Sample Size Re-Estimation Based on Two-Stage Analysis of Variance: Interim Analysis of Clinical Trials

Planning and conducting interim analysis are important steps for long-term clinical trials. In this article, the concept of conditional power is combined with the classic analysis of variance (ANOVA) for a study of two-stage sample size re-estimation based on interim analysis. The overall Type I and Type II errors would be inflated by interim analysis. We compared the effects on re-estimating sample sizes with and without the adjustment of Type I and Type II error rates due to interim analysis.     

Methods for clarifying criteria for study continuation at interim analysis

In monitoring clinical trials, the question of futility, or whether the data thus far suggest that the results at the final analysis are unlikely to be statistically successful, is regularly of interest over the course of a study. However, the opposite viewpoint of whether the study is sufficiently demonstrating proof of concept (POC) and should continue is a valuable consideration and ultimately should be addressed with high POC power so that a promising study is not prematurely terminated. Conditional power is often used to assess futility, and this article interconnects the ideas of assessing POC for the purpose of study continuation with conditional power, while highlighting the importance of the POC type I error and the POC type II error for study continuation or not at the interim analysis. Methods for analyzing subgroups motivate the interim analyses to maintain high POC power via an adjusted interim POC significance level criterion for study continuation or testing against an inferiority margin. Furthermore, two versions of conditional power based on the assumed effect size or the observed interim effect size are considered. Graphical displays illustrate the relationship of the POC type II error for premature study termination to the POC type I error for study continuation and the associated conditional power criteria.     

Sample size re-estimation for survival data in clinical trials with an adaptive design

In clinical trials with survival data, investigators may wish to re-estimate the sample size based on the observed effect size while the trial is ongoing. Besides the inflation of the type-I error rate due to sample size re-estimation, the method for calculating the sample size in an interim analysis should be carefully considered because the data in each stage are mutually dependent in trials with survival data. Although the interim hazard estimate is commonly used to re-estimate the sample size, the estimate can sometimes be considerably higher or lower than the hypothesized hazard by chance. We propose an interim hazard ratio estimate that can be used to re-estimate the sample size under those circumstances. The proposed method was demonstrated through a simulation study and an actual clinical trial as an example. The effect of the shape parameter for the Weibull survival distribution on the sample size re-estimation is presented.     

The perils with the misuse of predictive power

In early drug development, especially when studying new mechanisms of action or in new disease areas, little is known about the targeted or anticipated treatment effect or variability estimates. Adaptive designs that allow for early stopping but also use interim data to adapt the sample size have been proposed as a practical way of dealing with these uncertainties. Predictive power and conditional power are two commonly mentioned techniques that allow predictions of what will happen at the end of the trial based on the interim data. Decisions about stopping or continuing the trial can then be based on these predictions. However, unless the user of these statistics has a deep understanding of their characteristics important pitfalls may be encountered, especially with the use of predictive power. The aim of this paper is to highlight these potential pitfalls. It is critical that statisticians understand the fundamental differences between predictive power and conditional power as they can have dramatic effects on decision making at the interim stage, especially if used to re-evaluate the sample size. The use of predictive power can lead to much larger sample sizes than either conditional power or standard sample size calculations. One crucial difference is that predictive power takes account of all uncertainty, parts of which are ignored by standard sample size calculations and conditional power. By comparing the characteristics of each of these statistics we highlight important characteristics of predictive power that experimenters need to be aware of when using this approach.     

A testing strategy for two crossing survival curves

In biomedical studies, the testing problem of two sample survival curves is commonly seen. The most popular approach is the log-rank test. However, the log-rank test may lead to misleading results when two survival curves cross each other. From Li et al., it is difficult to find a good method to test two sample survival curves for all situations. Here, we propose a strategy procedure to combine some existing approaches for the testing problem. Then, we conduct simulations to examine the power and Type I error rate, and compare the proposed methods with five competitive approaches from Li et al. under various crossing situations of two survival curves. From the results, we suggest the Strategy 2 for the two survival curves testing problem, which has higher power and appropriate Type I error for each situation. Finally, we analyze two real data examples with the proposed methods for illustrations.     

