scholarly journals Adaptive design clinical trials: a review of the literature and ClinicalTrials.gov

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018320 ◽  
Author(s):  
Laura E Bothwell ◽  
Jerry Avorn ◽  
Nazleen F Khan ◽  
Aaron S Kesselheim
Keyword(s):  
Clinical Trials ◽  
Phase I ◽  
Interim Analysis ◽  
Adaptive Design ◽  
Drug Application ◽  
Adaptive Designs ◽  
European Medicines Agency ◽  
Product Approval ◽  
New Drug ◽  
Adaptive Trials

ObjectivesThis review investigates characteristics of implemented adaptive design clinical trials and provides examples of regulatory experience with such trials.DesignReview of adaptive design clinical trials in EMBASE, PubMed, Cochrane Registry of Controlled Clinical Trials, Web of Science and ClinicalTrials.gov. Phase I and seamless Phase I/II trials were excluded. Variables extracted from trials included basic study characteristics, adaptive design features, size and use of independent data monitoring committees (DMCs) and blinded interim analyses. We also examined use of the adaptive trials in new drug submissions to the Food and Drug Administration (FDA) and European Medicines Agency (EMA) and recorded regulators’ experiences with adaptive designs.Results142 studies met inclusion criteria. There has been a recent growth in publicly reported use of adaptive designs among researchers around the world. The most frequently appearing types of adaptations were seamless Phase II/III (57%), group sequential (21%), biomarker adaptive (20%), and adaptive dose-finding designs (16%). About one-third (32%) of trials reported an independent DMC, while 6% reported blinded interim analysis. We found that 9% of adaptive trials were used for FDA product approval consideration, and 12% were used for EMA product approval consideration. International regulators had mixed experiences with adaptive trials. Many product applications with adaptive trials had extensive correspondence between drug sponsors and regulators regarding the adaptive designs, in some cases with regulators requiring revisions or alterations to research designs.ConclusionsWider use of adaptive designs will necessitate new drug application sponsors to engage with regulatory scientists during planning and conduct of the trials. Investigators need to more consistently report protections intended to preserve confidentiality and minimise potential operational bias during interim analysis.

scholarly journals The Bayesian Design of Adaptive Clinical Trials

2021 ◽  
Vol 18 (2) ◽  
pp. 530
Author(s):  
Alessandra Giovagnoli
Keyword(s):  
Clinical Trials ◽  
Adaptive Design ◽  
Recent Literature ◽  
Adaptive Designs ◽  
Bayesian Design ◽  
High Expectations ◽  
Reading Material ◽  
Adaptive Trials ◽  
Adaptive Clinical Trials ◽  
Interesting Reading

This paper presents a brief overview of the recent literature on adaptive design of clinical trials from a Bayesian perspective for statistically not so sophisticated readers. Adaptive designs are attracting a keen interest in several disciplines, from a theoretical viewpoint and also—potentially—from a practical one, and Bayesian adaptive designs, in particular, have raised high expectations in clinical trials. The main conceptual tools are highlighted here, with a mention of several trial designs proposed in the literature that use these methods, including some of the registered Bayesian adaptive trials to this date. This review aims at complementing the existing ones on this topic, pointing at further interesting reading material.

scholarly journals Costs and staffing resource requirements for adaptive clinical trials: quantitative and qualitative results from the Costing Adaptive Trials project

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Nina Wilson ◽  
Katie Biggs ◽  
Sarah Bowden ◽  
Julia Brown ◽  
Munyaradzi Dimairo ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Data Management ◽  
Adaptive Design ◽  
Adaptive Designs ◽  
Great Promise ◽  
Percentage Increase ◽  
Trial Management ◽  
High Quality ◽  
Adaptive Trials ◽  
Adaptive Trial

