On the Comparison of Umbrella Pattern Treatment Means with a Control Mean

This paper is concerned with comparing several increasing dose levels (treatments) with a zero dose control when the prior information about the umbrella pattern treatment means is available. The problem of testing whether there is at least one treatment which is better than the control is considered. Multiple test procedures are then proposed for deciding treatments (if any) which are better than the control. Some approximate criticial values of the proposed tests are reported. The results of a Monte Carlo power study are presented.     

Nonparametric identification of the minimum effective dose

We consider identifying the minimum effective dose (MED) in a dose-response study, where the MED is defined to be the lowest dose level producing an effect over that of the zero-dose control. Proposed herein is a nonparametric procedure based on the Mann-Whitney statistic incorporated with the step-down closed testing scheme. A numerical example demonstrates the feasibility of the proposed nonparametric procedure. Finally, the comparative results of a Monte Carlo level and power study for small sample sizes are presented and discussed.     

Evaluation of Animal Carcinogenicity Studies: Cochran‐Armitage Trend Test vs. Multiple Contrast Tests

Typical animal carcinogenicity studies involve the comparison of several dose groups to a negative control. The uncorrected asymptotic Cochran‐Armitage trend test with equally spaced dose scores is the most frequently used test in such set‐ups. However, this test based on a weighted linear regression on proportions. It is well known that the Cochran‐Armitage test lacks in power for other shapes than the assumed linear one. Therefore, dichotomous multiple contrast tests are introduced. These build the maximum over several single contrasts, where each of them is chosen appropriately to cover a specific dose‐response shape. An extensive power study has been conducted to compare multiple contrast tests with the approaches used so far. Crucial results will be presented in this paper. Moreover, exact tests and continuity corrected versions are introduced and compared to the traditional uncorrected approaches regarding size and power behaviour. A trend test for any shape of the dose‐response relationship for either crude tumour rates or mortality‐ adjusted rates based on the simple Poly‐3 transformation is proposed for evaluation of carcinogenicity studies.     

Evaluation of Ecotoxicological Field Studies for Authorization of Plant Protection Products in Europe

An increasing number of ecotoxicological field studies are being submitted in the European Union procedure for authorization of pesticides. Although there is some guidance on how these studies can be used for risk assessment, not all aspects of field tests are covered and the guidance differs per type of test and per non-target group. To facilitate a more uniform approach by the regulatory authorities in the EU, a basic scheme is proposed with qualitative tools to: (i) assess the scientific reliability of individual field tests, and (ii) to assess the usefulness of field tests for regulatory risk assessment of the pesticide under registration. In this way, the treatment, evaluation, and the mutual comparability of field data for regulatory purposes is harmonized. It thereby provides a more consistent foundation for further risk assessment.     

The role of thresholds in the response of lambs to vaccination with irradiated Trichostrongylus colubriformis larvae

A piecewise logarithmic model fitted to worm counts of ewe lambs vaccinated and challenged in pens with a range of doses of irradiated and normal Trichostrongylus colubriformis larvae respectively, indicated that the threshold for response to both vaccine (V₀ = 4400) and challenge dose is exceeded by 5000 larvae. Whereas response was vaccine dose dependent, it was independent of challenge dose.Ram lambs vaccinated at low dose levels were as resistant against challenge as ewe lambs, but by contrast, failed to show increased protection after vaccination with high doses of irradiated larvae.Serum titre of antiworm complement-fixing antibodies at the time of challenge also indicated that ram lambs were less responsive immunologically than ewe lambs following vaccination at the higher dose levels.A field study showed that response to vaccination was only apparent after transfer of the sheep to heavily contaminated pastures, suggesting that previous exposure of the vaccinated animals to the low dose of infective larvae available on a lightly contaminated pasture constituted a challenge which was below the threshold.     

Drug therapy: dose-response relationship of oral mesalazine in inflammatory bowel disease.

Mesalazine is widely used in the treatment of inflammatory bowel disease. Little is known about the dose-response relationship and about possible dose related side effects. In ulcerative colitis higher dosages of mesalazine (3 g) are more effective in maintaining a remission than lower dosages (1.5 g). In mild to moderately active ulcerative colitis, studies also indicate that higher dosages might be more effective in inducing remission. Dose-comparing studies in Crohn''s disease are even more sparse, but the available results indicate higher efficacy at higher dose levels. None of the known side effects of mesalazine are clearly dose-related. A pH-dependent release system, however, can cause a sudden release of high doses of mesalazine. Consequent peak levels in serum have been implicated in mesalazine induced nephrotoxicity. In conclusion, despite the current practice of using increasing dosages of mesalazine in inflammatory bowel disease, both efficacy and safety have been established tentatively.     

