scholarly journals A novel approach to sample size determination of clinical trials for rare diseases assuming symmetry

2019 ◽  
Author(s):  
Emma Wang ◽  
Bernard North ◽  
Peter Sasieni
Keyword(s):  
Clinical Trials ◽  
Hypothesis Testing ◽  
Rare Diseases ◽  
Statistical Power ◽  
Type I Error ◽  
Standard Of Care ◽  
Testing Procedure ◽  
Sample Size Determination ◽  
Type I ◽  
Number Of Patients

Abstract Abstract Background Rare and uncommon diseases are difficult to study in clinical trials due to limited recruitment. If the incidence of the disease is very low, international collaboration can only solve the problem to a certain extent. A consequence is a disproportionately high number of deaths from rare diseases, due to unclear knowledge of the best way to treat patients suffering from these diseases. Hypothesis testing using the conventional Type I error in conjunction with the number of patients who can realistically be enrolled for a rare disease, would cause the trial to be severely underpowered. Methods Our proposed method recognises these pragmatic limitations and suggests a new testing procedure, wherein conclusion of efficacy of one arm is grounded in robust evidence of non-inferiority in the endpoint of interest, and reasonable evidence of superiority, over the other arm. Results Simulations were conducted to illustrate the gains in statistical power compared with conventional hypothesis testing in several statistical settings as well as the example of clinical trials for Merkel cell carcinoma, a rare skin tumour. Conclusions Our proposed analysis method enables conducting clinical trials for rare diseases, potentially leading to better standard of care for patients suffering from rare diseases

Sequential designs with small samples: Evaluation and recommendations for normal responses

2016 ◽  
Vol 27 (4) ◽  
pp. 1115-1127 ◽  
Author(s):  
Stavros Nikolakopoulos ◽  
Kit CB Roes ◽  
Ingeborg van der Tweel
Keyword(s):  
Clinical Trials ◽  
Sample Size ◽  
Rare Diseases ◽  
Type I Error ◽  
Small Samples ◽  
Type I ◽  
Sequential Designs ◽  
Sequential Methods ◽  
Maximum Sample Size ◽  
Number Of Patients

Sequential monitoring is a well-known methodology for the design and analysis of clinical trials. Driven by the lower expected sample size, recent guidelines and published research suggest the use of sequential methods for the conduct of clinical trials in rare diseases. However, the vast majority of the developed and most commonly used sequential methods relies on asymptotic assumptions concerning the distribution of the test statistics. It is not uncommon for trials in (very) rare diseases to be conducted with only a few decades of patients and the use of sequential methods that rely on large-sample approximations could inflate the type I error probability. Additionally, the setting of a rare disease could make the traditional paradigm of designing a clinical trial (deciding on the sample size given type I and II errors and anticipated effect size) irrelevant. One could think of the situation where the number of patients available has a maximum and this should be utilized in the most efficient way. In this work, we evaluate the operational characteristics of sequential designs in the setting of very small to moderate sample sizes with normally distributed outcomes and demonstrate the necessity of simple corrections of the critical boundaries. We also suggest a method for deciding on an optimal sequential design given a maximum sample size and some (data driven or based on expert opinion) prior belief on the treatment effect.

Use of interval estimations in design and evaluation of multiregional clinical trials with continuous outcomes

2018 ◽  
Vol 28 (7) ◽  
pp. 2179-2195 ◽  
Author(s):  
Chieh Chiang ◽  
Chin-Fu Hsiao
Keyword(s):  
Clinical Trials ◽  
Sample Size ◽  
Type I Error ◽  
Interval Estimation ◽  
Error Rates ◽  
New Drugs ◽  
Sample Size Determination ◽  
Type I ◽  
Size Determination ◽  
Interval Estimators

Multiregional clinical trials have been accepted in recent years as a useful means of accelerating the development of new drugs and abridging their approval time. The statistical properties of multiregional clinical trials are being widely discussed. In practice, variance of a continuous response may be different from region to region, but it leads to the assessment of the efficacy response falling into a Behrens–Fisher problem—there is no exact testing or interval estimator for mean difference with unequal variances. As a solution, this study applies interval estimations of the efficacy response based on Howe’s, Cochran–Cox’s, and Satterthwaite’s approximations, which have been shown to have well-controlled type I error rates. However, the traditional sample size determination cannot be applied to the interval estimators. The sample size determination to achieve a desired power based on these interval estimators is then presented. Moreover, the consistency criteria suggested by the Japanese Ministry of Health, Labour and Welfare guidance to decide whether the overall results from the multiregional clinical trial obtained via the proposed interval estimation were also applied. A real example is used to illustrate the proposed method. The results of simulation studies indicate that the proposed method can correctly determine the required sample size and evaluate the assurance probability of the consistency criteria.

