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Adaptive Trial Designs

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Clinical Trial Simulations

Part of the book series: AAPS Advances in the Pharmaceutical Sciences Series ((AAPS,volume 1))

Abstract

Adaptive designs (AD) have received a great deal of attention in recent years because of the potential they offer to improve the efficiency of clinical drug development. In an increasingly challenging environment, characterized by escalating costs and decreasing likelihood of regulatory approval, sponsors and regulators alike have a keen interest in strategies to modernize drug development – the use of AD is a key one among them.

This chapter presents an overview of AD and their use in clinical drug development. It starts with some background and definitions, followed by sections on AD in the Learn and Confirm phases of clinical development. In later sections, the importance of trial simulations in the context of AD is discussed, followed by thoughts on the future of AD.

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References

  • Armitage P (1975) Sequential medical trials. Wiley, New York

    Google Scholar 

  • Bauer P, Koehne K (1994) Evaluation of experiments with adaptive interim analyses. Biometrics 50:1029–1041

    Google Scholar 

  • Berry DA, Mueller P, Grieve AP, Smith MK, Parke T, Krams M (2002) Bayesian designs for dose-ranging drug trials. In: Gatsonis C, Kass RE, Carlin B, Carriquiry A, Gelman A, Verdinelli I, West M (eds) Case studies in Bayesian statistics, vol 5. Springer, New York, pp 99–181

    Chapter  Google Scholar 

  • Bornkamp B, Bretz F, Dmitrienko A, Enas G, Gaydos B, Hsu CH, Koenig F, Krams M, Liu Q, Neuenschwander B, Parke T, Pinheiro J, Roy A, Sax R, Shen F (2007) Innovative approaches for designing and analyzing adaptive dose-ranging trials (with discussion). J Biopharm Stat 17:965–995

    Article  PubMed  Google Scholar 

  • Brannath W, Zuber E, Branson M, Bretz F, Gallo P, Posch M, Racine-Poon A (2009) Confirmatory adaptive designs with Bayesian decision tools for a targeted therapy in oncology. Stat Med 28(10):1445–1463

    Article  PubMed  Google Scholar 

  • Barnes PJ, Pocock SJ, Magnussen H, Iqbal A, Kramer B, Higgins M, Lawrence D (2010) Integrating Indacaterol dose selection in a clinical study in COPD using an adaptive seamless design. Pulmonary & Therapeutics 23:165–171

    Google Scholar 

  • Bretz F, Pinheiro J, Branson M (2006a) Combining multiple comparisons and modeling techniques in dose-response studies. Biometrics 61(3):738–748

    Article  Google Scholar 

  • Bretz F, Schmidli H, König F, Racine A, Maurer W (2006b) Confirmatory seamless phase II/III clinical trials with hypotheses selection at interim: general concepts (with discussion). Biom J 48(4):623–634

    Article  PubMed  Google Scholar 

  • Bretz F, König F, Brannath W, Glimm E, Posch M (2009) Adaptive designs for confirmatory clinical trials. Stat Med 28(8):1181–1217

    Article  PubMed  Google Scholar 

  • Chevret S (2006) Statistical methods for dose-finding experiments. Wiley, Chichester, England

    Book  Google Scholar 

  • CHMP Working party on Efficacy of Medicinal Products (1995) Biostatistical methodology in clinical trials in applications for marketing authorizations for medicinal products. Stat Med 14:1659–1682

    Article  Google Scholar 

  • Cross J, Lee H, Westelinck A, Nelson J, Grudzinkas C, Peck C (2002) Postmarketing drug dosage changes of 499 FDA-approved new molecular entities, 1980–1999. Pharmacoepidemiol Drug Saf 11(6):439–446

    Article  PubMed  Google Scholar 

  • Cui L, Hung HMJ, Wang S-J (1999) Modification of sample size in group sequential clinical trials. Biometrics 55:853–857

    Article  PubMed  CAS  Google Scholar 

  • Dette H, Bretz F, Pepelyshev A, Pinheiro J (2008) Optimal designs for dose finding studies. J Am Stat Assoc 103:1225–1237

    Article  CAS  Google Scholar 

  • Dmitrienko A, Tamhane AC, Bretz F (eds) (2009) Multiple testing problems in pharmaceutical statistics. Taylor & Francis, New York

    Google Scholar 

  • Dunnett CW (1955) A multiple comparison procedure for comparing several treatments with a control. J Am Stat Assoc 50:1096–1121

    Article  Google Scholar 

  • EMEA/CHMP (2007) Reflection paper on methodological issues in confirmatory clinical trials with flexible design and analysis plan (draft CHMP/EWP/2459/02, 23-Mar-2006). www.ema.europa.eu/pdfs/human/ewp/245902en.pdf

  • FDA (2004) Innovation/stagnation: critical path opportunities report. www.fda.gov/downloads/ScienceResearch/SpecialTopics/CriticalPathInitiative/CriticalPathOpportunitiesReports/UCM077258.pdf

  • FDA (2006) Guidance for clinical trial sponsors on the establishment and operation of clinical trial data monitoring committees. www.fda.gov/downloads/RegulatoryInformation/Guidances/UCM127073.pdf

  • FDA (2010) Adaptive design clinical trials for drug and biologics draft guidance. www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM201790.pdf