Response of cotton and sorghum to several levels of subambient solar UV-B radiation: a test of the saturation hypothesis

Some have proposed that plant responses to above-ambient or supplemented levels of solar ultraviolet-B radiation (UV-B; 280–315 nm) are typically subtle because targets or receptors in plants become saturated. If true, in solar UV-B filter exclusion experiments we would expect that plant responses would level off or 'saturate' as doses approached ambient levels. To test this so-called 'saturation hypothesis' we examined the response of Gossypium hirsutum (cotton) and Sorghum bicolor (sorghum) to filter exclusions that provided five levels of biologically effective UV-B, ranging from 36 to 91% of ambient solar levels in Arizona, USA. UV-B dose had no effect on biomass production of either species. As UV-B dose increased or approached ambient, individual leaves of S. bicolor were smaller, but plants produced more tillers and leaves. In G. hirsutum , individual leaves as well as total plant leaf area were smaller, but plants produced more branches. Bulk concentrations of soluble UV-B absorbing compounds increased with UV-B dose in both species. Leaf epidermal UV-B transmittance, assessed with the chlorophyll fluorescence technique, declined with increasing UV-B dose, and was well correlated with bulk concentrations of soluble UV-B screening compounds. Bulk concentrations of insoluble or wall-bound UV-B absorbing compounds were not affected by UV-B dose. The intensity of UV-induced blue fluorescence from leaf surfaces was strongly correlated with bulk concentrations of wall-bound UV-B absorbing compounds, and this signal has the potential to provide a rapid, non-invasive method to estimate concentrations of these compounds, which are time-consuming to extract. While both species were responsive to solar UV-B, responses did not appear to become saturated as doses approached ambient levels. Rather, responses required a threshold dose of >70% of solar ambient UV-B levels before they became apparent.     

Adjusted regression trend test for a multicenter clinical trial

Studies using a series of increasing doses of a compound, including a zero dose control, are often conducted to study the effect of the compound on the response of interest. For a one-way design, Tukey et al. (1985, Biometrics 41, 295-301) suggested assessing trend by examining the slopes of regression lines under arithmetic, ordinal, and arithmetic-logarithmic dose scalings. They reported the smallest p-value for the three significance tests on the three slopes for safety assessments. Capizzi et al. (1992, Biometrical Journal 34, 275-289) suggested an adjusted trend test, which adjusts the p-value using a trivariate t-distribution, the joint distribution of the three slope estimators. In this paper, we propose an adjusted regression trend test suitable for two-way designs, particularly for multicenter clinical trials. In a step-down fashion, the proposed trend test can be applied to a multicenter clinical trial to compare each dose with the control. This sequential procedure is a closed testing procedure for a trend alternative. Therefore, it adjusts p-values and maintains experimentwise error rate. Simulation results show that the step-down trend test is overall more powerful than a step-down least significant difference test.     

Thiazide-induced hypercholesterolemia: sex differences

Thiazide diuretics are used commonly to treat hypertension. Unfortunately, they also are known to elevate serum cholesterol levels. Because serum lipid fraction levels differ between the sexes, possible sex-related differences in thiazide-induced changes in serum total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-C) levels were examined. Four groups of male and female hamsters were treated for a minimum of 3 months with hydrochlorothiazide (HCTZ) at zero, 1, 2 or 4 mg/kg/day. At zero dose, there was no difference in TG levels between the sexes; however, females had significantly higher TG concentrations than did males at 1, 2 and 4 mg HCTZ (all p less than 0.05). Females demonstrate a significant dose response with HCL-C levels increasing with increasing doses of HCTZ, (r = 0.983; p less than 0.02); in contrast males had a similar increase in HDL-C at all dose levels (all p less than 0.05) thus there was no demonstrable dose response (r = 0.539). Total cholesterol concentrations were significantly higher in the females than in males (p less than 0.05) at all 3 dose levels as well as at zero dose. Further, the females demonstrated a direct dose response in TC levels (r = 0.986; p less than 0.02) while the males showed no such dose response (r = 0.824; p less than 0.01). Based on these findings we conclude that: 1) HCTZ increases TG, TC and HDL-C levels in both male and female hamsters; 2) TC levels are higher in females than in males regardless of HCTZ dose; 3) only females show a dose-dependent increase in HCL-C and TC in response to HCTZ. These sex-related changes in lipid fractions occurring with HCTZ treatment, if they occur in humans, may contribute to sex-related differences in rates and severity of atherosclerosis in HCTZ-treated populations.     