A phase II trial design with direct assignment option for initial marker validation.

2012 ◽  
Vol 30 (30_suppl) ◽  
pp. 34-34 ◽  
Author(s):  
Sumithra J. Mandrekar ◽  
Ming-Wen An ◽  
Daniel J. Sargent
Keyword(s):  
Clinical Trials ◽  
Phase Ii ◽  
Type I Error ◽  
Predictive Biomarkers ◽  
Stage Ii ◽  
Phase Iii ◽  
Type I ◽  
Design Strategies ◽  
Number Of Patients ◽  
The Impact

34 Background: Phase II clinical trials aim to identify promising experimental regimens for further testing in phase III trials. Testing targeted therapies with predictive biomarkers mandates efficient trial designs. Current biomarker-based trial designs, including the enrichment, all-comers, and adaptive designs, randomize patients to receive treatment or not throughout the entire duration of the trial. Recognizing the need for randomization yet acknowledging the possibility of promising but nonconclusive results after a preplanned interim analysis (IA), we propose a two-stage phase II design that allows for the possibility of direct assignment (i.e., stop randomization and assign all patients to the experimental arm in stage II) based on IA results. Methods: Using simulations, we compared properties of the direct assignment option design to a 1:1 randomized phase II design and assessed the impact of the timing of IA (after 33%, 50%, or 67% of accrual) and number of IA (one versus two with option for direct assignment at the first and second) over a range of response rate ratios (between 1.0 and 3.0). Results: Between 12% and 30% of the trials (out of 6,000 simulated trials) adopt direct assignment in stage II, with direct adoption depending on the treatment effect size and specified type I error rate (TIER). The direct assignment option design has minimal loss in power (<1.8%) and minimal increase in T1ER (<2.1%) compared to a 1:1 randomized design. The maximum loss in power across possible timings of IA was <1.2%. For the direct assignment option design, there was a 20%-50% increase in the number of patients treated on the experimental (vs. control) arm for the 1 IA case, and 40%-100% increase for the 2 IA case. Conclusions: Testing predictive biomarkers in clinical trials requires new design strategies. In the spectrum of phase II designs from adaptive to balanced randomized all-comers or enrichment designs, the direct assignment design provides a middle ground with desirable statistical properties that may appeal to both clinicians and patients.

scholarly journals On sample size calculation in testing treatment efficacy in clinical trials

2021 ◽  
Vol 58 (2) ◽  
pp. 133-147
Author(s):  
Rownak Jahan Tamanna ◽  
M. Iftakhar Alam ◽  
Ahmed Hossain ◽  
Md Hasinur Rahaman Khan
Keyword(s):  
Clinical Trials ◽  
Sample Size ◽  
Type I Error ◽  
Statistical Significance ◽  
Sample Size Calculation ◽  
Clinical Trial Design ◽  
Sample Size Determination ◽  
Cluster Sampling ◽  
Effective Sample Size ◽  
Type I

Summary Sample size calculation is an integral part of any clinical trial design, and determining the optimal sample size for a study ensures adequate power to detect statistical significance. It is a critical step in designing a planned research protocol, since using too many participants in a study is expensive, exposing more subjects to the procedure. If a study is underpowered, it will be statistically inconclusive and may cause the whole protocol to fail. Amidst the attempt to maximize power and the underlying effort to minimize the budget, the optimization of both has become a significant issue in the determination of sample size for clinical trials in recent decades. Although it is hard to generalize a single method for sample size calculation, this study is an attempt to offer something that might be a basis for finding a permanent answer to the contradictions of sample size determination, by the use of simulation studies under simple random and cluster sampling schemes, with different sizes of power and type I error. The effective sample size is much higher when the design effect of the sampling method is smaller, particularly less than 1. Sample size increases for cluster sampling when the number of clusters increases.

