TRIAL DESIGNS THAT SIMULTANEOUSLY OPTIMIZE THE POPULATION ENROLLED AND THE TREATMENT ALLOCATION PROBABILITIES

摘要

Standard randomized trials may have lower than desired power when the treatment effect is only strong in certain subpopulations. This may occur, for example, in populations with varying disease severities or when subpopulations carry distinct biomarkers and only those who are biomarker positive respond to treatment. To address such situations, we develop a new trial design that combines two types of preplanned rules for updating how the trial is conducted based on data accrued during the trial. The aim is a design with greater overall power and that can better determine subpopulation specific treatment effects, while maintaining strong control of the familywise Type I error rate. The first component of our design involves response-adaptive randomization, in which the probability of being assigned to the treatment or control arm is updated during the trial to target an optimal allocation. The second component of our design involves enrichment, where the criteria for patient enrollment may be modified to help learn which subpopulations benefit from the treatment. We do a simulation study to compare the power of our design, which we call a response-adaptive enrichment design, to three simpler designs: a standard randomized trial design, a response-adaptive design, and an enrichment design. Our simulation study compares these designs in scenarios that arise from the problem of testing the effectiveness of a hypothetical new antidepressant.