arXiv subjects

Tim Friede

Publications and source records attributed to Tim Friede.

At least 55 records · Page 3Linked to original sources

arXiv2022

A straightforward meta-analysis approach for oncology phase I dose-finding studies

Phase I early-phase clinical studies aim at investigating the safety and the underlying dose-toxicity relationship of a drug or combination. While little may still be known about the compound's properties, it is crucial to consider quantitative information available from any studies that may have been conducted previously on the same drug. A meta-analytic approach has the advantages of being able to properly account for between-study heterogeneity, and it may be readily extended to prediction or shrinkage applications. Here we propose a simple and robust two-stage approach for the estimation of maximum tolerated dose(s) (MTDs) utilizing penalized logistic regression and Bayesian random-effects meta-analysis methodology. Implementation is facilitated using standard R packages. The properties of the proposed methods are investigated in Monte-Carlo simulations. The investigations are motivated and illustrated by two examples from oncology.

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arXiv2022

MetaStan: An R package for Bayesian (model-based) meta-analysis using Stan

Meta-analysis methods are used to combine evidence from multiple studies. Meta-regression as well as model-based meta-analysis are extensions of standard pairwise meta-analysis in which information about study-level covariates and (arm-level) dosing amount or exposure may be taken into account. A Bayesian approach to inference is very attractive in this context, especially when a meta-analysis is based on few studies only or rare events. In this article, we present the R package MetaStan which implements a wide range of pairwise and model-based meta-analysis models. A generalised linear mixed model (GLMM) framework is used to describe the pairwise meta-analysis, meta-regression and model-based meta-analysis models. Within the GLMM framework, the likelihood and link functions are adapted to reflect the nature of the data. For example, a binomial likelihood with a logit link is used to perform a meta-analysis based on datasets with dichotomous endpoints. Bayesian computations are conducted using Stan via the rstan interface. Stan uses a Hamiltonian Monte Carlo sampler which belongs to the family of Markov chain Monte Carlo methods. Stan implementations are done by using suitable parametrizations to ease computations. The user-friendly R package MetaStan, available on CRAN, supports a wide range of pairwise and model-based meta-analysis models. MetaStan provides fitting functions for pairwise meta-analysis with the option of including covariates and model-based meta-analysis. The supported outcome types are continuous, binary, and count. Forest plots for the pairwise meta-analysis and dose-response plots for the model-based meta-analysis can be obtained from the package. The use of MetaStan is demonstrated through clinical examples.

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arXiv2021

Adjusting for publication bias in meta-analysis via inverse probability weighting using clinical trial registries

Publication bias is a major concern in conducting systematic reviews and meta-analyses. Various sensitivity analysis or bias-correction methods have been developed based on selection models and they have some advantages over the widely used bias-correction method of the trim-and-fill method. However, likelihood methods based on selection models may have difficulty in obtaining precise estimates and reasonable confidence intervals or require a complicated sensitivity analysis process. In this paper, we develop a simple publication bias adjustment method utilizing information on conducted but still unpublished trials from clinical trial registries. We introduce an estimating equation for parameter estimation in the selection function by regarding the publication bias issue as a missing data problem under missing not at random. With the estimated selection function, we introduce the inverse probability weighting (IPW) method to estimate the overall mean across studies. Furthermore, the IPW versions of heterogeneity measures such as the between-study variance and the I2 measure are proposed. We propose methods to construct asymptotic confidence intervals and suggest intervals based on parametric bootstrapping as an alternative. Through numerical experiments, we observed that the estimators successfully eliminate biases and the confidence intervals had empirical coverage probabilities close to the nominal level. On the other hand, the asymptotic confidence interval is much wider in some scenarios than the bootstrap confidence interval. Therefore, the latter is recommended for practical use.

