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.     

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.     

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.     

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.     

Randomization tests in recursive response-adaptive randomization procedures

In a randomized clinical trial, response-adaptive randomization procedures use the information gathered, including the previous patients' responses, to allocate the next patient. In this setting, we consider randomization-based inference. We provide an algorithm to obtain exact p-values for statistical tests that compare two treatments with dichotomous responses. This algorithm can be applied to a family of response adaptive randomization procedures which share the following property: the distribution of the allocation rule depends only on the imbalance between treatments and on the imbalance between successes for treatments 1 and 2 in the previous step. This family includes some outstanding response adaptive randomization procedures. We study a randomization test to contrast the null hypothesis of equivalence of treatments and we show that this test has a similar performance to that of its parametric counterpart. Besides, we study the effect of a covariate in the inferential process. First, we obtain a parametric test, constructed assuming a logit model which relates responses to treatments and covariate levels, and we give conditions that guarantee its asymptotic normality. Finally, we show that the randomization test, which is free of model specification, performs as well as the parametric test that takes the covariate into account.     

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.     

Using partial ranking information in the design of small-sample comparisons

Random assignment of experimental units to treatment and control groups is a conventional device tob create unbiased comparisons. However, when sample sizes are small and the units differ considerably, there is a significant risk that randomization will create seriously unbalanced partitions of the units into treatment and control groups. We develop and evaluate an alternative to complete randomization for small-sample comparisons involving ordinal data with partial information on ranks of units. For instance, we might know that, of eight units, Rank (A) < Rank (C), Rank (A) < Rank (E) and Rank(D) < Rank(H). We develop an efficient computational procedure to use such information as the basis for restricted randomization of units to the treatment group. We compare our methods to complete randomization in the context of the Mann-Whitney test. With sufficient ranking information, the restricted randomization results in more powerful comparisons.     

A class of treatment assignment rules for sequential experiments

In an experiment to compare K(<2) treatments, suppose that eligible subjects arrive at an experimental site sequentially and must be treated immediately. In this paper, we assume that the size of the experiment cannot be predetermined and propose and analyze a class of treatment assignment rules which offer compromises between the complete randomization and the perfect balance schemes, A special case of these assignment rules is thoroughly investigated and is featured in the numerical compu-tations. For practical use, a method of implementation of this special rule is provided.     

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.     

Properties of a randomization test for multifactor comparisons of groups

Multivariate hypothesis testing in studies of vegetation is likely to be hindered by unrealistic assumptions when based on conventional statistical methods. This can be overcome by randomization tests. In this paper, the accuracy and power of a MANOVA randomization test are evaluated for one and two factors with interaction with simulated data from three distributions. The randomization test is based on the partitioning of sum of squares computed from Euclidean distances. In one-factor designs, sample size and variance inequality were evaluated. The results showed a high level of accuracy. The power curve was higher with normal distribution, lower with uniform, intermediate with lognormal and was sensitive to variance inequality. In two-factor designs, three methods of permutations and two statistics were compared. The results showed that permutation of the residuals with F _pseudo is accurate and can give good power for testing the interaction and restricted permutation for testing main factors.     

Sample size determination for cluster randomization phase II trials of dichotomous data

One of the main goals for a phase II trial is to screen and select the best treatment to proceed onto further studies in a phase III trial. Under the flexible design proposed elsewhere, we discuss for cluster randomization trials sample size calculation with a given desired probability of correct selection to choose the best treatment when one treatment is better than all the others. We develop exact procedures for calculating the minimum required number of clusters with a given cluster size (or the minimum number of patients with a given number of repeated measurements) per treatment. An approximate sample size and the evaluation of its performance for two arms are also given. To help readers employ the results presented here, tables are provided to summarize the resulting minimum required sample sizes for cluster randomization trials with two arms and three arms in a variety of situations. Finally, to illustrate the sample size calculation procedures developed here, we use the data taken from a cluster randomization trial to study the association between the dietary sodium and the blood pressure.     

Application of Bayesian hierarchical models for phase I/II clinical trials in oncology

Treatment during cancer clinical trials sometimes involves the combination of multiple drugs. In addition, in recent years there has been a trend toward phase I/II trials in which a phase I and a phase II trial are combined into a single trial to accelerate drug development. Methods for the seamless combination of phases I and II parts are currently under investigation. In the phase II part, adaptive randomization on the basis of patient efficacy outcomes allocates more patients to the dose combinations considered to have higher efficacy. Patient toxicity outcomes are used for determining admissibility to each dose combination and are not used for selection of the dose combination itself. In cases where the objective is not to find the optimum dose combination solely for efficacy but regarding both toxicity and efficacy, the need exists to allocate patients to dose combinations with consideration of the balance of existing trade‐offs between toxicity and efficacy. We propose a Bayesian hierarchical model and an adaptive randomization with consideration for the relationship with toxicity and efficacy. Using the toxicity and efficacy outcomes of patients, the Bayesian hierarchical model is used to estimate the toxicity probability and efficacy probability in each of the dose combinations. Here, we use Bayesian moving‐reference adaptive randomization on the basis of desirability computed from the obtained estimator. Computer simulations suggest that the proposed method will likely recommend a higher percentage of target dose combinations than a previously proposed method.     

