difficulty in interpreting conventional asymptotic statistical tests under restricted methods of treatment allocation. We argue that the use of minimization should be critically evaluated when designing the study for which it is proposed. We demonstrate by example how simulation can be used to investigate whether minimization improves treatment balance compared with stratified randomization, and how much randomness can be incorporated into the minimization before any balance advantage is no longer retained. We also illustrate by example how the performance of the traditional model-based analysis can be assessed, by comparing the nominal test size with the observed test size over a large number of simulations. We recommend that the assignment probability for the minimization be selected using such simulations.     

Some Restricted randomization rules in sequential designs

This paper presents a new class of designs (Big Stick Designs) for sequentially assigning experimental units to treatments, when only the time covariate is considered. By prescribing the degree of imbalance which the experimenters can tolerate, complete randomization is used as long as the imbalance of the treatment allocation does not exceed the prescribed value. Once it reaches the value, a deterministic assignment is made to lower the imbalance. Such designs can be easily implemented with no programming and little personnel support. They compare favorably with the Biased Coin Designs, the Permuted Black Designs, and the Urn Designs, as far as the accidental bias and selection bias are concerned. Generalizations of these designs are considered to achieve various purposes, e.g., avoidance of deterministic assignments, early balance, etc.     

Restricted Estimation in Partially Linear Errors-in-Variables Models

As a compromise between parametric regression and nonparametric regression, partially linear models are frequently used in statistical modelling. This article considers statistical inference for this semiparametric model when the linear covariate is measured with additive error and some additional linear restrictions on the parametric component are assumed to hold. We propose a restricted corrected profile least-squares estimator for the parametric component, and study the asymptotic normality of the estimator. To test hypothesis on the parametric component, we construct a Wald test statistic and obtain its limiting distribution. Some simulation studies are conducted to illustrate our approaches.     

Better experimental design by hybridizing binary matching with imbalance optimization

We present a new experimental design procedure that divides a set of experimental units into two groups in order to minimize error in estimating a treatment effect. One concern is the elimination of large covariate imbalance between the two groups before the experiment begins. Another concern is robustness of the design to misspecification in response models. We address both concerns in our proposed design: we first place subjects into pairs using optimal nonbipartite matching, making our estimator robust to complicated nonlinear response models. Our innovation is to keep the matched pairs extant, take differences of the covariate values within each matched pair, and then use the greedy switching heuristic of Krieger et al. (2019) or rerandomization on these differences. This latter step greatly reduces covariate imbalance. Furthermore, our resultant designs are shown to be nearly as random as matching, which is robust to unobserved covariates. When compared to previous designs, our approach exhibits significant improvement in the mean squared error of the treatment effect estimator when the response model is nonlinear and performs at least as well when the response model is linear. Our design procedure can be found as a method in the open source R package available on CRAN called GreedyExperimentalDesign .