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arXiv2021

Improving the Power of Economic Experiments Using Adaptive Designs

An important issue for many economic experiments is how the experimenter can ensure sufficient power for rejecting one or more hypotheses. Here, we apply methods developed mainly within the area of clinical trials for testing multiple hypotheses simultaneously in adaptive, two-stage designs. Our main goal is to illustrate how this approach can be used to improve the power of economic experiments. Having briefly introduced the relevant theory, we perform a simulation study supported by the open source R package asd in order to evaluate the power of some different designs. The simulations show that the power to reject at least one hypothesis can be improved while still ensuring strong control of the overall Type I error probability, and without increasing the total sample size and thus the costs of the study. The derived designs are further illustrated by applying them to two different real-world data sets from experimental economics.

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arXiv2021

Improving Adaptive Seamless Designs through Bayesian optimization

We propose to use Bayesian optimization (BO) to improve the efficiency of the design selection process in clinical trials. BO is a method to optimize expensive black-box functions, by using a regression as a surrogate to guide the search. In clinical trials, planning test procedures and sample sizes is a crucial task. A common goal is to maximize the test power, given a set of treatments, corresponding effect sizes, and a total number of samples. From a wide range of possible designs we aim to select the best one in a short time to allow quick decisions. The standard approach to simulate the power for each single design can become too time-consuming. When the number of possible designs becomes very large, either large computational resources are required or an exhaustive exploration of all possible designs takes too long. Here, we propose to use BO to quickly find a clinical trial design with high power from a large number of candidate designs. We demonstrate the effectiveness of our approach by optimizing the power of adaptive seamless designs for different sets of treatment effect sizes. Comparing BO with an exhaustive evaluation of all candidate designs shows that BO finds competitive designs in a fraction of the time.

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arXiv2021

On weakly informative prior distributions for the heterogeneity parameter in Bayesian random-effects meta-analysis

The normal-normal hierarchical model (NNHM) constitutes a simple and widely used framework for meta-analysis. In the common case of only few studies contributing to the meta-analysis, standard approaches to inference tend to perform poorly, and Bayesian meta-analysis has been suggested as a potential solution. The Bayesian approach, however, requires the sensible specification of prior distributions. While non-informative priors are commonly used for the overall mean effect, the use of weakly informative priors has been suggested for the heterogeneity parameter, in particular in the setting of (very) few studies. To date, however, a consensus on how to generally specify a weakly informative heterogeneity prior is lacking. Here we investigate the problem more closely and provide some guidance on prior specification.

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arXiv2020

Blinded sample size re-calculation in multiple composite population designs with normal data and baseline adjustments

The increasing interest in subpopulation analysis has led to the development of various new trial designs and analysis methods in the fields of personalized medicine and targeted therapies. In this paper, subpopulations are defined in terms of an accumulation of disjoint population subsets and will therefore be called composite populations. The proposed trial design is applicable to any set of composite populations, considering normally distributed endpoints and random baseline covariates. Treatment effects for composite populations are tested by combining $p$-values, calculated on the subset levels, using the inverse normal combination function to generate test statistics for those composite populations. The family-wise type I error rate for simultaneous testing is controlled in the strong sense by the application of the closed testing procedure. Critical values for intersection hypothesis tests are derived using multivariate normal distributions, reflecting the joint distribution of composite population test statistics under the null hypothesis. For sample size calculation and sample size re-calculation multivariate normal distributions are derived which describe the joint distribution of composite population test statistics under an assumed alternative hypothesis. Simulations demonstrate the strong control of the family-wise type I error rate in fixed designs and re-calculation designs with blinded sample size re-calculation. The target power after sample size re-calculation is typically met or close to being met.

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arXiv2020

Design aspects of COVID-19 treatment trials: Improving probability and time of favourable events

As a reaction to the pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a multitude of clinical trials for the treatment of SARS-CoV-2 or the resulting corona disease (COVID-19) are globally at various stages from planning to completion. Although some attempts were made to standardize study designs, this was hindered by the ferocity of the pandemic and the need to set up trials quickly. We take the view that a successful treatment of COVID-19 patients (i) increases the probability of a recovery or improvement within a certain time interval, say 28 days; (ii) aims to expedite favourable events within this time frame; and (iii) does not increase mortality over this time period. On this background we discuss the choice of endpoint and its analysis. Furthermore, we consider consequences of this choice for other design aspects including sample size and power and provide some guidance on the application of adaptive designs in this particular context.