  • Friede T, Kieser M (2006) Sample size recalculation in internal pilot study designs: a review. Biom J 48(4):537–555

    Article  PubMed  Google Scholar 

  • Gallo P, Chuang-Stein C, Dragalin V, Gaydos B, Ktams M, Pinheiro J (2006) Adaptive designs in clinical drug development – an executive summary of the PhRMA Working Group. J Biopharm Stat 16:275–283

    Article  PubMed  Google Scholar 

  • Gallo P, Fardipour P, Dragalin V, Krams M, Litman GS, Bretz F (2010) Data monitoring in adaptive dose ranging trials. Stat Biopharm Res (in press)

    Google Scholar 

  • Garret-Mayer E (2006) The continual reassessment method for dose-finding studies: a tutorial. Clin Trials 3(1):57–71

    Article  Google Scholar 

  • Heerdink ER, Urquhart J, Leufkens HG (2002) Changes in prescribed dose after market introduction. Pharmacoepidemiol Drug Saf 11(6):447–453

    Article  PubMed  Google Scholar 

  • ICH E-9 Expert Working Group (1999) Statistical principles for clinical trials (ICH Harmonized Tripartite Guideline E-9). Stat Med 18:1905–1942

    Google Scholar 

  • Jennison C, Turnbull BW (2000) Group sequential methods with applications to clinical trials. Chapman & Hall/CRC, Florida

    Google Scholar 

  • Kraiczi H, Jang T, Ludden T, Peck CC (2003) Randomized concentration-controlled trials: motivations, use, and limitations. Clin Pharmacol Theory 74:203–214

    Article  CAS  Google Scholar 

  • Krams M, Lees KR, Hacke W, Grieve AP, Orgogozo JM, Ford GA for the ASTIN Study investigators (2003) ASTIN: an adaptive dose-response study of UK-279, 276 in acute ischemic stroke. Stroke 34:2543–2548

    Article  Google Scholar 

  • Lan K, DeMets DL (1983) Discrete sequential boundaries for clinical trials. Biometrika 70:659–663

    Article  Google Scholar 

  • Lehmacher W, Wassmer G (1999) Adaptive sample size calculations in group sequential trials. Biometrics 55:1286–1290

    Article  PubMed  CAS  Google Scholar 

  • Miller F, Guilbaud O, Dette H (2007) Optimal designs for estimating the interesting part of a dose-effect curve. J Biopharm Stat 17:1097–1115

    Article  PubMed  Google Scholar 

  • Mueller HH, Schaefer H (2004) A general statistical principle for changing a design any time during the course of a trial. Stat Med 23:2497–2508

    Article  Google Scholar 

  • O’Brien PC, Fleming TR (1979) A multiple testing procedure for clinical trials. Biometrics 35:549–556

    Article  PubMed  Google Scholar 

  • Pinheiro J, Sax R, Antonijevic Z, Bornkamp B, Bretz F, Chuang-Stein C, Dragalin V, Fardipour P, Gallo P, Gillespie W, Hsu CH, Miller F, Padmanabhan SK, Patel N, Perevozskaya I, Roy A, Sanil A, Smith JR (2010) Adaptive and model-based dose ranging trials: quantitative evaluation and recommendations (with discussion). Stat Biopharm Res (in press)

    Google Scholar 

  • Pocock SJ (1977) Group sequential methods in the design and analysis of clinical trials. Biometrika 64:191–199

    Article  Google Scholar 

  • Posch M, Koenig F, Branson M, Brannath W, Dunger-Baldauf C, Bauer P (2005) Testing and estimation in flexible group sequential designs with adaptive treatment selection. Stat Med 24:3697–3714

    Article  PubMed  Google Scholar 

  • Posch M, Maurer W, Bretz F (2010) Type I error rate control in adaptive designs for confirmatory clinical trials with treatment selection at interim. Pharm Stat (in press) 10.1002/pst.413

    Google Scholar 

  • Proschan M (2005) Two-stage sample size reestimation based on a nuisance parameter: a review. J Biopharm Stat 15:559–574

    Article  PubMed  Google Scholar 

  • Proschan MA, Hunsberger SA (1995) Designed extension of studies based on conditional power. Biometrics 51:1315–1324

    Article  PubMed  CAS  Google Scholar 

  • Wang SJ, O’Neill RT, Hung JHM (2007) Approaches to evaluation of treatment effect in randomized clinical trials with genomic subset. Pharm Stat 6:227–244

    Article  PubMed  Google Scholar 

  • Wang SJ, Hung HMJ, O’Neill R (2009) Adaptive patient enrichment designs in therapeutic trials. Biom J 51:358–374

    Article  PubMed  Google Scholar 

  • Wassmer G, Vandemeulebroecke M (2006) A brief review of software developments for group sequential and adaptive designs. Biom J 48(4):732–737

    Article  PubMed  Google Scholar 

  • Wittes J, Brittain E (1990) The role of internal pilot studies in increasing the efficiency of clinical trials. Stat Med 9:65–72

    Article  PubMed  CAS  Google Scholar 

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Correspondence to José C. Pinheiro .

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Pinheiro, J.C., Bretz, F., Hsu, CH. (2011). Adaptive Trial Designs. In: Kimko, H., Peck, C. (eds) Clinical Trial Simulations. AAPS Advances in the Pharmaceutical Sciences Series, vol 1. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7415-0_6

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