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Guo J, Xu F, Li L, Zhang Z, Xing B, Fan Q, Wang Z, Li C. The EC90 of remifentanil for inhibiting endotracheal intubation responses under anesthesia induction with ciprofol: study protocol for a dose-finding trial with the biased-coin design. Trials 2024; 25:558. [PMID: 39180100 PMCID: PMC11344379 DOI: 10.1186/s13063-024-08397-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 08/12/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Tracheal intubation may cause significant hemodynamic responses. Many drugs have been shown to be effective in modifying these cardiovascular responses, including remifentanil, fentanyl, sufentanil, and alfentanil. However, the 90% effect-site concentration (EC90) of remifentanil required to control cardiovascular responses to tracheal intubation when combined with ciprofol remains unclear. The purpose of this study was to determine the EC90 of remifentanil inhibiting cardiovascular responses to tracheal intubation during anesthesia induction with ciprofol using biased-coin design up-and-down sequential method (BC-UDM). METHODS This is a prospective sequential allocation dose-finding study. American Society of Anesthesiologists physical status (ASA) I-II elective surgical patients receiving target-controlled infusion (TCI) of remifentanil effect-site concentration (Ce), followed by ciprofol and rocuronium for anesthesia, were enrolled. The cardiovascular response to tracheal intubation was defined as positive when mean arterial pressure (MAP) or heart rate (HR) is 15% higher than the baseline value. Using the BC-UDM, the Ce of remifentanil was determined based on the cardiovascular response to tracheal intubation of the previous patient. The EC90 and 90% confidence intervals (90% CIs) were estimated by R-Foundation centered isotonic regression and the pooled adjacent violators algorithm with bootstrapping. DISCUSSION The results of this study sought to demonstrate EC90 of remifentanil blunting sympathetic responses to tracheal intubation during anesthesia index (Ai)-guided ciprofol anesthesia using BCD-UDM. It may help to minimize the cardiovascular responses to tracheal intubation. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300078275. Registered on December 3, 2023.
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Affiliation(s)
- Jianing Guo
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi Province, China
- Department of Anesthesiology, Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Fangsheng Xu
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi Province, China
- Department of Anesthesiology, Changzhi Medical College, Changzhi, Shanxi Province, China
- Department of Anesthesiology, Affiliated Changshu Hospital of Nantong University, Changshu, Jiangsu, China
| | - Luoyun Li
- Neurology Department, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Zeru Zhang
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi Province, China
- Department of Anesthesiology, Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Baichun Xing
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi Province, China
- Department of Anesthesiology, Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Qin Fan
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi Province, China
- Department of Anesthesiology, Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Zehua Wang
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi Province, China.
- Department of Anesthesiology, Changzhi Medical College, Changzhi, Shanxi Province, China.
| | - Chunyu Li
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi Province, China.
- Department of Anesthesiology, Changzhi Medical College, Changzhi, Shanxi Province, China.
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Holbrook A, Perri D, Levine M, Mbuagbaw L, Jarmain S, Thabane L, Tarride JE, Dolovich L, Hyland S, Telford V, Silva J, Nieuwstraten C. Improving medication prescribing-related outcomes for vulnerable elderly in transitions on high-risk medications (IMPROVE-IT HRM): a pilot randomized trial protocol. Pilot Feasibility Stud 2024; 10:60. [PMID: 38600599 PMCID: PMC11005201 DOI: 10.1186/s40814-024-01484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Seniors with recurrent hospitalizations who are taking multiple medications including high-risk medications are at particular risk for serious adverse medication events. We will assess whether an expert Clinical Pharmacology and Toxicology (CPT) medication management intervention during hospitalization with follow-up post-discharge and communication with circle of care is feasible and can decrease drug therapy problems amongst this group. METHODS The design is a pragmatic pilot randomized trial with 1:1 patient-level concealed randomization with blinded outcome assessment and data analysis. Participants will be adults 65 years and older admitted to internal medicine services for more than 2 days, who have had at least one other hospitalization in the prior year, taking five or more chronic medications including at least one high-risk medication. The CPT intervention identifies medication targets; completes consult, including priorities for improving prescribing negotiated with the patient; starts the care plan; ensures a detailed discharge medication reconciliation and circle-of-care communication; and sees the patient at least twice after hospital discharge via virtual visits to consolidate the care plan in the community. Control group receives usual care. Primary outcomes are feasibility - recruitment, retention, costs, and clinical - number of drug therapy problems improved, with secondary outcomes examining coordination of transitions in care, quality of life, and healthcare utilization and costs. Follow-up is to 3-month posthospital discharge. DISCUSSION If results support feasibility of ramp-up and promising clinical outcomes, a follow-up definitive trial will be organized using a developing national platform and medication appropriateness network. Since the intervention allows a very scarce medical specialty expertise to be offered via virtual care, there is potential to improve the safety, outcomes, and cost of care widely. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT04077281.