Sample size determination and treatment screening in two‐stage phase II clinical trials via ROC curve

In pharmaceutical‐related research, we usually use clinical trials methods to identify valuable treatments and compare their efficacy with that of a standard control therapy. Although clinical trials are essential for ensuring the efficacy and postmarketing safety of a drug, conducting clinical trials is usually costly and time‐consuming. Moreover, to allocate patients to the little therapeutic effect treatments is inappropriate due to the ethical and cost imperative. Hence, there are several 2‐stage designs in the literature where, for reducing cost and shortening duration of trials, they use the conditional power obtained from interim analysis results to appraise whether we should continue the lower efficacious treatments in the next stage. However, there is a lack of discussion about the influential impacts on the conditional power of a trial at the design stage in the literature. In this article, we calculate the optimal conditional power via the receiver operating characteristic curve method to assess the impacts on the quality of a 2‐stage design with multiple treatments and propose an optimal design using the minimum expected sample size for choosing the best or promising treatment(s) among several treatments under an optimal conditional power constraint. In this paper, we provide tables of the 2‐stage design subject to optimal conditional power for various combinations of design parameters and use an example to illustrate our methods.     

Improving interim decisions in randomized trials by exploiting information on short‐term endpoints and prognostic baseline covariates

Conditional power calculations are frequently used to guide the decision whether or not to stop a trial for futility or to modify planned sample size. These ignore the information in short‐term endpoints and baseline covariates, and thereby do not make fully efficient use of the information in the data. We therefore propose an interim decision procedure based on the conditional power approach which exploits the information contained in baseline covariates and short‐term endpoints. We will realize this by considering the estimation of the treatment effect at the interim analysis as a missing data problem. This problem is addressed by employing specific prediction models for the long‐term endpoint which enable the incorporation of baseline covariates and multiple short‐term endpoints. We show that the proposed procedure leads to an efficiency gain and a reduced sample size, without compromising the Type I error rate of the procedure, even when the adopted prediction models are misspecified. In particular, implementing our proposal in the conditional power approach enables earlier decisions relative to standard approaches, whilst controlling the probability of an incorrect decision. This time gain results in a lower expected number of recruited patients in case of stopping for futility, such that fewer patients receive the futile regimen. We explain how these methods can be used in adaptive designs with unblinded sample size re‐assessment based on the inverse normal P‐value combination method to control Type I error. We support the proposal by Monte Carlo simulations based on data from a real clinical trial.     

A practical comparison of blinded methods for sample size reviews in survival data clinical trials

This paper presents practical approaches to the problem of sample size re-estimation in the case of clinical trials with survival data when proportional hazards can be assumed. When data are readily available at the time of the review, on a full range of survival experiences across the recruited patients, it is shown that, as expected, performing a blinded re-estimation procedure is straightforward and can help to maintain the trial's pre-specified error rates. Two alternative methods for dealing with the situation where limited survival experiences are available at the time of the sample size review are then presented and compared. In this instance, extrapolation is required in order to undertake the sample size re-estimation. Worked examples, together with results from a simulation study are described. It is concluded that, as in the standard case, use of either extrapolation approach successfully protects the trial error rates.     

Combining an Internal Pilot with an Interim Analysis for Single Degree of Freedom Tests

An internal pilot with interim analysis (IPIA) design combines interim power analysis (an internal pilot) with interim data analysis (two stage group sequential). We provide IPIA methods for single df hypotheses within the Gaussian general linear model, including one and two group t tests. The design allows early stopping for efficacy and futility while also re-estimating sample size based on an interim variance estimate. Study planning in small samples requires the exact and computable forms reported here. The formulation gives fast and accurate calculations of power, type I error rate, and expected sample size.     

Combining an Internal Pilot with an Interim Analysis for Single Degree of Freedom Tests

An internal pilot with interim analysis (IPIA) design combines interim power analysis (an internal pilot) with interim data analysis (two-stage group sequential). We provide IPIA methods for single df hypotheses within the Gaussian general linear model, including one and two group t tests. The design allows early stopping for efficacy and futility while also re-estimating sample size based on an interim variance estimate. Study planning in small samples requires the exact and computable forms reported here. The formulation gives fast and accurate calculations of power, Type I error rate, and expected sample size.     

Modified ratio estimators using robust regression methods

When there is an outlier in the data set, the efficiency of traditional methods decreases. In order to solve this problem, Kadilar et al. (2007) adapted Huber-M method which is only one of robust regression methods to ratio-type estimators and decreased the effect of outlier problem. In this study, new ratio-type estimators are proposed by considering Tukey-M, Hampel M, Huber MM, LTS, LMS and LAD robust methods based on the Kadilar et al. (2007). Theoretically, we obtain the mean square error (MSE) for these estimators. We compared with MSE values of proposed estimators and MSE values of estimators based on Huber-M and OLS methods. As a result of these comparisons, we observed that our proposed estimators give more efficient results than both Huber M approach which was proposed by Kadilar et al. (2007) and OLS approach. Also, under all conditions, all of the other proposed estimators except Lad method are more efficient than robust estimators proposed by Kadilar et al. (2007). And, these theoretical results are supported with the aid of a numerical example and simulation by basing on data that includes an outlier.     

