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DOSE FINDING STRATEGIES FOR SINGLE DRUG AND COMBINATION DRUG TRIALS

机译:单一药物和联合药物试验的剂量寻找策略

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摘要

A key component of drug development is to establish the compound's dose-response relationship, and identify all effective doses of the drug with a general goal of selecting the minimum effective dose (MED). A new closed testing procedure is proposed for identifying the MED for a single component drug. This procedure is based on constructing simultaneous one-sided confidence bands for the response surface of each dose's effect relative to placebo. Our methodology utilizes a stepwise closed testing to test the ordered hypotheses of equality of mean dose-responses. The pattern of the rejected and accepted null hypotheses provides the estimate of the MED, if it exists.In the case of a combination drug, in addition to demonstrating safety and efficacy the FDA requires demonstrating that each component makes a contribution to the claimed effects. A combination which satisfies the last requirement is called an efficacious combination. In the most common case both single drugs are approved ones, and therefore, the efficacious combinations are effective, that is, they produce a therapeutic effect which is superior to placebo.We propose a closed testing procedure for estimating the minimum efficacious combinations (MeD's) in a two-drug study and introduce a notion of the MeD-set.The main advantage of a closed testing procedure is the strong control of the familywise error at level of significance á and allowing testing individual hypotheses at the same significance level á without multiplicity adjustments.The proposed procedure is based on two main steps. In the first step, all possible structures of the population MeD-set are identified and the related closed family of hypotheses is constructed, and the proper step-down testing partial order is established. The second step is the "á-testing" step. Using the closed testing principle, we test the hypotheses by constructing the AVE-test statistic. The pattern of the rejected null hypotheses identifies the MeD-set. In order to assess the performance of our procedure, we define several statistical measures. These notions are used in a large simulation study to examine the goodness of the estimation procedures and to identify the population configurations when the procedure performs the best.
机译:药物开发的关键组成部分是建立化合物的剂量反应关系,并以选择最小有效剂量(MED)的总体目标来确定药物的所有有效剂量。提出了一种新的封闭测试程序,用于识别单组分药物的MED。此过程基于为每种剂量相对于安慰剂的反应表面构建同时的一侧置信带。我们的方法采用逐步封闭测试来检验平均剂量反应相等的有序假设。被拒绝和被接受的零假设的模式提供了MED的估计值(如果存在)。就联合药物而言,除了证明安全性和有效性之外,FDA还需要证明每种成分均对所要求的作用做出了贡献。满足最后要求的组合称为有效组合。在最常见的情况下,两种单一药物都是获批的药物,因此有效的组合是有效的,也就是说,它们产生的疗效要优于安慰剂。我们提出了一种封闭的测试程序,以估算最低有效组合(MeD's)在一项针对两种药物的研究中,并介绍了MeD集的概念。封闭测试程序的主要优点是可以在显着性水平á上对家庭错误进行有力的控制,并允许在相同显着性水平á上对单个假设进行测试而无需多重性调整。建议的程序基于两个主要步骤。第一步,确定总体MeD集的所有可能结构,并构建相关的假设封闭族,并建立适当的降压测试偏序。第二步是“á-testing”步骤。使用封闭检验原理,我们通过构造AVE检验统计量检验假设。被拒绝的零假设的模式标识了MeD集。为了评估我们程序的性能,我们定义了几种统计方法。这些概念用于大型模拟研究中,以检验估计程序的优缺点,并在程序执行效果最佳时确定总体配置。

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    Soulakova Julia;

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  • 年度 2006
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