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Affiliation(s)
- Anne Holbrook
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
- Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada.
| | - Dan Perri
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Digital Solutions, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Mitch Levine
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Biotatistics Unit, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Sarah Jarmain
- Medical and Academic Affairs, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Biotatistics Unit, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Center for Health Economic and Policy Analysis, McMaster University, Hamilton, ON, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sylvia Hyland
- Institute for Safe Medication Practices Canada, North York, ON, Canada
| | - Victoria Telford
- Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
| | - Jessyca Silva
- Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
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Wood OR, Schnall R, Kay ES, Jia H, Abua JA, Nichols TK, Olender SA, Mugavero MJ, Batey DS. A community health worker and mobile health app intervention to improve adherence to HIV medication among persons with HIV: the CHAMPS study protocol. BMC Public Health 2023; 23:942. [PMID: 37226141 DOI: 10.1186/s12889-023-15616-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/05/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Persons with HIV (PWH) can now achieve a near-normal life expectancy due to antiretroviral therapy (ART). Despite widespread availability of ART in the United States (US), many of the country's approximate 1.1 million PWH are not achieving viral suppression due to poor ART adherence. Viral suppression rates are particularly low in Alabama (AL, 62%) and New York City (NYC, 67%). There is mixed evidence on the efficacy of community health workers (CHW) and mHealth interventions for improving ART adherence and viral suppression in PWH thus, we sought to combine these interventions and test the efficacy for improving health outcomes in PWH. METHODS The CHAMPS study is a two-arm randomized controlled trial among 300 PWH with suboptimal primary care appointment adherence (n = 150 in AL and 150 in NYC) over the course of 12 months. Participants are randomly assigned to CHAMPS (intervention) or a standard-of-care (control) arm. Participants in the intervention arm are given a CleverCap pill bottle that syncs to the WiseApp to track medication adherence, reminds users to take their medication at a set time, and enables communication with CHW. All participants complete baseline, 6-month, and 12-month follow-up visits where surveys are administered and, CD4 and HIV-1 viral load are obtained through blood draw. DISCUSSION Maintaining ART adherence has significant implications in HIV management and transmission. mHealth technologies have been shown to optimize the provision of health services, produce positive changes in health behavior, and significantly improve health outcomes. CHW interventions also provide personal support to PWH. The combination of these strategies may provide the necessary intensity to increase ART adherence and clinic attendance among PWH at highest risk for low engagement. Delivering care remotely enables CHW to contact, assess, and support numerous participants throughout the day, reducing burden on CHW and potentially improving intervention durability for PWH. The adoption of the WiseApp coupled with community health worker sessions in the CHAMPS study has the potential to improve HIV health outcomes, and will add to the growing knowledge of mHealth and CHW efforts to improve PWH medication adherence and viral suppression. TRIAL REGISTRATION This trial was registered with Clinicaltrials.gov (NCT04562649) on 9/24/20.
