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Group Sequential Methods with Applications to Clinical Trials

TL;DR: A short history of sequential and group sequential methods can be found in this paper, where the authors present a road map for the application of two-sided tests for comparing two treatments with normal response of known variance.
Abstract: INTRODUCTION About This Book Why Sequential Methods A Short History of Sequential and Group Sequential Methods Chapter Organization: A Roadmap Bibliography and Notes TWO-SIDED TESTS: INTRODUCTION Two-Sided Tests for Comparing Two Treatments with Normal Response of Known Variance A Fixed Sample Test Group Sequential Tests Pocock's Test O'Brien and Fleming's Test Properties of Pocock and O'Brien and Fleming Tests Other Tests Conclusions TWO-SIDED TESTS: GENERAL APPLICATIONS A Unified Formulation Applying the Tests with Equal Group Sizes Applying the Tests with Unequal Increments in Information Normal Linear Models Other Parametric Models Binary Data: Group Sequential Tests for Proportions The Group Sequential Log-Rank Test for Survival Data Group Sequential t-Tests ONE-SIDED TESTS Introduction The Power Family of One-Sided Group Sequential Tests Adapting Power Family Tests to Unequal Increments in Information Group Sequential One-Sided t-Tests Whitehead's Triangular Test TWO-SIDED TESTS WITH EARLY STOPPING UNDER THE NULL HYPOTHESIS Introduction The Power Family of Two-Sided, Inner Wedge Tests Whitehead's Double Triangular Test EQUIVALENCE TESTS Introduction One-Sided Tests of Equivalence Two-Sided Tests of Equivalence: Application to Comparative Bioavailability Studies Individual Bioequivalence: A One-Sided Test for Proportions Bibliography and Notes FLEXIBLE MONITORING: THE ERROR SPENDING APPROACH Unpredictable Information Sequences Two-Sided Tests One-Sided Tests Data Dependent Timing of Analyses Computations for Error Spending Tests ANALYSIS FOLLOWING A SEQUENTIAL TEST Introduction Distribution Theory Point Estimation P-Values Confidence intervals REPEATED CONFIDENCE INTERVALS Introduction Example: Difference of Normal Means Derived Tests: Use of RCIs to Aid Early Stopping Decisions Repeated P-Values Discussion STOCHASTIC CURTAILMENT Introduction Conditional Power Approach Predictive Power Approach A Parameter-Free Approach A Case Study with Survival Data Bibliography and Notes GENERAL GROUP SEQUENTIAL DISTRIBUTION THEORY Introduction A Standard Joint Distribution for Successive Estimates of a Parameter Vector Normal Linear Models Normal Linear Models with Unknown Variance: Group Sequential t-Tests Example: An Exact One-Sample Group Sequential t-Test General Parametric Models: Generalized Linear Models Connection with Survival Analysis BINARY DATA A Single Bernoulli Probability Two Bernoulli Probabilities The Odds Ratio and Multiple 2 x 2 Tables Case-Control and Matched Pair Analysis Logistic Regression: Adjusting for Covariates Bibliography and Notes SURVIVAL DATA Introduction The Log Rank Test The Stratified Log-Rank Test Group Sequential Methods for Survival Data with Covariates Repeated Confidence Intervals for a Hazard Ratio Example: A Clinical Trial for Carcinoma of the Oropharynx Survival Probabilities and Quantiles Bibliography and Notes INTERNAL PILOT STUDIES: SAMPLE SIZE RE-ESTIMATION The Role of an Internal Pilot Phase Sample Size Re-estimation for a Fixed Sample Test Sample Size Re-estimation in Group Sequential Tests MULTIPLE ENDPOINTS Introduction The Bonferroni Procedure A Group Sequential Hotelling Test A Group Sequential Version of O'Brien's Test Tests Based on other Global Statistics Tests Based on Marginal Criteria Bibliography and Notes MULTI-ARMED TRIALS Introduction Global Tests Monitoring Pairwise Comparisons Bibliography and Notes ADAPTIVE TREATMENT ASSIGNMENT A Multi-Stage Adaptive Design A Multi-Stage Adaptive Design with Time Trends Validity of Adaptive Multi-Stage Procedures Bibliography and Notes BAYESIAN APPROACHES The Bayesian Paradigm Stopping Rules Choice of Prior Distribution Discussion NUMERICAL COMPUTATIONS FOR GROUP SEQUENTIAL TESTS Introduction The Basic Calculation Error Probabilities and Sample Size Distributions Tests Defined by Error Spending Functions Analysis Following a Group Sequential Test Further Applications of Numerical Computation Computer Software
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Journal ArticleDOI
TL;DR: The use of a target hemoglobin level of 13.5 g per deciliter (as compared with 11.3 g perDeciliter) was associated with increased risk and no incremental improvement in the quality of life and the use of epoetin alfa targeted to achieve a level of 11.4 g perdeciliter was not associated with an increased risk.
Abstract: Background Anemia, a common complication of chronic kidney disease, usually develops as a consequence of erythropoietin deficiency. Recombinant human erythropoietin (epoetin alfa) is indicated for the correction of anemia associated with this condition. However, the optimal level of hemoglobin correction is not defined. Methods In this open-label trial, we studied 1432 patients with chronic kidney disease, 715 of whom were randomly assigned to receive a dose of epoetin alfa targeted to achieve a hemoglobin level of 13.5 g per deciliter and 717 of whom were assigned to receive a dose targeted to achieve a level of 11.3 g per deciliter. The median study duration was 16 months. The primary end point was a composite of death, myocardial infarction, hospitalization for congestive heart failure (without renal replacement therapy), and stroke. Results A total of 222 composite events occurred: 125 events in the high-hemoglobin group, as compared with 97 events in the low-hemoglobin group (hazard ratio, 1.34; 95% confidence interval, 1.03 to 1.74; P = 0.03). There were 65 deaths (29.3%), 101 hospitalizations for congestive heart failure (45.5%), 25 myocardial infarctions (11.3%), and 23 strokes (10.4%). Seven patients (3.2%) were hospitalized for congestive heart failure and myocardial infarction combined, and one patient (0.5%) died after having a stroke. Improvements in the quality of life were similar in the two groups. More patients in the high-hemoglobin group had at least one serious adverse event. Conclusions The use of a target hemoglobin level of 13.5 g per deciliter (as compared with 11.3 g per deciliter) was associated with increased risk and no incremental improvement in the quality of life. (ClinicalTrials.gov number, NCT00211120.)

