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Adaptive patient enrichment designs in therapeutic trials.治疗性试验中的适应性患者富集设计。
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在调整入组人群的随机试验中,针对选定人群的置信区间。

Confidence intervals for the selected population in randomized trials that adapt the population enrolled.

作者信息

Rosenblum Michael

机构信息

Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.

出版信息

Biom J. 2013 May;55(3):322-40. doi: 10.1002/bimj.201200080. Epub 2013 Apr 3.

DOI:10.1002/bimj.201200080
PMID:23553577
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5018400/
Abstract

It is a challenge to design randomized trials when it is suspected that a treatment may benefit only certain subsets of the target population. In such situations, trial designs have been proposed that modify the population enrolled based on an interim analysis, in a preplanned manner. For example, if there is early evidence during the trial that the treatment only benefits a certain subset of the population, enrollment may then be restricted to this subset. At the end of such a trial, it is desirable to draw inferences about the selected population. We focus on constructing confidence intervals for the average treatment effect in the selected population. Confidence interval methods that fail to account for the adaptive nature of the design may fail to have the desired coverage probability. We provide a new procedure for constructing confidence intervals having at least 95% coverage probability, uniformly over a large class Q of possible data generating distributions. Our method involves computing the minimum factor c by which a standard confidence interval must be expanded in order to have, asymptotically, at least 95% coverage probability, uniformly over Q. Computing the expansion factor c is not trivial, since it is not a priori clear, for a given decision rule, for which data generating distribution leads to the worst-case coverage probability. We give an algorithm that computes c, and then prove an optimality property for the resulting confidence interval procedure.

摘要

当怀疑一种治疗方法可能仅对目标人群的某些亚组有益时,设计随机试验是一项挑战。在这种情况下,已经提出了一些试验设计,这些设计以预先计划的方式根据中期分析修改入组人群。例如,如果在试验期间有早期证据表明该治疗仅对人群的某个亚组有益,那么入组可能随后被限制在这个亚组。在这样的试验结束时,希望对所选人群进行推断。我们专注于为所选人群的平均治疗效果构建置信区间。未能考虑设计的适应性的置信区间方法可能无法具有所需的覆盖概率。我们提供了一种新的程序,用于构建在一大类可能的数据生成分布(Q)上均匀具有至少(95%)覆盖概率的置信区间。我们的方法涉及计算一个标准置信区间必须扩大的最小因子(c),以便在(Q)上渐近地均匀具有至少(95%)的覆盖概率。计算扩展因子(c)并非易事,因为对于给定的决策规则,事先不清楚哪种数据生成分布会导致最坏情况的覆盖概率。我们给出一种计算(c)的算法,然后证明所得置信区间程序的最优性性质。