The dual test: safeguarding p-value combination tests for adaptive designs

Improved group sequential Holm procedures for testing multiple correlated hypotheses over time

Clinical trials can typically feature two different types of multiple inference: testing of more than one null hypothesis and testing at multiple time points. These modes of multiplicity are closely related mathematically but distinct statistically and philosophically. Regulatory agencies require strong control of the family-wise error rate (FWER), the risk of falsely rejecting any null hypothesis at any analysis. The correlations between test statistics at interim analyses and the final analysis are therefore routinely used in group sequential designs to achieve less conservative critical values. However, the same type of correlations between different comparisons, endpoints or sub-populations are less commonly used. As a result, FWER is in practice often controlled conservatively for commonly applied procedures.Repeated testing of the same null hypothesis may give changing results, when the hypothesis is rejected at an interim but accepted at the final analysis. The mathematically correct overall rejection is at odds with an inference theoretic approach and with common sense. We discuss these two issues, of incorporating correlations and how to interpret time-changing conclusions, and provide case studies where power can be increased while adhering to sound statistical principles.

Twenty-five years of confirmatory adaptive designs: opportunities and pitfalls

'Multistage testing with adaptive designs' was the title of an article by Peter Bauer that appeared 1989 in the German journal Biometrie und Informatik in Medizin und Biologie. The journal does not exist anymore but the methodology found widespread interest in the scientific community over the past 25 years. The use of such multistage adaptive designs raised many controversial discussions from the beginning on, especially after the publication by Bauer and Köhne 1994 in Biometrics: Broad enthusiasm about potential applications of such designs faced critical positions regarding their statistical efficiency. Despite, or possibly because of, this controversy, the methodology and its areas of applications grew steadily over the years, with significant contributions from statisticians working in academia, industry and agencies around the world. In the meantime, such type of adaptive designs have become the subject of two major regulatory guidance documents in the US and Europe and the field is still evolving. Developments are particularly noteworthy in the most important applications of adaptive designs, including sample size reassessment, treatment selection procedures, and population enrichment designs. In this article, we summarize the developments over the past 25 years from different perspectives. We provide a historical overview of the early days, review the key methodological concepts and summarize regulatory and industry perspectives on such designs. Then, we illustrate the application of adaptive designs with three case studies, including unblinded sample size reassessment, adaptive treatment selection, and adaptive endpoint selection. We also discuss the availability of software for evaluating and performing such designs. We conclude with a critical review of how expectations from the beginning were fulfilled, and - if not - discuss potential reasons why this did not happen.

Methods for flexible sample-size design in clinical trials: Likelihood, weighted, dual test, and promising zone approaches

Sample size plays a crucial role in clinical trials. Flexible sample-size designs, as part of the more general category of adaptive designs that utilize interim data, have been a popular topic in recent years. In this paper, we give a comparative review of four related methods for such a design. The likelihood method uses the likelihood ratio test with an adjusted critical value. The weighted method adjusts the test statistic with given weights rather than the critical value. The dual test method requires both the likelihood ratio statistic and the weighted statistic to be greater than the unadjusted critical value. The promising zone approach uses the likelihood ratio statistic with the unadjusted value and other constraints. All four methods preserve the type-I error rate. In this paper we explore their properties and compare their relationships and merits. We show that the sample size rules for the dual test are in conflict with the rules of the promising zone approach. We delineate what is necessary to specify in the study protocol to ensure the validity of the statistical procedure and what can be kept implicit in the protocol so that more flexibility can be attained for confirmatory phase III trials in meeting regulatory requirements. We also prove that under mild conditions, the likelihood ratio test still preserves the type-I error rate when the actual sample size is larger than the re-calculated one.