SMART Thinking: a Review of Recent Developments in Sequential Multiple Assignment Randomized Trials


With the increasing interest in personalized medicine, over the last decade, sequential multiple assignment randomized trials (SMARTs) have become a more common fixture of the clinical trial landscape. Primarily of use in the identification of dynamic treatment regimes, they have experienced a shift from the more complex designs of the past to the considerably streamlined versions seen today. In this review, we summarize their history, outline recent and ongoing examples, and discuss some of the important methodological developments for their design and implementation.

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Papers of particular interest, published recently, have been highlighted as: • Of importance

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This work is funded by Natural Sciences and Engineering Research Council (NSERC) of Canada Discovery Grants. Dr. Moodie is sponsored by a Chercheur-Boursier career award from the Fonds de Recherche du Québec-Santé (FRSQ), and Dr. Wallace is partially supported by a training scholarship from the Canadian Network for Advanced Interdisciplinary Methods for comparative effectiveness research, Drug Safety and Effectiveness Network (CAN-AIM DSEN).

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Correspondence to Michael P. Wallace.

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This article is part of the Topical Collection on Epidemiologic Methods

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Wallace, M.P., Moodie, E.E.M. & Stephens, D.A. SMART Thinking: a Review of Recent Developments in Sequential Multiple Assignment Randomized Trials. Curr Epidemiol Rep 3, 225–232 (2016).

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  • SMARTs
  • Dynamic treatment regimes
  • Adaptive treatment strategies
  • Longitudinal data
  • Causal inference