Early stopping by using stochastic curtailment in a three-arm sequential trial

Summary. Interim analysis is important in a large clinical trial for ethical and cost considerations. Sometimes, an interim analysis needs to be performed at an earlier than planned time point. In that case, methods using stochastic curtailment are useful in examining the data for early stopping while controlling the inflation of type I and type II errors. We consider a three-arm randomized study of treatments to reduce perioperative blood loss following major surgery. Owing to slow accrual, an unplanned interim analysis was required by the study team to determine whether the study should be continued. We distinguish two different cases: when all treatments are under direct comparison and when one of the treatments is a control. We used simulations to study the operating characteristics of five different stochastic curtailment methods. We also considered the influence of timing of the interim analyses on the type I error and power of the test. We found that the type I error and power between the different methods can be quite different. The analysis for the perioperative blood loss trial was carried out at approximately a quarter of the planned sample size. We found that there is little evidence that the active treatments are better than a placebo and recommended closure of the trial.     

A stratified estimation of a sensitive character by using geometric distribution

Abstract

In this paper, we consider the estimation of a sensitive character when the population is consisted of several strata; this is undertaken by applying Niharika et al.’s model which is using geometric distribution as a randomization device. A sensitive parameter is estimated for the case in which stratum size is known, and proportional and optimum allocation methods are taken into account. We extended the Niharika et al.’s model to the case of an unknown stratum size; a sensitive parameter is estimated by applying stratified double sampling to the Niharika et al.’s model. Finally, the efficiency of the proposed model is compared with that of Niharika et al. in terms of the estimator variance.     

Adaptive designs for IVPT data with mixed scaled average bioequivalence

In vitro permeation tests (IVPT) offer accurate and cost-effective development pathways for locally acting drugs, such as topical dermatological products. For assessment of bioequivalence, the FDA draft guidance on generic acyclovir 5% cream introduces a new experimental design, namely the single-dose, multiple-replicate per treatment group design, as IVPT pivotal study design. We examine the statistical properties of its hypothesis testing method—namely the mixed scaled average bioequivalence (MSABE). Meanwhile, some adaptive design features in clinical trials can help researchers make a decision earlier with fewer subjects or boost power, saving resources, while controlling the impact on family-wise error rate. Therefore, we incorporate MSABE in an adaptive design combining the group sequential design and sample size re-estimation. Simulation studies are conducted to study the passing rates of the proposed methods—both within and outside the average bioequivalence limits. We further consider modifications to the adaptive designs applied for IVPT BE trials, such as Bonferroni's adjustment and conditional power function. Finally, a case study with real data demonstrates the advantages of such adaptive methods.     

Doubly robust empirical likelihood inference in covariate-missing data problems

Missing covariate data occurs often in regression analysis. We study methods for estimating the regression coefficients in an assumed conditional mean function when some covariates are completely observed but other covariates are missing for some subjects. We adopt the semiparametric perspective of Robins et al. [Estimation of regression coefficients when some regressors are not always observed. J Amer Statist Assoc. 1994;89:846–866] on regression analyses with missing covariates, in which they pioneered the use of two working models, the working propensity score model and the working conditional score model. A recent approach to missing covariate data analysis is the empirical likelihood method of Qin et al. [Empirical likelihood in missing data problems. J Amer Statist Assoc. 2009;104:1492–1503], which effectively combines unbiased estimating equations. In this paper, we consider an alternative likelihood approach based on the full likelihood of the observed data. This full likelihood-based method enables us to generate estimators for the vector of the regression coefficients that are (a) asymptotically equivalent to those of Qin et al. [Empirical likelihood in missing data problems. J Amer Statist Assoc. 2009;104:1492–1503] when the working propensity score model is correctly specified, and (b) doubly robust, like the augmented inverse probability weighting (AIPW) estimators of Robins et al. [Estimation of regression coefficients when some regressors are not always observed. J Am Statist Assoc. 1994;89:846–866]. Thus, the proposed full likelihood-based estimators improve on the efficiency of the AIPW estimators when the working propensity score model is correct but the working conditional score model is possibly incorrect, and also improve on the empirical likelihood estimators of Qin, Zhang and Leung [Empirical likelihood in missing data problems. J Amer Statist Assoc. 2009;104:1492–1503] when the reverse is true, that is, the working conditional score model is correct but the working propensity score model is possibly incorrect. In addition, we consider a regression method for estimation of the regression coefficients when the working conditional score model is correctly specified; the asymptotic variance of the resulting estimator is no greater than the semiparametric variance bound characterized by the theory of Robins et al. [Estimation of regression coefficients when some regressors are not always observed. J Amer Statist Assoc. 1994;89:846–866]. Finally, we compare the finite-sample performance of various estimators in a simulation study.     