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Affiliation(s)
- Olivia R Wood
- School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, USA
| | - Rebecca Schnall
- School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, USA.
| | - Emma S Kay
- Magic City Research Institute, Birmingham AIDS Outreach, Birmingham, AL, USA
| | - Haomiao Jia
- School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, USA
| | | | - Tyler K Nichols
- School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, USA
| | - Susan A Olender
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Holbrook AM, Vidug K, Yoo L, Troyan S, Schulman S, Douketis J, Thabane L, Giilck S, Koubaesh Y, Hyland S, Keshavjee K, Ho J, Tarride JE, Ahmed A, Talman M, Leonard B, Ahmed K, Refaei M, Siegal DM. Coordination of Oral Anticoagulant Care at Hospital Discharge (COACHeD): protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2022; 8:166. [PMID: 35918731 PMCID: PMC9344454 DOI: 10.1186/s40814-022-01130-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Oral anticoagulants (OACs) are commonly prescribed, have well-documented benefits for important clinical outcomes but have serious harms as well. Rates of OAC-related adverse events including thromboembolic and hemorrhagic events are especially high shortly after hospital discharge. Expert OAC management involving virtual care is a research priority given its potential to reach remote communities in a more feasible, timely, and less costly way than in-person care. Our objective is to test whether a focused, expert medication management intervention using a mix of in-person consultation and virtual care follow-up, is feasible and effective in preventing anticoagulation-related adverse events, for patients transitioning from hospital to home. Methods and analysis A randomized, parallel, multicenter design enrolling consenting adult patients or the caregivers of cognitively impaired patients about to be discharged from medical wards with a discharge prescription for an OAC. The interdisciplinary multimodal intervention is led by a clinical pharmacologist and includes a detailed discharge medication reconciliation and management plan focused on oral anticoagulants at hospital discharge; a circle of care handover and coordination with patient, hospital team and community providers; and early post-discharge follow-up virtual medication check-up visits at 24 h, 1 week, and 1 month. The control group will receive usual care plus encouragement to use the Thrombosis Canada website. The primary feasibility outcomes include recruitment rate, participant retention rates, trial resources management, and the secondary clinical outcomes include adverse anticoagulant safety events composite (AASE), coordination and continuity of care, medication-related problems, quality of life, and healthcare resource utilization. Follow-up is 3 months. Discussion This pilot RCT tests whether there is sufficient feasibility and merit in coordinating oral anticoagulant care early post-hospital discharge to warrant a full sized RCT. Trial registration NCT02777047. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01130-z.
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Affiliation(s)
- Anne M Holbrook
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada. .,Clinical Pharmacology Research, Research Institute of St Joes Hamilton, Hamilton, ON, Canada. .,Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada. .,Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. .,Department of Medicine, Hamilton Health Sciences, Hamilton, ON, Canada.
