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Farewell VT, Su L, Jackson C. Partially hidden multi-state modelling of a prolonged disease state defined by a composite outcome. LIFETIME DATA ANALYSIS 2019; 25:696-711. [PMID: 30661194 PMCID: PMC6776496 DOI: 10.1007/s10985-018-09460-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/29/2018] [Indexed: 06/09/2023]
Abstract
For rheumatic diseases, Minimal Disease Activity (MDA) is usually defined as a composite outcome which is a function of several individual outcomes describing symptoms or quality of life. There is ever increasing interest in MDA but relatively little has been done to characterise the pattern of MDA over time. Motivated by the aim of improving the modelling of MDA in psoriatic arthritis, the use of a two-state model to estimate characteristics of the MDA process is illustrated when there is particular interest in prolonged periods of MDA. Because not all outcomes necessary to define MDA are measured at all clinic visits, a partially hidden multi-state model with latent states is used. The defining outcomes are modelled as conditionally independent given these latent states, enabling information from all visits, even those with missing data on some variables, to be used. Data from the Toronto Psoriatic Arthritis Clinic are analysed to demonstrate improvements in accuracy and precision from the inclusion of data from visits with incomplete information on MDA. An additional benefit of this model is that it can be extended to incorporate explanatory variables, which allows process characteristics to be compared between groups. In the example, the effect of explanatory variables, modelled through the use of relative risks, is also summarised in a potentially more clinically meaningful manner by comparing times in states, and probabilities of visiting states, between patient groups.
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Affiliation(s)
- Vernon T. Farewell
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Robinson Way, Cambridge, CB2 0SR UK
| | - Li Su
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Robinson Way, Cambridge, CB2 0SR UK
| | - Christopher Jackson
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Robinson Way, Cambridge, CB2 0SR UK
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Ferrer L, Rondeau V, Dignam J, Pickles T, Jacqmin-Gadda H, Proust-Lima C. Joint modelling of longitudinal and multi-state processes: application to clinical progressions in prostate cancer. Stat Med 2016; 35:3933-48. [PMID: 27090611 PMCID: PMC5012926 DOI: 10.1002/sim.6972] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 02/09/2016] [Accepted: 03/24/2016] [Indexed: 11/10/2022]
Abstract
Joint modelling of longitudinal and survival data is increasingly used in clinical trials on cancer. In prostate cancer for example, these models permit to account for the link between longitudinal measures of prostate-specific antigen (PSA) and time of clinical recurrence when studying the risk of relapse. In practice, multiple types of relapse may occur successively. Distinguishing these transitions between health states would allow to evaluate, for example, how PSA trajectory and classical covariates impact the risk of dying after a distant recurrence post-radiotherapy, or to predict the risk of one specific type of clinical recurrence post-radiotherapy, from the PSA history. In this context, we present a joint model for a longitudinal process and a multi-state process, which is divided into two sub-models: a linear mixed sub-model for longitudinal data and a multi-state sub-model with proportional hazards for transition times, both linked by a function of shared random effects. Parameters of this joint multi-state model are estimated within the maximum likelihood framework using an EM algorithm coupled with a quasi-Newton algorithm in case of slow convergence. It is implemented under R, by combining and extending mstate and JM packages. The estimation program is validated by simulations and applied on pooled data from two cohorts of men with localized prostate cancer. Thanks to the classical covariates available at baseline and the repeated PSA measurements, we are able to assess the biomarker's trajectory, define the risks of transitions between health states and quantify the impact of the PSA dynamics on each transition intensity. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Loïc Ferrer
- INSERM U1219, ISPED, Université de Bordeaux, Bordeaux, France
| | | | - James Dignam
- Department of Public Health Sciences, University of Chicago and NRG Oncology, Chicago, IL, U.S.A
| | - Tom Pickles
- Department of Radiation Oncology, University of British Columbia, Vancouver, Canada
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Li S, Sun Y, Huang CY, Follmann DA, Krause R. Recurrent event data analysis with intermittently observed time-varying covariates. Stat Med 2016; 35:3049-65. [PMID: 26887664 DOI: 10.1002/sim.6901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 01/10/2016] [Accepted: 01/19/2016] [Indexed: 11/11/2022]
Abstract
Although recurrent event data analysis is a rapidly evolving area of research, rigorous studies on estimation of the effects of intermittently observed time-varying covariates on the risk of recurrent events have been lacking. Existing methods for analyzing recurrent event data usually require that the covariate processes are observed throughout the entire follow-up period. However, covariates are often observed periodically rather than continuously. We propose a novel semiparametric estimator for the regression parameters in the popular proportional rate model. The proposed estimator is based on an estimated score function where we kernel smooth the mean covariate process. We show that the proposed semiparametric estimator is asymptotically unbiased, normally distributed, and derives the asymptotic variance. Simulation studies are conducted to compare the performance of the proposed estimator and the simple methods carrying forward the last covariates. The different methods are applied to an observational study designed to assess the effect of group A streptococcus on pharyngitis among school children in India. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Shanshan Li