2,474 citations

Journal ArticleDOI
TL;DR: This vaccine was efficacious in preventing rotavirus gastroenteritis, decreasing severe disease and health care contacts, and the risk of intussusception was similar in vaccine and placebo recipients.
Abstract: BACKGROUND: Rotavirus is a leading cause of childhood gastroenteritis and death worldwide. METHODS: We studied healthy infants approximately 6 to 12 weeks old who were randomly assigned to receive ...

1,754 citations

Journal ArticleDOI
TL;DR: Dulaglutide could be considered for the management of glycaemic control in middle-aged and older people with type 2 diabetes with either previous cardiovascular disease or cardiovascular risk factors.

1,449 citations

Journal Article
19 Apr 2000-JAMA
TL;DR: The data indicate that compared with doxazosin, chlorthalidone reduces the risk of combined CVD events, particularly CHD death/nonfatal MI, in high-risk hypertensive patients.
Abstract: CONTEXT Hypertension is associated with a significantly increased risk of morbidity and mortality. Only diuretics and beta-blockers have been shown to reduce this risk in long-term clinical trials. Whether newer antihypertensive agents reduce the incidence of cardiovascular disease (CVD) is unknown. OBJECTIVE To compare the effect of doxazosin, an alpha-blocker, with chlorthalidone, a diuretic, on incidence of CVD in patients with hypertension as part of a study of 4 types of antihypertensive drugs: chlorthalidone, doxazosin, amlodipine, and lisinopril. DESIGN Randomized, double-blind, active-controlled clinical trial, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, initiated in February 1994. In January 2000, after an interim analysis, an independent data review committee recommended discontinuing the doxazosin treatment arm based on comparisons with chlorthalidone. Therefore, outcomes data presented herein reflect follow-up through December 1999. SETTING A total of 625 centers in the United States and Canada. PARTICIPANTS A total of 24,335 patients (aged > or = 55 years) with hypertension and at least 1 other coronary heart disease (CHD) risk factor who received either doxazosin or chlorthalidone. INTERVENTIONS Participants were randomly assigned to receive chlorthalidone, 12.5 to 25 mg/d (n=15,268), or doxazosin, 2 to 8 mg/d (n=9067), for a planned follow-up of 4 to 8 years. MAIN OUTCOME MEASURES The primary outcome measure was fatal CHD or nonfatal myocardial infarction (MI), analyzed by intent to treat; secondary outcome measures included all-cause mortality, stroke, and combined CVD (CHD death, nonfatal MI, stroke, angina, coronary revascularization, congestive heart failure [CHF], and peripheral arterial disease); compared by the chlorthalidone group vs the doxazosin group. RESULTS Median follow-up was 3.3 years. A total of 365 patients in the doxazosin group and 608 in the chlorthalidone group had fatal CHD or nonfatal MI, with no difference in risk between the groups (relative risk [RR], 1.03; 95% confidence interval [CI], 0.90-1.17; P=.71). Total mortality did not differ between the doxazosin and chlorthalidone arms (4-year rates, 9.62% and 9.08%, respectively; RR, 1.03; 95% CI, 0.90-1.15; P=.56.) The doxazosin arm, compared with the chlorthalidone arm, had a higher risk of stroke (RR, 1.19; 95% CI, 1.01-1.40; P=.04) and combined CVD (4-year rates, 25.45% vs 21.76%; RR, 1.25; 95% CI, 1.17-1.33; P<.001). Considered separately, CHF risk was doubled (4-year rates, 8.13% vs 4.45%; RR, 2.04; 95% CI, 1.79-2.32; P<.001); RRs for angina, coronary revascularization, and peripheral arterial disease were 1.16 (P<.001), 1.15 (P=.05), and 1.07 (P=.50), respectively. CONCLUSION Our data indicate that compared with doxazosin, chlorthalidone yields essentially equal risk of CHD death/nonfatal MI but significantly reduces the risk of combined CVD events, particularly CHF, in high-risk hypertensive patients.

1,334 citations