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arXiv · 2607.18501

SPYCE: A Doubly Robust Estimator for Trials Targeting Early Huntington Disease under Outcome-Dependent Censoring

Kihyun Han·Yanyuan Ma·Karen Marder·Tanya P. Garcia
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Abstract

Clinical trials for neurodegenerative diseases must identify sensitive endpoints -- outcomes that change rapidly enough to detect treatment effects. In Huntington disease, this requires measuring how outcomes change as participants approach Stage 1. Yet many participants exit studies before reaching this stage, making their time to Stage 1 right-censored. Estimating how outcomes change requires models for both time to Stage 1 and time to study exit. When participants with worse outcomes exit earlier, this outcome-dependent censoring causes existing estimators to produce contradictory results: for the same cognitive outcome, one estimator suggests improvement while another shows decline. Existing estimators either ignore outcome-dependent censoring or require one model to be correctly specified, with no protection when it is not. We introduce SPYCE, a doubly robust estimator (consistent when either model is correctly specified) that achieves the smallest possible variance and allows both models to be estimated nonparametrically without sacrificing efficiency. Applied to data from PREDICT-HD, an observational Huntington disease study, SPYCE resolves current contradictions, identifies caudate and putamen volume ratios as the most promising sensitive endpoints, and shows that as few as 241 participants per arm are needed to detect treatment effects, versus hundreds of thousands under estimators that cannot handle outcome-dependent censoring.

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Kihyun Han, Yanyuan Ma, Karen Marder, Tanya P. Garcia. 2026-07-20. SPYCE: A Doubly Robust Estimator for Trials Targeting Early Huntington Disease under Outcome-Dependent Censoring. https://arxiv.org/abs/2607.18501

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