How to Detect Publication Bias in Psychological Research

2019 ◽  
Vol 227 (4) ◽  
pp. 261-279 ◽  
Author(s):  
Frank Renkewitz ◽  
Melanie Keiner
Keyword(s):  
Publication Bias ◽  
Effect Size ◽  
Statistical Power ◽  
Type I Error ◽  
Psychological Research ◽  
Type I ◽  
True Effect Size ◽  
Questionable Research Practices ◽  
True Effect ◽  
Meta Analyses

Abstract. Publication biases and questionable research practices are assumed to be two of the main causes of low replication rates. Both of these problems lead to severely inflated effect size estimates in meta-analyses. Methodologists have proposed a number of statistical tools to detect such bias in meta-analytic results. We present an evaluation of the performance of six of these tools. To assess the Type I error rate and the statistical power of these methods, we simulated a large variety of literatures that differed with regard to true effect size, heterogeneity, number of available primary studies, and sample sizes of these primary studies; furthermore, simulated studies were subjected to different degrees of publication bias. Our results show that across all simulated conditions, no method consistently outperformed the others. Additionally, all methods performed poorly when true effect sizes were heterogeneous or primary studies had a small chance of being published, irrespective of their results. This suggests that in many actual meta-analyses in psychology, bias will remain undiscovered no matter which detection method is used.

Testing hypotheses under adaptive randomization with continuous covariates in clinical trials

2018 ◽  
Vol 28 (6) ◽  
pp. 1609-1621
Author(s):  
Xiaoming Li ◽  
Jianhui Zhou ◽  
Feifang Hu
Keyword(s):  
Clinical Trials ◽  
Hypothesis Testing ◽  
Treatment Effects ◽  
Linear Models ◽  
Adaptive Designs ◽  
Cumulative Distribution ◽  
Type I ◽  
Percentile Method ◽  
Continuous Covariates ◽  
Leibler Divergence

Covariate-adaptive designs are widely used to balance covariates and maintain randomization in clinical trials. Adaptive designs for discrete covariates and their asymptotic properties have been well studied in the literature. However, important continuous covariates are often involved in clinical studies. Simply discretizing or categorizing continuous covariates can result in loss of information. The current understanding of adaptive designs with continuous covariates lacks a theoretical foundation as the existing works are entirely based on simulations. Consequently, conventional hypothesis testing in clinical trials using continuous covariates is still not well understood. In this paper, we establish a theoretical framework for hypothesis testing on adaptive designs with continuous covariates based on linear models. For testing treatment effects and significance of covariates, we obtain the asymptotic distributions of the test statistic under null and alternative hypotheses. Simulation studies are conducted under a class of covariate-adaptive designs, including the p-value-based method, the Su’s percentile method, the empirical cumulative-distribution method, the Kullback–Leibler divergence method, and the kernel-density method. Key findings about adaptive designs with independent covariates based on linear models are (1) hypothesis testing that compares treatment effects are conservative in terms of smaller type I error, (2) hypothesis testing using adaptive designs outperforms complete randomization method in terms of power, and (3) testing on significance of covariates is still valid.

scholarly journals A Multi-faceted Mess: A Review of Statistical Power Analysis in Psychology Journal Articles

2019 ◽  
Author(s):  
Rob Cribbie ◽  
Nataly Beribisky ◽  
Udi Alter
Keyword(s):  
Sample Size ◽  
Effect Size ◽  
Power Analysis ◽  
Statistical Power ◽  
Type I Error ◽  
A Priori ◽  
Type I ◽  
Specific Level ◽  
Maximum Sample Size ◽  
Power Analyses

Many bodies recommend that a sample planning procedure, such as traditional NHST a priori power analysis, is conducted during the planning stages of a study. Power analysis allows the researcher to estimate how many participants are required in order to detect a minimally meaningful effect size at a specific level of power and Type I error rate. However, there are several drawbacks to the procedure that render it “a mess.” Specifically, the identification of the minimally meaningful effect size is often difficult but unavoidable for conducting the procedure properly, the procedure is not precision oriented, and does not guide the researcher to collect as many participants as feasibly possible. In this study, we explore how these three theoretical issues are reflected in applied psychological research in order to better understand whether these issues are concerns in practice. To investigate how power analysis is currently used, this study reviewed the reporting of 443 power analyses in high impact psychology journals in 2016 and 2017. It was found that researchers rarely use the minimally meaningful effect size as a rationale for the chosen effect in a power analysis. Further, precision-based approaches and collecting the maximum sample size feasible are almost never used in tandem with power analyses. In light of these findings, we offer that researchers should focus on tools beyond traditional power analysis when sample planning, such as collecting the maximum sample size feasible.

scholarly journals Cognitive tests used in chronic adult human randomised controlled trial micronutrient and phytochemical intervention studies