| | - Kristina Vidug
- Clinical Pharmacology Research, Research Institute of St Joes Hamilton, Hamilton, ON, Canada
| | - Lindsay Yoo
- Clinical Pharmacology Research, Research Institute of St Joes Hamilton, Hamilton, ON, Canada
| | - Sue Troyan
- Clinical Pharmacology Research, Research Institute of St Joes Hamilton, Hamilton, ON, Canada
| | - Sam Schulman
- Divsion of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - James Douketis
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada.,Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Divsion of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Clinical Pharmacology Research, Research Institute of St Joes Hamilton, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Stephen Giilck
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Grand River Hospital, Kitchener, ON, Canada
| | - Yousery Koubaesh
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Brantford General Hospital, Brantford, ON, Canada
| | - Sylvia Hyland
- Institute for Safe Medication Practices Canada, North York, ON, Canada
| | - Karim Keshavjee
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Joanne Ho
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Research Institute for Aging, Schlegel-University of Waterloo, Waterloo, ON, Canada.,Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada.,Center for Health Economic and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada.,Programs for Assessment of Technology in Health (PATH), Research Institute of St. Joe's Hamilton, Hamilton, ON, Canada
| | - Amna Ahmed
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Marianne Talman
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Blair Leonard
- Department of Medicine, Niagara Health System, Regional Municipality of Niagara, Canada
| | - Khursheed Ahmed
- Clinical Pharmacology Research, Research Institute of St Joes Hamilton, Hamilton, ON, Canada
| | - Mohammad Refaei
- Department of Medicine, Niagara Health System, Regional Municipality of Niagara, Canada
| | - Deborah M Siegal
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Hu F, Ye X, Zhang LX. Multi-arm covariate-adaptive randomization. SCIENCE CHINA. MATHEMATICS 2022; 66:163-190. [PMID: 35912316 PMCID: PMC9326148 DOI: 10.1007/s11425-020-1954-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/21/2022] [Indexed: 06/15/2023]
Abstract
Simultaneously investigating multiple treatments in a single study achieves considerable efficiency in contrast to the traditional two-arm trials. Balancing treatment allocation for influential covariates has become increasingly important in today's clinical trials. The multi-arm covariate-adaptive randomized clinical trial is one of the most powerful tools to incorporate covariate information and multiple treatments in a single study. Pocock and Simon's procedure has been extended to the multi-arm case. However, the theoretical properties of multi-arm covariate-adaptive randomization have remained largely elusive for decades. In this paper, we propose a general framework for multi-arm covariate-adaptive designs which also includes the two-arm case, and establish the corresponding theory under widely satisfied conditions. The theoretical results provide new insights into the balance properties of covariate-adaptive randomization procedures and make foundations for most existing statistical inferences under two-arm covariate-adaptive randomization. Furthermore, these open a door to study the theoretical properties of statistical inferences for clinical trials based on multi-arm covariate-adaptive randomization procedures.
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Affiliation(s)
- Feifang Hu
- Department of Statistics, The George Washington University, Washington, DC, 20052 USA
| | - Xiaoqing Ye
- Institute of Statistics and Big Data, Renmin University of China, Beijing, 100872 China
| | - Li-Xin Zhang
- School of Mathematical Sciences, Zhejiang University, Hangzhou, 310058 China
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P. Johnson V. Conditioning Efron’s biased coin design to ensure final balance. Electron J Stat 2021. [DOI: 10.1214/21-ejs1866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Victoria P. Johnson
- GlaxoSmithKline, Inc., 1250 Collegeville Road, Collegeville, Pennsylvania 19426, U.S.A
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Abstract
Abstract
In clinical trials with two treatment arms, Efron's biased coin design, Efron (1971), sequentially assigns a patient to the underrepresented arm with probability p > ½. Under this design the proportion of patients in any arm converges to ½, and the convergence rate is n-1, as opposed to n-½ under some other popular designs. The generalization of Efron's design to K ≥ 2 arms and an unequal target allocation ratio (q1, . . ., qK) can be found in some papers, most of which determine the allocation probabilities ps in a heuristic way. Nonetheless, it has been noted that by using inappropriate ps, the proportion of patients in the K arms never converges to the target ratio. We develop a general theory to answer the question of what allocation probabilities ensure that the realized proportions under a generalized design still converge to the target ratio (q1, . . ., qK) with rate n-1.