Abstract Background Adaptive designs offer great promise in improving the efficiency and patient-benefit of clinical trials. An important barrier to further increased use is a lack of understanding about which additional resources are required to conduct a high-quality adaptive clinical trial, compared to a traditional fixed design. The Costing Adaptive Trials (CAT) project investigated which additional resources may be required to support adaptive trials. Methods We conducted a mock costing exercise amongst seven Clinical Trials Units (CTUs) in the UK. Five scenarios were developed, derived from funded clinical trials, where a non-adaptive version and an adaptive version were described. Each scenario represented a different type of adaptive design. CTU staff were asked to provide the costs and staff time they estimated would be needed to support the trial, categorised into specified areas (e.g. statistics, data management, trial management). This was calculated separately for the non-adaptive and adaptive version of the trial, allowing paired comparisons. Interviews with 10 CTU staff who had completed the costing exercise were conducted by qualitative researchers to explore reasons for similarities and differences. Results Estimated resources associated with conducting an adaptive trial were always (moderately) higher than for the non-adaptive equivalent. The median increase was between 2 and 4% for all scenarios, except for sample size re-estimation which was 26.5% (as the adaptive design could lead to a lengthened study period). The highest increase was for statistical staff, with lower increases for data management and trial management staff. The percentage increase in resources varied across different CTUs. The interviews identified possible explanations for differences, including (1) experience in adaptive trials, (2) the complexity of the non-adaptive and adaptive design, and (3) the extent of non-trial specific core infrastructure funding the CTU had. Conclusions This work sheds light on additional resources required to adequately support a high-quality adaptive trial. The percentage increase in costs for supporting an adaptive trial was generally modest and should not be a barrier to adaptive designs being cost-effective to use in practice. Informed by the results of this research, guidance for investigators and funders will be developed on appropriately resourcing adaptive trials.

scholarly journals The data and safety monitoring board in sponsored pediatric clinical trials: practical applications

2015 ◽  
Vol 4 (1) ◽  
pp. 57
Author(s):  
Pramod M. Lad ◽  
Rebecca Dahl
Keyword(s):  
Clinical Trials ◽  
Los Angeles ◽  
Phase I ◽  
Drug Application ◽  
Safety Monitoring ◽  
Stopping Rules ◽  
Practical Applications ◽  
Time Of Application ◽  
Safety Monitoring Board ◽  
Institutional Review

The Data and Safety Monitoring Board (DSMB) monitors the progress of clinical trials for safety and implements stopping rules as needed. Although NIH and FDA guidelines recommend the use of a DSMB for phase I, II, and III pediatric clinical trials, the manner in which the DSMB is constituted has received little attention. In this study we reviewed the Institutional Review Board (IRB) applications submitted between 2008 and 2012 at our institution (Children’s Hospital Los Angeles) for phase I, II and III studies which were multi-site, sponsored and performed under a sponsor’s Investigation New Drug Application (IND) for the type of data and safety monitoring that was being used. Our results indicate that approximately two-third of the studies used an independent DSMB, 10% utilized a sponsor’s DSMB and the remaining studies (25%) did not utilize a DSMB and relied instead on safety monitoring by the Principal Investigator (PI) and the medical monitor/director. This pattern was observed across all study phases and for blinded as well as unblinded studies. Our result suggests that a Data and Safety Monitoring Plan (DSMP), although required by the IRB, is rarely submitted by the sponsor at the time of application. Instead the DSMP is submitted to the IRB by the PI on IRB supplied templates. IRB review of these completed templates were critical to ensuring DSMB related compliance. Additionally, a significant percent of sponsored clinical trials used the PI or an individual designated as medical director/monitor, rather than constituting a DSMB.

scholarly journals REVIEW ON SPONSOR / APPLICANT MEETINGS WITH FDA: HIGHLIGHTS OF NEW GUIDANCE OVER EXISTING

2018 ◽  
Vol 4 (2) ◽  
pp. 19-26
Author(s):  
Charmy Kothari ◽  
Kavina Shah
Keyword(s):  
Clinical Trials ◽  
Management Practices ◽  
Drug Application ◽  
Development Program ◽  
The United States ◽  
United States Department ◽  
Biological Products ◽  
New Drug ◽  
License Application ◽  
New Drug Application

The United States Department of Health and Human Services has a federal agency called the Food and Drug Administration (FDA or USFDA). A pre-planned assembling of two or more people who have been together for the purpose of getting a common goal via verbal interaction is called a formal meeting. During development stage of any drug or biological products pharmaceutical companies face trouble for both scientific and regulatory point of view, here role of formal meetings comes. Formal meetings between sponsor or applicant and FDA are usually related to development and review of drug and biological products. Center for Drug evaluation and Research (CDER) and Center for Biologics Evaluation and Research (CBER) regulates the formal meetings. These meetings are applicable to Pre – Investigational New Drug Application, Pre – Biologics License Application, New Drug Application for drugs and biological products and not applicable to Abbreviated New Drug Applications (ANDA), application of medical devices and submission of biosimilar biological products. Meetings between FDA and sponsor or applicant are for resolution of dispute, clinical holds discussion, Assessment of protocols of clinical trial, during clinical trials, in between clinical trials – at the phase 1 ending or at the phase 2 ending, to discuss development program. The FDA has classified these formal meetings in different types based on the nature of the request, the information in the meeting request and each meeting type is handled through different procedures. The principles of Good Meeting Management Practices (GMMPs) must be maintained. There are specific requirements and procedures to request, prepare, schedule, conduct and document formal meetings. As the guidance documents for meetings are revised by FDA, Change in procedure and requirements takes place. Any pharmaceutical company need to be in line with new guidance requirements to avoid rejection. Formal meetings between sponsor or applicant and FDA save time, cost and will increase the probability of product approval.

