Estimation in multi-arm two-stage trials with treatment selection and time-to-event endpoint

Stat Med. 2017 Sep 10;36(20):3137-3153. doi: 10.1002/sim.7367. Epub 2017 Jun 13.

Abstract

We consider estimation of treatment effects in two-stage adaptive multi-arm trials with a common control. The best treatment is selected at interim, and the primary endpoint is modeled via a Cox proportional hazards model. The maximum partial-likelihood estimator of the log hazard ratio of the selected treatment will overestimate the true treatment effect in this case. Several methods for reducing the selection bias have been proposed for normal endpoints, including an iterative method based on the estimated conditional selection biases and a shrinkage approach based on empirical Bayes theory. We adapt these methods to time-to-event data and compare the bias and mean squared error of all methods in an extensive simulation study and apply the proposed methods to reconstructed data from the FOCUS trial. We find that all methods tend to overcorrect the bias, and only the shrinkage methods can reduce the mean squared error. © 2017 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

Keywords: adaptive design; bias; empirical Bayes; multi-arm trial; time-to-event.

MeSH terms

  • Adaptive Clinical Trials as Topic / statistics & numerical data
  • Bayes Theorem
  • Biostatistics
  • Clinical Trials as Topic / statistics & numerical data*
  • Colorectal Neoplasms / drug therapy
  • Computer Simulation
  • Confidence Intervals
  • Controlled Clinical Trials as Topic / statistics & numerical data
  • Humans
  • Kaplan-Meier Estimate
  • Likelihood Functions
  • Selection Bias
  • Time Factors