Learning : Short Courses

 
 


Adaptive Clinical Trials

Scott S. Emerson, MD, PhD

November, 2010

Abstract: Increasingly, clinical trials are conducted using group sequential methods and, more recently, adaptive clinical trial designs in order to address the ethical and efficiency issues that arise when performing experiments with human volunteers. The design, conduct, and analysis of a sequential clinical trial is necessarily more involved than that for a clinical trial in which the data would only be analyzed at the end of the study. However, the basic tenets of careful consideration of the scientific question and clinical setting remains the same. In this short course we present an overview of the issues that must be considered when conducting any sequential trial, and contrast the more commonly used group sequential approach to the various forms of adaptive designs that have been described in the statistical literature.






Course Materials (pdf):               Presentation Handouts


Learning Material:


  1. Short Courses

  2. Research Talks

  3. Case Studies


1. Introduction and Overview: 

Scientific design of clinical trials

(Slides:1-47) (60:59)



2. Phases of Investigation: 

Definition of an “indication”;
 
Phase I, II, III, IV trials

(Slides:48-56) (7:52)



3. Confirmatory Trials: 

Motivating the need for confirmatory phase III trials

(Slides:57-66) (15:46)



4. Efficacy vs Effectiveness: 

Definition of efficacy and effectiveness trials; 
RCT settings where effectiveness might be preferred

(Slides:67-78) (12:03)



5. Screening Trials: 

Phase II as screening trials, Phase I, IV trials

(Slides:79-97) (29:07)



http://www.rct-design.com/ShortCourses/CDRH2010 Introduction and Overview/CDRH2010 Introduction and Overview.html http://www.rct-design.com/ShortCourses/CDRH2010 Phases of Investigation/CDRH2010 Phases of Investigation.html http://www.rct-design.com/ShortCourses/CDRH2010 Confirmatory Trials/CDRH2010 Confirmatory Trials.html http://www.rct-design.com/ShortCourses/CDRH2010 Efficacy vs Effectiveness/CDRH2010 Efficacy vs Effectiveness.html http://www.rct-design.com/ShortCourses/CDRH2010 Screening Trials/CDRH2010 Screening Trials.html shapeimage_3_link_0shapeimage_3_link_1shapeimage_3_link_2shapeimage_3_link_3shapeimage_3_link_4
6. Motivating Example: 

Progression from phase II to phase III; 
Selection of stopping rules

(Slides:98-111) (29:48)


7. Study Precision: 

Statistical design, sample size determination

(Slides:112-136) (32:22)


8. GSD - O'Brien-Fleming Efficacy Boundaries: 

Effect of O'Brien-Fleming efficacy boundaries on power, sample size requirements

(Slides:137-148) (22:23)


9. GSD - Futility Boundaries: 

Effect of futility boundaries on power, sample size requirements; 
correspondence to conditional/predictive power

(Slides:149-160) (6:32)



http://www.rct-design.com/ShortCourses/CDRH2010 Motivating Example/CDRH2010 Motivating Example.html http://www.rct-design.com/ShortCourses/CDRH2010 Study Precision/CDRH2010 Study Precision.html http://www.rct-design.com/ShortCourses/CDRH2010 OBrien-Fleming Efficacy Boundary/CDRH2010 OBrien-Fleming Efficacy Boundary.html http://www.rct-design.com/ShortCourses/CDRH2010 OBrien-Fleming Efficacy Boundary/CDRH2010 OBrien-Fleming Efficacy Boundary.html http://www.rct-design.com/ShortCourses/CDRH2010 Futility Boundaries/CDRH2010 Futility Boundaries.html http://www.rct-design.com/ShortCourses/CDRH2010 Futility Boundaries/CDRH2010 Futility Boundaries.html shapeimage_4_link_0shapeimage_4_link_1shapeimage_4_link_2shapeimage_4_link_3shapeimage_4_link_4shapeimage_4_link_5
10. GSD - Efficient Boundaries: 

Effect of increasing number of analyses; optimal boundary shapes

(Slides:161-173) (14:59)


11. Response Adaptive Modifications: 

Results of Proschan & Hunsberger; Reweighting incremental statistics

(Slides:174-187) (27:30)


12. Modification of Maximal Sample Size: 

Efficient response adaptive modification of the maximal sample size

(Slides:188-198) (18:41)


13. Comments on example from Mehta and Pocock: 

Discussion of a manuscript that appeared in Statistics in Medicine

(Slides II:199-204) (17:36)


14. Final Comments: 

Cost of planning not to plan; Other adaptive applications; Final comments

(Slides:205-240) (16:46)

http://www.rct-design.com/ShortCourses/CDRH2010 Efficient Boundaries/CDRH2010 Efficient Boundaries.html http://www.rct-design.com/ShortCourses/CDRH2010 Efficient Boundaries/CDRH2010 Efficient Boundaries.html http://www.rct-design.com/ShortCourses/CDRH2010 Response Adaptive Modifications/CDRH2010 Response Adaptive Modifications.html http://www.rct-design.com/ShortCourses/CDRH2010 Modification of Maximal Sample Size/CDRH2010 Modification of Maximal Sample Size.html http://www.rct-design.com/ShortCourses/CDRH2010 Example from Mehta and Pocock/CDRH2010 Example from Mehta and Pocock.html http://www.rct-design.com/ShortCourses/CDRH2010 Example from Mehta and Pocock/CDRH2010 Example from Mehta and Pocock.html http://www.rct-design.com/ShortCourses/CDRH2010 Final Comments/CDRH2010 Final Comments.html shapeimage_5_link_0shapeimage_5_link_1shapeimage_5_link_2shapeimage_5_link_3shapeimage_5_link_4shapeimage_5_link_5shapeimage_5_link_6

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