scholarly journals The Adaptive designs CONSORT Extension (ACE) statement: a checklist with explanation and elaboration guideline for reporting randomised trials that use an adaptive design

BMJ ◽  
2020 ◽  
pp. m115 ◽  
Author(s):  
Munyaradzi Dimairo ◽  
Philip Pallmann ◽  
James Wason ◽  
Susan Todd ◽  
Thomas Jaki ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Adaptive Design ◽  
Randomised Trial ◽  
Adaptive Designs ◽  
Future Research ◽  
Randomised Trials ◽  
Public And Private ◽  
Key Stakeholders ◽  
Potential Benefits ◽  
Explanatory Text

AbstractAdaptive designs (ADs) allow pre-planned changes to an ongoing trial without compromising the validity of conclusions and it is essential to distinguish pre-planned from unplanned changes that may also occur. The reporting of ADs in randomised trials is inconsistent and needs improving. Incompletely reported AD randomised trials are difficult to reproduce and are hard to interpret and synthesise. This consequently hampers their ability to inform practice as well as future research and contributes to research waste. Better transparency and adequate reporting will enable the potential benefits of ADs to be realised.This extension to the Consolidated Standards Of Reporting Trials (CONSORT) 2010 statement was developed to enhance the reporting of randomised AD clinical trials. We developed an Adaptive designs CONSORT Extension (ACE) guideline through a two-stage Delphi process with input from multidisciplinary key stakeholders in clinical trials research in the public and private sectors from 21 countries, followed by a consensus meeting. Members of the CONSORT Group were involved during the development process.The paper presents the ACE checklists for AD randomised trial reports and abstracts, as well as an explanation with examples to aid the application of the guideline. The ACE checklist comprises seven new items, nine modified items, six unchanged items for which additional explanatory text clarifies further considerations for ADs, and 20 unchanged items not requiring further explanatory text. The ACE abstract checklist has one new item, one modified item, one unchanged item with additional explanatory text for ADs, and 15 unchanged items not requiring further explanatory text.The intention is to enhance transparency and improve reporting of AD randomised trials to improve the interpretability of their results and reproducibility of their methods, results and inference. We also hope indirectly to facilitate the much-needed knowledge transfer of innovative trial designs to maximise their potential benefits.

scholarly journals Age disparity between a cancer population and participants in clinical trials submitted as a new drug application of anticancer drugs in Japan

Cancer ◽  
2007 ◽  
Vol 109 (12) ◽  
pp. 2541-2546 ◽  
Author(s):  
Akiko Hori ◽  
Taro Shibata ◽  
Masahiro Kami ◽  
Eiji Kusumi ◽  
Hiroto Narimatsu ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Anticancer Drugs ◽  
Drug Application ◽  
New Drug ◽  
New Drug Application ◽  
Age Disparity

Adaptive Trials and Interim Analysis

2018 ◽  
pp. 377-394
Author(s):  
Priscila Caldeira Andrade ◽  
Nazem Atassi ◽  
Laura Castillo-Saavedra ◽  
Andre Brunoni ◽  
Felipe Fregni
Keyword(s):  
Study Protocol ◽  
Interim Analysis ◽  
Adaptive Design ◽  
Clinical Development ◽  
Early Termination ◽  
Adaptive Trials

This chapter discusses the important aspect of changing trial aspects, including analyzing data, before formal completion of a trial. Interim analysis (or analyses before trial is finished) should be planned and described in the study protocol, before starting the trial, to ensure the potential penalties for doing such analyses do not invalidate trial results and/or satisfy ethical requirements. The chapter discusses reasons and methods to perform interim analysis. Based on the results from interim analysis, some adjustments in the trial should be required, including early termination. Although the main goal of adaptive design is to increase the success of clinical development, making the studies more efficient and more likely to demonstrate the effect of a treatment, the investigator needs to be careful when using these methods as they can also introduce other potential biases in the study.