Age-adjusted exact trend tests in the event of rare occurrences

Preclinical animal carcinogenicity studies are usually concerned with testing the statistical significance of a dose-response relationship. When the response consists of a rare event such as the development of a certain type of tumor, exact statistical methods are often employed. The exact randomization trend test based on the multivariate hypergeometric distribution is less powerful in the presence of treatment-related risks other than the specified response. Particularly, the loss of power becomes more pronounced when competing risks cause progressively higher mortality rates with increasing dose, which is usual in practice. An age-adjusted form of the randomization test is proposed to adjust for this effect. Permutational distribution for Peto's cause-of-death (COD) test is also explored and compared with its asymptotic counterpart by simulation. The use of COD information has been a controversial issue due to the subjectivity in the pathologists' determinations as well as for economic reasons. The proposed age-adjusted exact test does not require COD, and it is shown to compare favorably to the COD tests via an extensive Monte Carlo simulation. Applications of the methods to two real data sets are included.     

Carcinogenicity study of GSM and DCS wireless communication signals in B6C3F1 mice

The purpose of this study using a total of 1170 B6C3F1 mice was to detect and evaluate possible carcinogenic effects in mice exposed to radio-frequency-radiation (RFR) from Global System for Mobile Communication (GSM) and Digital Personal Communications System (DCS) handsets as emitted by handsets operating in the center of the communication band, that is, at 902 MHz (GSM) and 1747 MHz (DCS). Restrained mice were exposed for 2 h per day, 5 days per week over a period of 2 years to three different whole-body averaged specific absorption rate (SAR) levels of 0.4, 1.3, 4.0 mW/g bw (SAR), or were sham exposed. Regarding the organ-related tumor incidence, pairwise Fisher's test did not show any significant increase in the incidence of any particular tumor type in the RF exposed groups as compared to the sham exposed group. Interestingly, while the incidences of hepatocellular carcinomas were similar in EMF and sham exposed groups, in both studies the incidences of liver adenomas in males decreased with increasing dose levels; the incidences in the high dose groups were statistically significantly different from those in the sham exposed groups. Comparison to published tumor rates in untreated mice revealed that the observed tumor rates were within the range of historical control data. In conclusion, the present study produced no evidence that the exposure of male and female B6C3F1 mice to wireless GSM and DCS radio frequency signals at a whole body absorption rate of up to 4.0 W/kg resulted in any adverse health effect or had any cumulative influence on the incidence or severity of neoplastic and non-neoplastic background lesions, and thus the study did not provide any evidence of RF possessing a carcinogenic potential.     

炎症状态下水肿与即早期和持续期痛行为之间的相关性分析:治疗意义探讨

迄今,有关个体的疼痛程度和炎症程度之间的精确关系一直存在争论,主要原因是缺乏能够同时反映多种痛(尤其是可鉴别疼痛即早期和持续期)的炎症模型以及定量方法的合理应用。因此,本研究在啮齿类动物评价了外周皮下组织致炎后炎症水肿与伤害性反应以及痛敏之间的相关性。为了更好地认识炎症特异性特征在治疗中的价值,我们对非甾体类抗炎药的作用效果也进行了评价。将一个剂量的蜜蜂毒(0．05mg／0．025m1)注入12个近交系(129P3/J、A／J、AKR／J、BALB／cJ、C3H／HeJ、C57BL／6J、C57BL／10J、C58／J、CBA／J、DBA／2J、RIIIS／J和SM／J)4、鼠或6个剂量的蜜蜂毒(0．001、0．005、0.01、0．05、0．1、0、2mg／0．05m1)注入远交系(Sprague-Dawley)大鼠的一侧足底皮下,分别检测自发伤害性反应、热和机械性痛敏,以及炎症的水肿和局部皮温,然后对组间和组内数据进行相关性分析。此外,观察非甾体类抗炎药吲哚美辛对痛和炎症的作用效果。结果显示：(1)炎症水肿程度与注射侧自发缩足反射次数、舔足抬足时间等伤害性反射程度呈高度正相关(P≤0．003),而与热或机械性痛敏的程度没有相关性;(2)吲哚美辛(0．5、2．5、25mg／kg,i．p．,稀释于60％二甲基桠枫)可以剂量依赖性地抑制炎症水肿和自发伤害性反应,但是对热或机械性痛敏却只有在最高剂量下才有作用。这些结果提示,炎症水肿过程可能只参与动物受炎症刺激而引起的即早自发伤害性反应过程,而不参与与临床更加密切相关的痛敏过程。这个分析结果为确定抗炎治疗有益于缓解多种炎性痛中的哪个靶表证提供了一个有用的分析方法。     