A hybrid approach to achieving both marginal and conditional balances for stratification variables in sequential clinical trials

Various methods exist in the literature for achieving marginal balance for baseline stratification variables in sequential clinical trials. One major limitation with balancing on the margins of the stratification variables is that there is an efficiency loss when the primary analysis is stratified. To preserve the efficiency of a stratified analysis one recently proposed approach balances on the crossing of the stratification variables included in the analysis, which achieves conditional balance for the variables. A hybrid approach to achieving both marginal and conditional balances in sequential clinical trials is proposed, which is applicable to both continuous and categorical stratification variables. Numerical results based on extensive simulation studies and a real dataset show that the proposed approach outperforms the existing ones and is particularly useful when both additive and stratified models are planned for a trial. Copyright © 2013 John Wiley & Sons, Ltd.     

An exact test for trend among binomial proportions based on a modified Baumgartner-Weiß-Schindler statistic

The Cochran-Armitage test is the most frequently used test for trend among binomial proportions. This test can be performed based on the asymptotic normality of its test statistic or based on an exact null distribution. As an alternative, a recently introduced modification of the Baumgartner-Weiß-Schindler statistic, a novel nonparametric statistic, can be used. Simulation results indicate that the exact test based on this modification is preferable to the Cochran-Armitage test. This exact test is less conservative and more powerful than the exact Cochran-Armitage test. The power comparison to the asymptotic Cochran-Armitage test does not show a clear winner, but the difference in power is usually small. The exact test based on the modification is recommended here because, in contrast to the asymptotic Cochran-Armitage test, it guarantees a type I error rate less than or equal to the significance level. Moreover, an exact test is often more appropriate than an asymptotic test because randomization rather than random sampling is the norm, for example in biomedical research. The methods are illustrated with an example data set.     

A Mann–Whitney type effect measure of interaction for factorial designs

We propose a measure for interaction for factorial designs that is formulated in terms of a probability similar to the effect size of the Mann–Whitney test. It is shown how asymptotic confidence intervals can be obtained for the effect size and how a statistical test can be constructed. We further show how the test is related to the test proposed by Bhapkar and Gore [Sankhya A, 36:261–272 (1974)]. The results of a simulation study indicate that the test has good power properties and illustrate when the asymptotic approximations are adequate. The effect size is demonstrated on an example dataset.     

A general scheme for sequential treatment allocation vith balancing for prognostic factors in clinical trials

A general family of dynamic treatment allocations is defined, and it is shown that the permuted block procedure (Zelen 1974) and Begg and Iglewicz method (1980) are extreme choices in this family. A compromise method is suggested. The framework of this general family allows the relationships between these methods to be examined. By means of a simulation study these three methods plus the complete randomization method are compared in terms of efficiency and balance. The compromise method is shown to have good overall properties. In addition, an illustrative example is given     

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.     

Issues for stratified randomization based on a factor derived from a continuous baseline variable

Stratified randomization based on the baseline value of the primary analysis variable is common in clinical trial design. We illustrate from a theoretical viewpoint the advantage of such a stratified randomization to achieve balance of the baseline covariate. We also conclude that the estimator for the treatment effect is consistent when including both the continuous baseline covariate and the stratification factor derived from the baseline covariate. In addition, the analysis of covariance model including both the continuous covariate and the stratification factor is asymptotically no less efficient than including either only the continuous baseline value or only the stratification factor. We recommend that the continuous baseline covariate should generally be included in the analysis model. The corresponding stratification factor may also be included in the analysis model if one is not confident that the relationship between the baseline covariate and the response variable is linear. In spite of the above recommendation, one should always carefully examine relevant historical data to pre-specify the most appropriate analysis model for a perspective study.     

Estimation of survival quantiles in two-stage randomization designs

In two-stage randomization designs, patients are randomized to one or more available therapies upon entry into the study. Depending on the response to the initial treatment (such as complete remission or shrinkage of tumor), patients are then randomized to receive maintenance treatments to maintain the response or salvage treatment to induce response. One goal of such trials is to compare the combinations of initial and maintenance or salvage therapies in the form of treatment strategies. In cases where the endpoint is defined as overall survival, Lunceford et al. [2002. Estimation of survival distributions of treatment policies in two-stage and randomization designs in clinical trials. Biometrics 58, 48–57] used mean survival time and pointwise survival probability to compare treatment strategies. But, mean survival time or survival probability at a specific time may not be a good summary representative of the overall distribution when the data are skewed or contain influential tail observations. In this article, we propose consistent and asymptotic normal estimators for percentiles of survival curves under various treatment strategies and demonstrate the use of percentiles for comparing treatment strategies. Small sample properties of these estimators are investigated using simulation. We demonstrate our methods by applying them to a leukemia clinical trial data set that motivated this research.     

A design for testing clinical strategies: biased adaptive within-subject randomization

We propose a method for assigning treatment in clinical trials, called the 'biased coin adaptive within-subject' (BCAWS) design: during the course of follow-up, the subject's response to a treatment is used to influence the future treatment, through a 'biased coin' algorithm. This design results in treatment patterns that are closer to actual clinical practice and may be more acceptable to patients with chronic disease than the usual fixed trial regimens, which often suffer from drop-out and non-adherence. In this work, we show how to use the BCAWS design to compare treatment strategies, and we provide a simple example to illustrate the method.