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, 46202, IN, U.S.A
| | - Yifei Sun
- Department of Biostatistics, Johns Hopkins University, Baltimore, 21205, MD, U.S.A
| | - Chiung-Yu Huang
- Department of Biostatistics, Johns Hopkins University, Baltimore, 21205, MD, U.S.A.,Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, 21205, MD, U.S.A
| | - Dean A Follmann
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, 20817, MD, U.S.A
| | - Richard Krause
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, 20817, MD, U.S.A
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Thom HHZ, Jackson CH, Commenges D, Sharples LD. State selection in Markov models for panel data with application to psoriatic arthritis. Stat Med 2015; 34:2456-75. [PMID: 25739994 DOI: 10.1002/sim.6460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 01/17/2015] [Accepted: 02/11/2015] [Indexed: 11/09/2022]
Abstract
Markov multistate models in continuous-time are commonly used to understand the progression over time of disease or the effect of treatments and covariates on patient outcomes. The states in multistate models are related to categorisations of the disease status, but there is often uncertainty about the number of categories to use and how to define them. Many categorisations, and therefore multistate models with different states, may be possible. Different multistate models can show differences in the effects of covariates or in the time to events, such as death, hospitalisation, or disease progression. Furthermore, different categorisations contain different quantities of information, so that the corresponding likelihoods are on different scales, and standard, likelihood-based model comparison is not applicable. We adapt a recently developed modification of Akaike's criterion, and a cross-validatory criterion, to compare the predictive ability of multistate models on the information which they share. All the models we consider are fitted to data consisting of observations of the process at arbitrary times, often called 'panel' data. We develop an implementation of these criteria through Hidden Markov models and apply them to the comparison of multistate models for the Health Assessment Questionnaire score in psoriatic arthritis. This procedure is straightforward to implement in the R package 'msm'.
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Affiliation(s)
| | | | - Daniel Commenges
- Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
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Barnabe C, Homik J, Barr SG, Martin L, Maksymowych WP. The effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy. J Rheumatol 2014; 41:1607-13. [PMID: 25028371 DOI: 10.3899/jrheum.131451] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Predictors of remission in rheumatoid arthritis (RA) have been defined in cross-sectional analyses using the 28-joint Disease Activity Score (DAS28), but not with newer composite disease activity measures or using the more clinically relevant state of sustained remission. We have evaluated predictors of remission using cross-sectional and longitudinal durations of disease state, and by applying additional definitions of remission [American College of Rheumatology/European League Against Rheumatism Boolean, Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI)]. METHODS Individuals in the Alberta Biologics Pharmacosurveillance Program were classified for the presence of remission (point and/or sustained > 1 yr) by each of the 4 definitions. Multivariate models were constructed including all available variables in the dataset and refined to optimize model fit and predictive ability to calculate OR for remission. RESULTS Nonsmoking status independently predicted point remission by all definitions (OR range 1.20-2.71). Minority ethnicity decreased odds of remission by DAS28 (OR 0.13) and CDAI (OR 0.09) definitions. Male sex was associated with DAS28 remission (OR 2.85), whereas higher baseline physician global (OR 0.67) and erythrocyte sedimentation rate values (OR 0.98) decreased odds of DAS28 remission. Higher baseline patient global score (OR 0.77) and swollen joint counts (OR 0.93) were negative predictors for CDAI remission. Higher baseline Health Assessment Questionnaire (OR 0.62) reduced odds for remission by the SDAI definition, and educational attainment increased these odds (OR 2.13). Sustained remission was negatively predicted by baseline physician global for the DAS28 (OR 0.80), and higher tender joint count (OR 0.96) for the CDAI. CONCLUSION We demonstrate the influence of duration of remission state and remission definition on defining independent predictors for remission in RA requiring anti-tumor necrosis factor therapy. These predictors offer improved applicability for modern rheumatology practice.
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Affiliation(s)
- Cheryl Barnabe
- From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta.
| | - Joanne Homik
- From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta
| | - Susan G Barr
- From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta
| | - Liam Martin
- From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta
| | - Walter P Maksymowych
- From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta
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