Averaging estimation for conditional covariance models

Estimating conditional covariance matrices is important in statistics and finance. In this paper, we propose an averaging estimator for the conditional covariance, which combines the estimates of marginal conditional covariance matrices by Model Averaging MArginal Regression of Li, Linton, and Lu. This estimator avoids the “curse of dimensionality” problem that the local constant estimator of Yin et al. suffered from. We establish the asymptotic properties of the averaging weights and that of the proposed conditional covariance estimator. The finite sample performances are augmented by simulation. An application to portfolio allocation illustrates the practical superiority of the averaging estimator.     

Bayesian CV@R/super-quantile regression

In this paper we provide a Bayesian interpretation of the conditional value at risk, CV@R, or super-quantile regression recently developed by Rockafellar et al. [Super-quantile regression with applications to buffered reliability, uncertainty quantification, and conditional value-at-risk, Eur. J. Oper. Res. 234 (2014), pp. 140–154]. Computations are based on particle filtering using a special posterior distribution consistent with the super-quantile concept. An empirical application to data used by RRM as well to another data set on energy prices confirms their results and shows the applicability of the new techniques.     

A note on nonparametric estimation of circular conditional densities

ABSTRACT

The conditional density offers the most informative summary of the relationship between explanatory and response variables. We need to estimate it in place of the simple conditional mean when its shape is not well-behaved. A motivation for estimating conditional densities, specific to the circular setting, lies in the fact that a natural alternative of it, like quantile regression, could be considered problematic because circular quantiles are not rotationally equivariant. We treat conditional density estimation as a local polynomial fitting problem as proposed by Fan et al. [Estimation of conditional densities and sensitivity measures in nonlinear dynamical systems. Biometrika. 1996;83:189–206] in the Euclidean setting, and discuss a class of estimators in the cases when the conditioning variable is either circular or linear. Asymptotic properties for some members of the proposed class are derived. The effectiveness of the methods for finite sample sizes is illustrated by simulation experiments and an example using real data.     

Methodological issues with adaptation of clinical trial design

Adaptation of clinical trial design generates many issues that have not been resolved for practical applications, though statistical methodology has advanced greatly. This paper focuses on some methodological issues. In one type of adaptation such as sample size re-estimation, only the postulated value of a parameter for planning the trial size may be altered. In another type, the originally intended hypothesis for testing may be modified using the internal data accumulated at an interim time of the trial, such as changing the primary endpoint and dropping a treatment arm. For sample size re-estimation, we make a contrast between an adaptive test weighting the two-stage test statistics with the statistical information given by the original design and the original sample mean test with a properly corrected critical value. We point out the difficulty in planning a confirmatory trial based on the crude information generated by exploratory trials. In regards to selecting a primary endpoint, we argue that the selection process that allows switching from one endpoint to the other with the internal data of the trial is not very likely to gain a power advantage over the simple process of selecting one from the two endpoints by testing them with an equal split of alpha (Bonferroni adjustment). For dropping a treatment arm, distributing the remaining sample size of the discontinued arm to other treatment arms can substantially improve the statistical power of identifying a superior treatment arm in the design. A common difficult methodological issue is that of how to select an adaptation rule in the trial planning stage. Pre-specification of the adaptation rule is important for the practicality consideration. Changing the originally intended hypothesis for testing with the internal data generates great concerns to clinical trial researchers.     

Testing multiple primary endpoints in clinical trials with sample size adaptation

In this paper, we propose a design that uses a short‐term endpoint for accelerated approval at interim analysis and a long‐term endpoint for full approval at final analysis with sample size adaptation based on the long‐term endpoint. Two sample size adaptation rules are compared: an adaptation rule to maintain the conditional power at a prespecified level and a step function type adaptation rule to better address the bias issue. Three testing procedures are proposed: alpha splitting between the two endpoints; alpha exhaustive between the endpoints; and alpha exhaustive with improved critical value based on correlation. Family‐wise error rate is proved to be strongly controlled for the two endpoints, sample size adaptation, and two analysis time points with the proposed designs. We show that using alpha exhaustive designs greatly improve the power when both endpoints are effective, and the power difference between the two adaptation rules is minimal. The proposed design can be extended to more general settings. Copyright © 2015 John Wiley & Sons, Ltd.