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8
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Zhu H. Covariate-adjusted response adaptive designs incorporating covariates with and without treatment interactions. CAN J STAT 2015. [DOI: 10.1002/cjs.11260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hongjian Zhu
- Department of Biostatistics; The University of Texas School of Public Health at Houston; Houston, TX 77030 U.S.A
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9
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Antognini AB, Rosenberger WF, Wang Y, Zagoraiou M. Exact optimum coin bias in Efron's randomization procedure. Stat Med 2015; 34:3760-8. [DOI: 10.1002/sim.6576] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/29/2015] [Accepted: 06/02/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | - William F. Rosenberger
- Department of Statistics; George Mason University; 4400 University Drive MS 4A7 Fairfax VA U.S.A
| | - Yang Wang
- Department of Statistics; George Mason University; 4400 University Drive MS 4A7 Fairfax VA U.S.A
| | - Maroussa Zagoraiou
- Department of Business Administration and Law; University of Calabria; 87036 Arcavacata di Rende (CS) Italy
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10
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Haines LM, Sadiq H. Start-up designs for response-adaptive randomization procedures with sequential estimation. Stat Med 2015; 34:2958-70. [PMID: 25944171 DOI: 10.1002/sim.6528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/05/2015] [Accepted: 04/20/2015] [Indexed: 11/09/2022]
Abstract
Response-adaptive randomization procedures are appropriate for clinical trials in which two or more treatments are to be compared, patients arrive sequentially and the response of each patient is recorded before the next patient arrives. However, for those procedures that involve sequential estimation of model parameters, start-up designs are commonly required in order to provide initial estimates of the parameters. In this paper, a suite of such start-up designs for two treatments and binary patient responses are considered and compared in terms of the numbers of patients required in order to give meaningful parameters estimates, the number of patients allocated to the better treatment, and the bias in the parameter estimates. It is shown that permuted block designs with blocks of size 4 are to be preferred over a wide range of parameter values. For the case of two treatments, normal responses and selected start-up procedures, a design incorporating complete randomization followed appropriately by repeats of one of the treatments yields the minimum expected number of patients and is to be preferred.
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Affiliation(s)
- Linda M Haines
- Department of Statistical Sciences, University of Cape Town, Private Bag X3, Rondebosch, 7701, South Africa
| | - Hassan Sadiq
- Department of Statistical Sciences, University of Cape Town, Private Bag X3, Rondebosch, 7701, South Africa
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13
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Antognini AB, Zagoraiou M. Balance and randomness in sequential clinical trials: the dominant biased coin design. Pharm Stat 2014; 13:119-27. [PMID: 24443205 DOI: 10.1002/pst.1607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 11/13/2013] [Accepted: 12/15/2013] [Indexed: 11/11/2022]
Abstract
Efron's biased coin design (BCD) is a well-known randomization technique that helps neutralize selection bias, while keeping the experiment fairly balanced for every sample size. Several extensions of this rule have been proposed, and their properties were analyzed from an asymptotic viewpoint and compared via simulations in a finite setup. The aim of this paper is to push forward these comparisons by taking also into account the adjustable BCD, which is never considered up to now. Firstly, we show that the adjustable BCD performs better than Efron's coin with respect to both loss of precision and randomness. Moreover, the adjustable BCD is always more balanced than the other coins and, only for some sample sizes, slightly more predictable. Therefore, we suggest the dominant BCD, namely a new and flexible class of procedures that can change the allocation rule step by step in order to ensure very good performance in terms of both balance and selection bias for any sample size. Our simulations demonstrate that the dominant BCD is more balanced and, at the same time, less or equally predictable than Atkinson's optimum BCD.