A Bayesian Hybrid Adaptive Randomisation Design for Clinical Trials with Survival Outcomes

2016 ◽  
Vol 55 (01) ◽  
pp. 4-13
Author(s):  
M. Moatti ◽  
S. Zohar ◽  
W. F. Rosenberger ◽  
S. Chevret
Keyword(s):  
Clinical Trial ◽  
Multiple Myeloma ◽  
Clinical Trials ◽  
Adaptive Design ◽  
Hazard Ratio ◽  
Adaptive Designs ◽  
Stopping Rules ◽  
Phase Iii ◽  
Optimal Criterion ◽  
Fully Bayesian

SummaryBackground: Response-adaptive randomisation designs have been proposed to im -prove the efficiency of phase III randomised clinical trials and improve the outcomes of the clinical trial population. In the setting of failure time outcomes, Zhang and Rosen -berger (2007) developed a response-adaptive randomisation approach that targets an optimal allocation, based on a fixed sample size. Objectives: The aim of this research is to propose a response-adaptive randomisation procedure for survival trials with an interim monitoring plan, based on the following optimal criterion: for fixed variance of the esti -mated log hazard ratio, what allocation minimizes the expected hazard of failure? We demonstrate the utility of the design by re -designing a clinical trial on multiple myeloma. Methods: To handle continuous monitoring of data, we propose a Bayesian response-adap -tive randomisation procedure, where the log hazard ratio is the effect measure of interest. Combining the prior with the normal likelihood, the mean posterior estimate of the log hazard ratio allows derivation of the optimal target allocation. We perform a simu lationstudy to assess and compare the perform -ance of this proposed Bayesian hybrid adaptive design to those of fixed, sequential or adaptive – either frequentist or fully Bayesian – designs. Non informative normal priors of the log hazard ratio were used, as well as mixture of enthusiastic and skeptical priors. Stopping rules based on the posterior dis -tribution of the log hazard ratio were com -puted. The method is then illus trated by redesigning a phase III randomised clinical trial of chemotherapy in patients with multiple myeloma, with mixture of normal priors elicited from experts. Results: As expected, there was a reduction in the proportion of observed deaths in the adaptive vs. non-adaptive designs; this reduction was maximized using a Bayes mix -ture prior, with no clear-cut improvement by using a fully Bayesian procedure. The use of stopping rules allows a slight decrease in the observed proportion of deaths under the alternate hypothesis compared with the adaptive designs with no stopping rules. Conclusions: Such Bayesian hybrid adaptive survival trials may be promising alternatives to traditional designs, reducing the duration of survival trials, as well as optimizing the ethical concerns for patients enrolled in the trial.

scholarly journals COVID-19 Pandemic and Trends in Clinical Trials: A Multi-Region and Global Perspective

2021 ◽  
Vol 8 ◽  
Author(s):  
Satoshi Nishiwaki ◽  
Yuichi Ando
Keyword(s):  
Clinical Trials ◽  
Negative Correlation ◽  
Clinical Development ◽  
Global Perspective ◽  
Percentage Change ◽  
European Medicines Agency ◽  
Press Releases ◽  
Percentage Decrease ◽  
New Drug ◽  
The Mean

To evaluate the effect of the COVID-19 pandemic on clinical development, the number of newly started clinical trials in each geographical region between January 2018 and December 2020 were calculated based on data from the ClinicalTrials.gov database. Data regarding new drug applications were obtained from European Medicines Agency monthly reports, pharmaceutical company press releases, and the archives of the Drugs.com database. The mean percentage change in newly started clinical trials for diseases other than COVID-19 between each month in 2019 and the corresponding month in 2020 was −7.5%, with the maximum of −57.3% observed between April 2019 and April 2020. Similarly, the mean percentage change of reported results for each month in 2019 and 2020 was −5.1%, with the maximum of −27.4% observed in July 2020. The activity of clinical trials was decreased as the number of COVID-19 patients was increased, and a statistically negative correlation was observed between the prevalence of COVID-19 and the percentage decrease in the number of clinical trials stared or reported results. As for new drug submissions, decreases were observed in the latter half of 2020 compared with the same period during the previous year, for each indicator. A considerable decline in non-COVID-19 activity for all indicators regarding clinical developments was suggested during the first wave of the COVID-19 pandemic. It is important to recognize the situation and continue to make efforts to conduct clinical trials for both COVID-19 and no-COVID-19 for new medical developments in the future.

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