2010 ◽  
Vol 23 (2) ◽  
pp. 200-229 ◽  
Author(s):  
Anna L. Macready ◽  
Laurie T. Butler ◽  
Orla B. Kennedy ◽  
Judi A. Ellis ◽  
Claire M. Williams ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Statistical Power ◽  
Type I Error ◽  
Spatial Working Memory ◽  
Controlled Trial ◽  
Type I ◽  
Cognitive Tests ◽  
Cognitive Domains ◽  
Positive Effects ◽  
Randomised Controlled

In recent years there has been a rapid growth of interest in exploring the relationship between nutritional therapies and the maintenance of cognitive function in adulthood. Emerging evidence reveals an increasingly complex picture with respect to the benefits of various food constituents on learning, memory and psychomotor function in adults. However, to date, there has been little consensus in human studies on the range of cognitive domains to be tested or the particular tests to be employed. To illustrate the potential difficulties that this poses, we conducted a systematic review of existing human adult randomised controlled trial (RCT) studies that have investigated the effects of 24 d to 36 months of supplementation with flavonoids and micronutrients on cognitive performance. There were thirty-nine studies employing a total of 121 different cognitive tasks that met the criteria for inclusion. Results showed that less than half of these studies reported positive effects of treatment, with some important cognitive domains either under-represented or not explored at all. Although there was some evidence of sensitivity to nutritional supplementation in a number of domains (for example, executive function, spatial working memory), interpretation is currently difficult given the prevailing ‘scattergun approach’ for selecting cognitive tests. Specifically, the practice means that it is often difficult to distinguish between a boundary condition for a particular nutrient and a lack of task sensitivity. We argue that for significant future progress to be made, researchers need to pay much closer attention to existing human RCT and animal data, as well as to more basic issues surrounding task sensitivity, statistical power and type I error.

scholarly journals Required sample size for comparing two independent means

2020 ◽  
Vol 6 (2) ◽  
pp. 106-113
Author(s):  
A. M. Grjibovski ◽  
M. A. Gorbatova ◽  
A. N. Narkevich ◽  
K. A. Vinogradov
Keyword(s):  
Sample Size ◽  
Statistical Power ◽  
Type I Error ◽  
Sample Size Calculation ◽  
Biomedical Literature ◽  
Type I ◽  
Research Practice ◽  
False Null Hypothesis ◽  
Different Levels ◽  
Russian Research

Sample size calculation in a planning phase is still uncommon in Russian research practice. This situation threatens validity of the conclusions and may introduce Type I error when the false null hypothesis is accepted due to lack of statistical power to detect the existing difference between the means. Comparing two means using unpaired Students’ ttests is the most common statistical procedure in the Russian biomedical literature. However, calculations of the minimal required sample size or retrospective calculation of the statistical power were observed only in very few publications. In this paper we demonstrate how to calculate required sample size for comparing means in unpaired samples using WinPepi and Stata software. In addition, we produced tables for minimal required sample size for studies when two means have to be compared and body mass index and blood pressure are the variables of interest. The tables were constructed for unpaired samples for different levels of statistical power and standard deviations obtained from the literature.

scholarly journals Bayesian Two-Stage Adaptive Design in Bioequivalence

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Shengjie Liu ◽  
Jun Gao ◽  
Yuling Zheng ◽  
Lei Huang ◽  
Fangrong Yan
Keyword(s):  
Statistical Power ◽  
Adaptive Design ◽  
Type I Error ◽  
Probability Model ◽  
Type I ◽  
Two Stage ◽  
Stage Design ◽  
Estimation Strategy ◽  
Drug Products ◽  
Two Stage Design

AbstractBioequivalence (BE) studies are an integral component of new drug development process, and play an important role in approval and marketing of generic drug products. However, existing design and evaluation methods are basically under the framework of frequentist theory, while few implements Bayesian ideas. Based on the bioequivalence predictive probability model and sample re-estimation strategy, we propose a new Bayesian two-stage adaptive design and explore its application in bioequivalence testing. The new design differs from existing two-stage design (such as Potvin’s method B, C) in the following aspects. First, it not only incorporates historical information and expert information, but further combines experimental data flexibly to aid decision-making. Secondly, its sample re-estimation strategy is based on the ratio of the information in interim analysis to total information, which is simpler in calculation than the Potvin’s method. Simulation results manifested that the two-stage design can be combined with various stop boundary functions, and the results are different. Moreover, the proposed method saves sample size compared to the Potvin’s method under the conditions that type I error rate is below 0.05 and statistical power reaches 80 %.

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