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arXiv2020

Bounds for the weight of external data in shrinkage estimation

Shrinkage estimation in a meta-analysis framework may be used to facilitate dynamical borrowing of information. This framework might be used to analyze a new study in the light of previous data, which might differ in their design (e.g., a randomized controlled trial (RCT) and a clinical registry). We show how the common study weights arise in effect and shrinkage estimation, and how these may be generalized to the case of Bayesian meta-analysis. Next we develop simple ways to compute bounds on the weights, so that the contribution of the external evidence may be assessed a priori. These considerations are illustrated and discussed using numerical examples, including applications in the treatment of Creutzfeldt-Jakob disease and in fetal monitoring to prevent the occurrence of metabolic acidosis. The target study's contribution to the resulting estimate is shown to be bounded below. Therefore, concerns of evidence being easily overwhelmed by external data are largely unwarranted.

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arXiv2020

Causal inference methods for small non-randomized studies: Methods and an application in COVID-19

The usual development cycles are too slow for the development of vaccines, diagnostics and treatments in pandemics such as the ongoing SARS-CoV-2 pandemic. Given the pressure in such a situation, there is a risk that findings of early clinical trials are overinterpreted despite their limitations in terms of size and design. Motivated by a non-randomized open-label study investigating the efficacy of hydroxychloroquine in patients with COVID-19, we describe in a unified fashion various alternative approaches to the analysis of non-randomized studies. A widely used tool to reduce the impact of treatment-selection bias are so-called propensity score (PS) methods. Conditioning on the propensity score allows one to replicate the design of a randomized controlled trial, conditional on observed covariates. Extensions include the g-computation approach, which is less frequently applied, in particular in clinical studies. Moreover, doubly robust estimators provide additional advantages. Here, we investigate the properties of propensity score based methods including three variations of doubly robust estimators in small sample settings, typical for early trials, in a simulation study. R code for the simulations is provided.

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arXiv2020

Subgroup identification in individual patient data meta-analysis using model-based recursive partitioning

Model-based recursive partitioning (MOB) can be used to identify subgroups with differing treatment effects. The detection rate of treatment-by-covariate interactions and the accuracy of identified subgroups using MOB depend strongly on the sample size. Using data from multiple randomized controlled clinical trials can overcome the problem of too small samples. However, naively pooling data from multiple trials may result in the identification of spurious subgroups as differences in study design, subject selection and other sources of between-trial heterogeneity are ignored. In order to account for between-trial heterogeneity in individual participant data (IPD) meta-analysis random-effect models are frequently used. Commonly, heterogeneity in the treatment effect is modelled using random effects whereas heterogeneity in the baseline risks is modelled by either fixed effects or random effects. In this article, we propose metaMOB, a procedure using the generalized mixed-effects model tree (GLMM tree) algorithm for subgroup identification in IPD meta-analysis. Although the application of metaMOB is potentially wider, e.g. randomized experiments with participants in social sciences or preclinical experiments in life sciences, we focus on randomized controlled clinical trials. In a simulation study, metaMOB outperformed GLMM trees assuming a random intercept only and model-based recursive partitioning (MOB), whose algorithm is the basis for GLMM trees, with respect to the false discovery rates, accuracy of identified subgroups and accuracy of estimated treatment effect. The most robust and therefore most promising method is metaMOB with fixed effects for modelling the between-trial heterogeneity in the baseline risks.

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arXiv2020

Is there a role for statistics in artificial intelligence?

