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.     

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.     

Multi-treatment covariate-adjusted adaptive design under informative censoring

In the present work, we find a set of reliability functionals to fix up an allocation strategy among K(≥2) treatments when the response distributions, conditionally dependent on some continuous prognostic variable, are exponential with unknown linear regression functions as the means of the respective conditional distributions. Targeting such reliability functionals, we propose a covariate-adjusted response-adaptive randomization procedure for the multi-treatment single-period clinical trial under the Koziol–Green model for informative censoring. We compare the proposed procedure with its competitive covariate-eliminated procedure.     

A theoretical analysis of the power of biased coin designs

Outlining some recently obtained results of Hu and Rosenberger [2003. Optimality, variability, power: evaluating response-adaptive randomization procedures for treatment comparisons. J. Amer. Statist. Assoc. 98, 671–678] and Chen [2006. The power of Efron's biased coin design. J. Statist. Plann. Inference 136, 1824–1835] on the relationship between sequential randomized designs and the power of the usual statistical procedures for testing the equivalence of two competing treatments, the aim of this paper is to provide theoretical proofs of the numerical results of Chen [2006. The power of Efron's biased coin design. J. Statist. Plann. Inference 136, 1824–1835]. Furthermore, we prove that the Adjustable Biased Coin Design [Baldi Antognini A., Giovagnoli, A., 2004. A new “biased coin design” for the sequential allocation of two treatments. J. Roy. Statist. Soc. Ser. C 53, 651–664] is uniformly more powerful than the other “coin” designs proposed in the literature for any sample size.     

A new 'biased coin design' for the sequential allocation of two treatments

Summary.  Efron's biased coin design is a well-known randomization technique that helps to neutralize selection bias in sequential clinical trials for comparing treatments, while keeping the experiment fairly balanced. Extensions of the biased coin design have been proposed by several researchers who have focused mainly on the large sample properties of their designs. We modify Efron's procedure by introducing an adjustable biased coin design, which is more flexible than his. We compare it with other existing coin designs; in terms of balance and lack of predictability, its performance for small samples appears in many cases to be an improvement with respect to the other sequential randomized allocation procedures.     

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.     

Multiple-objective response-adaptive repeated measurement designs for clinical trials

In a response-adaptive design, we review and update the trial on the basis of outcomes in order to achieve a specific goal. Response-adaptive designs for clinical trials are usually constructed to achieve a single objective. In this paper, we develop a new adaptive allocation rule to improve current strategies for building response-adaptive designs to construct multiple-objective repeated measurement designs. This new rule is designed to increase estimation precision and treatment benefit by assigning more patients to a better treatment sequence. We demonstrate that designs constructed under the new proposed allocation rule can be nearly as efficient as fixed optimal designs in terms of the mean squared error, while leading to improved patient care.     

Optimal and lead-in adaptive allocation for binary outcomes: A comparison of Bayesian methods

We compare posterior and predictive estimators and probabilities in response-adaptive randomization designs for two- and three-group clinical trials with binary outcomes. Adaptation based upon posterior estimates are discussed, as are two predictive probability algorithms: one using the traditional definition, the other using a skeptical distribution. Optimal and natural lead-in designs are covered. Simulation studies show that efficacy comparisons lead to more adaptation than center comparisons, though at some power loss, skeptically predictive efficacy comparisons and natural lead-in approaches lead to less adaptation but offer reduced allocation variability. Though nuanced, these results help clarify the power-adaptation trade-off in adaptive randomization.     

Doubly adaptive biased coin designs with delayed responses

In clinical studies, patients are usually accrued sequentially. Response‐adaptive designs are then useful tools for assigning treatments to incoming patients as a function of the treatment responses observed thus far. In this regard, doubly adaptive biased coin designs have advantageous properties under the assumption that their responses can be obtained immediately after testing. However, it is a common occurrence that responses are observed only after a certain period of time. The authors examine the effect of delayed responses on doubly adaptive biased coin designs and derive some of their asymptotic properties. It turns out that these designs are relatively insensitive to delayed responses under widely satisfied conditions. This is illustrated with a simulation study.     

A new response-adaptive design for continuous treatment responses for phase III clinical trials

A new response-adaptive design, applicable for general class of continuous response distributions, is proposed. The allocation design is studied both theoretically and numerically and compared with some existing procedures. The applicability of the proposed procedure is also illustrated using real life data sets.     

Longitudinal covariate-adjusted response-adaptive randomized designs

Clinical trials often involve longitudinal data set which has two important characteristics: repeated and correlated measurements and time-varying covariates. In this paper, we propose a general framework of longitudinal covariate-adjusted response-adaptive (LCARA) randomization procedures. We study their properties under widely satisfied conditions. This design skews the allocation probabilities which depend on both patients' first observed covariates and sequentially estimated parameters based on the accrued longitudinal responses and covariates. The asymptotic properties of estimators for the unknown parameters and allocation proportions are established. The special case of binary treatment and continuous responses is studied in detail. Simulation studies and an analysis of the National Cooperative Gallstone Study (NCGS) data are carried out to illustrate the advantages of the proposed LCARA randomization procedure.     

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.     

The power of Efron's biased coin design

The power of a statistical test depends on the sample size. Moreover, in a randomized trial where two treatments are compared, the power also depends on the number of assignments of each treatment. We can treat the power as the conditional probability of correctly detecting a treatment effect given a particular treatment allocation status. This paper uses a simple z-test and a t-test to demonstrate and analyze the power function under the biased coin design proposed by Efron in 1971. We numerically show that Efron's biased coin design is uniformly more powerful than the perfect simple randomization.     

Multi-arm response-adaptive designs for circular responses

A multi-arm response-adaptive allocation design is developed for circular treatment outcomes. Several exact and asymptotic properties of the design are studied. Stage-wise treatment selection procedures based on the proposed response-adaptive design are also suggested to exclude the worse performing treatment(s) at earlier stages. Detailed simulation study is carried out to evaluate the proposed selection procedures. The applicability of the proposed methodologies is illustrated through a real clinical trial data on cataract surgery.     

An optimal response adaptive biased coin design with k heteroscedastic treatments

For comparing treatments in clinical trials, Atkinson (1982) introduced optimal biased coins for balancing patients across treatment assignments by using D-optimality under the assumption of homoscedastic responses of different treatments. However, this assumption can be violated in many real applications. In this paper, we relax the homoscedasticity assumption in the k treatments setting with k>2. A general family of optimal response adaptive biased coin designs are proposed following Atkinson's procedure. Asymptotic properties of the proposed designs are obtained. Some advantages of the proposed design are discussed.     

Variance-penalized response-adaptive randomization with mismeasurement

We consider response-adaptive design of clinical trials under a variance-penalized criterion in the presence of mismeasurement. An explicit expression for the variance-penalized criterion with misclassified dichotomous responses is derived for response-adaptive designs and some properties are discussed. A new target proportion of treatment allocation is proposed under the criterion and related simulation results are presented.     

Adaptive Crossover Design for Normal Responses

In a response-adaptive design, we review and update the trial on the basis of outcomes in order to achive a specific goal. In clinical trials our goal is to allocate a larger number of patients to the better treatment. In the present paper, we use a response adaptive design in a two-treatment two-period crossover trial where the treatment responses are continuous. We provide probability measures to choose between the possible treatment combinations AA, AB, BA, or BB. The goal is to use the better treatment combination a larger number of times. We calculate the allocation proportions to the possible treatment combinations and their standard errors. We also derive some asymptotic results and provide solutions on related inferential problems. The proposed procedure is compared with a possible competitor. Finally, we use a data set to illustrate the applicability of our proposed design.     

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 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.