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Kuznetsova OM, Tymofyeyev Y. Wide brick tunnel randomization - an unequal allocation procedure that limits the imbalance in treatment totals. Stat Med 2013; 33:1514-30. [DOI: 10.1002/sim.6051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/30/2013] [Accepted: 11/03/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Olga M. Kuznetsova
- Late Development Statistics, Merck & Co.; 126 E. Lincoln Avenue, PO box 2000 Rahway NJ 07065-0900 U.S.A
| | - Yevgen Tymofyeyev
- Quantitative Sciences, Janssen RD of Johnson & Johnson; TE2-3 1125 Trenton-Harbourton Road Titusville NJ 08560 U.S.A
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15
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Zhu H, Hu F, Zhao H. Adaptive clinical trial designs to detect interaction between treatment and a dichotomous biomarker. CAN J STAT 2013. [DOI: 10.1002/cjs.11184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Hongjian Zhu
- Division of Biostatistics; University of Texas School of Public Health; Houston, TX 77030; USA
| | - Feifang Hu
- Department of Statistics; University of Virginia; Charlottesville, VA 22904; USA
| | - Hongyu Zhao
- Division of Biostatistics; Yale School of Public Health; New Haven, CT 06520; USA
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Galbete A, Moler JA, Plo F. A Response-Driven Adaptive Design Based on the Klein Urn. Methodol Comput Appl Probab 2013. [DOI: 10.1007/s11009-013-9344-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kuznetsova OM, Tymofyeyev Y. Shift in re-randomization distribution with conditional randomization test. Pharm Stat 2013; 12:82-91. [DOI: 10.1002/pst.1556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/25/2012] [Accepted: 01/12/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Olga M. Kuznetsova
- Late Development Statistics; Merck Sharp & Dohme Corp.; Rahway; NJ; 07065-0900; USA
| | - Yevgen Tymofyeyev
- Quantitative Decision Strategies Department; Janssen RD of Johnson & Johnson; Titusville; NJ; USA
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Abstract
In February 2010, the U.S. Food and Drug Administration (FDA, 2010 ) drafted guidance that discusses the statistical, clinical, and regulatory aspects of various adaptive designs for clinical trials. An important class of adaptive designs is adaptive randomization, which is considered very briefly in subsection VI.B of the guidance. The objective of this paper is to review several important new classes of adaptive randomization procedures and convey information on the recent developments in the literature on this topic. Much of this literature has been focused on the development of methodology to address past criticisms and concerns that have hindered the broader use of adaptive randomization. We conclude that adaptive randomization is a very broad area of experimental design that has important application in modern clinical trials.
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Plamadeala V, Rosenberger WF. Sequential monitoring with conditional randomization tests. Ann Stat 2012. [DOI: 10.1214/11-aos941] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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Kuznetsova OM, Tymofyeyev Y. Preserving the allocation ratio at every allocation with biased coin randomization and minimization in studies with unequal allocation. Stat Med 2011; 31:701-23. [DOI: 10.1002/sim.4447] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 10/03/2011] [Indexed: 11/08/2022]
Affiliation(s)
- Olga M. Kuznetsova
- Late Development Statistics, Merck Sharp & Dohme Corp.; 126 E. Lincoln Avenue, P.O. Box 2000 Rahway NJ 07065-0900 USA
| | - Yevgen Tymofyeyev
- Quantitative Decision Strategies Department; J & J Pharmaceutical Research and Development; TE2-3 1125 Trenton-Harbourton Road Titusville NJ USA
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22
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Rosenkranz GK. The impact of randomization on the analysis of clinical trials. Stat Med 2011; 30:3475-87. [PMID: 21953285 DOI: 10.1002/sim.4376] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 08/01/2011] [Indexed: 11/11/2022]
Abstract
The design of a comparative clinical trial involves a method of allocating treatments to patients. Usually, this assignment is performed to achieve several objectives: to minimize selection and accidental bias, to achieve balanced treatment assignment in order to maximize the power of the comparison, and most importantly, to obtain the basis for a valid statistical inference. In this paper, we are concerned exclusively with the last point. In our investigation, we will assume that measurements can be decomposed in a patient-specific effect, a treatment effect, and a measurement error. If the patient can be considered to be randomly drawn from a population, the randomization method does not affect the analysis. In fact, under this so-called population model, randomization would be unnecessary to obtain a valid inference. However, when individuals cannot be considered randomly selected, the patient effects may become fixed but unknown constants. In this case, randomization is necessary to obtain valid statistical analyses, and it cannot be precluded that the randomization method has an impact on the results. This paper elaborates that the impact can be substantial even for a two-sample comparison when a standard t-test is used for data analysis. We provide some theoretical results as well as simulations.
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Baldi Antognini A, Zagoraiou M. The covariate-adaptive biased coin design for balancing clinical trials in the presence of prognostic factors. Biometrika 2011. [DOI: 10.1093/biomet/asr021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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