The research on and application of artificial intelligence (AI) has triggered a comprehensive scientific, economic, social and political discussion. Here we argue that statistics, as an interdisciplinary scientific field, plays a substantial role both for the theoretical and practical understanding of AI and for its future development. Statistics might even be considered a core element of AI. With its specialist knowledge of data evaluation, starting with the precise formulation of the research question and passing through a study design stage on to analysis and interpretation of the results, statistics is a natural partner for other disciplines in teaching, research and practice. This paper aims at contributing to the current discussion by highlighting the relevance of statistical methodology in the context of AI development. In particular, we discuss contributions of statistics to the field of artificial intelligence concerning methodological development, planning and design of studies, assessment of data quality and data collection, differentiation of causality and associations and assessment of uncertainty in results. Moreover, the paper also deals with the equally necessary and meaningful extension of curricula in schools and universities.

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arXiv2020

Data monitoring committees for clinical trials evaluating treatments of COVID-19

The first cases of coronavirus disease 2019 (COVID-19) were reported in December 2019 and the outbreak of SARS-CoV-2 was declared a pandemic in March 2020 by the World Health Organization. This sparked a plethora of investigations into diagnostics and vaccination for SARS-CoV-2, as well as treatments for COVID-19. Since COVID-19 is a severe disease associated with a high mortality, clinical trials in this disease should be monitored by a data monitoring committee (DMC), also known as data safety monitoring board (DSMB). DMCs in this indication face a number of challenges including fast recruitment requiring an unusually high frequency of safety reviews, more frequent use of complex designs and virtually no prior experience with the disease. In this paper, we provide a perspective on the work of DMCs for clinical trials of treatments for COVID-19. More specifically, we discuss organizational aspects of setting up and running DMCs for COVID-19 trials, in particular for trials with more complex designs such as platform trials or adaptive designs. Furthermore, statistical aspects of monitoring clinical trials of treatments for COVID-19 are considered. Some recommendations are made regarding the presentation of the data, stopping rules for safety monitoring and the use of external data. The proposed stopping boundaries are assessed in a simulation study motivated by clinical trials in COVID-19.

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arXiv2020

A Bayesian time-to-event pharmacokinetic model for sequential phase I dose-escalation trials with multiple schedules

Phase I dose-escalation trials constitute the first step in investigating the safety of potentially promising drugs in humans. Conventional methods for phase I dose-escalation trials are based on a single treatment schedule only. More recently, however, multiple schedules are more frequently investigated in the same trial. Here, we consider sequential phase I trials, where the trial proceeds with a new schedule (e.g. daily or weekly dosing) once the dose escalation with another schedule has been completed. The aim is to utilize the information from both the completed and the ongoing dose-escalation trial to inform decisions on the dose level for the next dose cohort. For this purpose, we adapted the time-to-event pharmacokinetics (TITE-PK) model, which were originally developed for simultaneous investigation of multiple schedules. TITE-PK integrates information from multiple schedules using a pharmacokinetics (PK) model. In a simulation study, the developed appraoch is compared to the bridging continual reassessment method and the Bayesian logistic regression model using a meta-analytic-prior. TITE-PK results in better performance than comparators in terms of recommending acceptable dose and avoiding overly toxic doses for sequential phase I trials in most of the scenarios considered. Furthermore, better performance of TITE-PK is achieved while requiring similar number of patients in the simulated trials. For the scenarios involving one schedule, TITE-PK displays similar performance with alternatives in terms of acceptable dose recommendations. The \texttt{R} and \texttt{Stan} code for the implementation of an illustrative sequential phase I trial example is publicly available at https://github.com/gunhanb/TITEPK_sequential.

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arXiv2020

Survival analysis for AdVerse events with VarYing follow-up times (SAVVY) -- estimation of adverse event risks

The SAVVY project aims to improve the analyses of adverse event (AE) data in clinical trials through the use of survival techniques appropriately dealing with varying follow-up times and competing events (CEs). Although statistical methodologies have advanced, in AE analyses often the incidence proportion, the incidence density, or a non-parametric Kaplan-Meier estimator (KME) are used, which either ignore censoring or CEs. In an empirical study including randomized clinical trials from several sponsor organisations, these potential sources of bias are investigated. The main aim is to compare the estimators that are typically used in AE analysis to the Aalen-Johansen estimator (AJE) as the gold-standard. Here, one-sample findings are reported, while a companion paper considers consequences when comparing treatment groups. Estimators are compared with descriptive statistics, graphical displays and with a random effects meta-analysis. The influence of different factors on the size of the bias is investigated in a meta-regression. Comparisons are conducted at the maximum follow-up time and at earlier evaluation time points. CEs definition does not only include death before AE but also end of follow-up for AEs due to events possibly related to the disease course or the treatment. Ten sponsor organisations provided 17 trials including 186 types of AEs. The one minus KME was on average about 1.2-fold larger than the AJE. Leading forces influencing bias were the amount of censoring and of CEs. As a consequence, the average bias using the incidence proportion was less than 5%. Assuming constant hazards using incidence densities was hardly an issue provided that CEs were accounted for. There is a need to improve the guidelines of reporting risks of AEs so that the KME and the incidence proportion are replaced by the AJE with an appropriate definition of CEs.

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arXiv2020

Using clinical trial registries to inform Copas selection model for publication bias in meta-analysis

Prospective registration of study protocols in clinical trial registries is a useful way to minimize the risk of publication bias in meta-analysis, and several clinical trial registries are available nowadays. However, they are mainly used as a tool for searching studies and information submitted to the registries has not been utilized as efficiently as it could. In addressing publication bias in meta-analyses, sensitivity analysis with the Copas selection model is a more objective alternative to widely-used graphical methods such as the funnel-plot and the trim-and-fill method. Despite its ability to quantify the potential impact of publication bias, a drawback of the model is that some parameters not to be specified. This may result in some difficulty in interpreting the results of the sensitivity analysis. In this paper, we propose an alternative inference procedure for the Copas selection model by utilizing information from clinical trial registries. Our method provides a simple and accurate way to estimate all unknown parameters in the Copas selection model. A simulation study revealed that our proposed method resulted in smaller biases and more accurate confidence intervals than existing methods. Furthermore, two published meta-analyses had been re-analysed to demonstrate how to implement the proposed method in practice.

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arXiv2020

Clinical trials impacted by the COVID-19 pandemic: Adaptive designs to the rescue?

Very recently the new pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified and the coronavirus disease 2019 (COVID-19) declared a pandemic by the World Health Organization. The pandemic has a number of consequences for the ongoing clinical trials in non-COVID-19 conditions. Motivated by four currently ongoing clinical trials in a variety of disease areas we illustrate the challenges faced by the pandemic and sketch out possible solutions including adaptive designs. Guidance is provided on (i) where blinded adaptations can help; (ii) how to achieve type I error rate control, if required; (iii) how to deal with potential treatment effect heterogeneity; (iv) how to utilize early readouts; and (v) how to utilize Bayesian techniques. In more detail approaches to resizing a trial affected by the pandemic are developed including considerations to stop a trial early, the use of group-sequential designs or sample size adjustment. All methods considered are implemented in a freely available R shiny app. Furthermore, regulatory and operational issues including the role of data monitoring committees are discussed.

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arXiv2020

Efficient adaptive designs for clinical trials of interventions for COVID-19

The COVID-19 pandemic has led to an unprecedented response in terms of clinical research activity. An important part of this research has been focused on randomized controlled clinical trials to evaluate potential therapies for COVID-19. The results from this research need to be obtained as rapidly as possible. This presents a number of challenges associated with considerable uncertainty over the natural history of the disease and the number and characteristics of patients affected, and the emergence of new potential therapies. These challenges make adaptive designs for clinical trials a particularly attractive option. Such designs allow a trial to be modified on the basis of interim analysis data or stopped as soon as sufficiently strong evidence has been observed to answer the research question, without compromising the trial's scientific validity or integrity. In this paper we describe some of the adaptive design approaches that are available and discuss particular issues and challenges associated with their use in the pandemic setting. Our discussion is illustrated by details of four ongoing COVID-19 trials that have used adaptive designs.

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