Stepwise confidence intervals for monotone dose-response studies

Summary .   In dose–response studies, one of the most important issues is the identification of the minimum effective dose (MED), where the MED is defined as the lowest dose such that the mean response is better than the mean response of a zero-dose control by a clinically significant difference. Dose–response curves are sometimes monotonic in nature. To find the MED, various authors have proposed step-down test procedures based on contrasts among the sample means. In this article, we improve upon the method of Marcus and Peritz (1976, Journal of the Royal Statistical Society, Series B 38 , 157–165) and implement the dose–response method of Hsu and Berger (1999, Journal of the American Statistical Association 94 , 468–482) to construct the lower confidence bound for the difference between the mean response of any nonzero-dose level and that of the control under the monotonicity assumption to identify the MED. The proposed method is illustrated by numerical examples, and simulation studies on power comparisons are presented.     

Combining multiple comparisons and modeling techniques in dose-response studies

The analysis of data from dose-response studies has long been divided according to two major strategies: multiple comparison procedures and model-based approaches. Model-based approaches assume a functional relationship between the response and the dose, taken as a quantitative factor, according to a prespecified parametric model. The fitted model is then used to estimate an adequate dose to achieve a desired response but the validity of its conclusions will highly depend on the correct choice of the a priori unknown dose-response model. Multiple comparison procedures regard the dose as a qualitative factor and make very few, if any, assumptions about the underlying dose-response model. The primary goal is often to identify the minimum effective dose that is statistically significant and produces a relevant biological effect. One approach is to evaluate the significance of contrasts between different dose levels, while preserving the family-wise error rate. Such procedures are relatively robust but inference is confined to the selection of the target dose among the dose levels under investigation. We describe a unified strategy to the analysis of data from dose-response studies which combines multiple comparison and modeling techniques. We assume the existence of several candidate parametric models and use multiple comparison techniques to choose the one most likely to represent the true underlying dose-response curve, while preserving the family-wise error rate. The selected model is then used to provide inference on adequate doses.     

Add-on therapy options in asthma not adequately controlled by inhaled corticosteroids: a comprehensive review

Many patients with persistent asthma can be controlled with inhaled corticosteroids (ICS). However, a considerable proportion of patients remain symptomatic, despite the use of ICS. We present systematically evidence that supports the different treatment options. A literature search was made of Medline/PubMed to identify randomised and blinded trials. To demonstrate the benefit that can be obtained by increasing the dose of ICS, dose-response studies with at least three different ICS doses were identified. To demonstrate whether more benefit can be obtained by adding long-acting β₂-agonist (LABA), leukotriene antagonist (LTRA) or theophylline than by increasing the dose of ICS, studies comparing these options were identified. Thirdly, studies comparing the different "add-on" options were identified. The addition of a LABA is more effective than increasing the dose of ICS in improving asthma control. By increasing the dose of ICS, clinical improvement is likely to be of small magnitude. Addition of a LTRA or theophylline to the treatment regimen appears to be equivalent to doubling the dose of ICS. Addition of a LABA seems to be superior to an LTRA in improving lung function. However, addition of LABA and LTRA may be equal with respect to asthma exacerbations. However, more and longer studies are needed to better clarify the role of LTRAs and theophylline as add-on therapies.     

Dose and litter allocations in the design of teratological studies for detecting hormesis

BACKGROUND: Hormesis is being recognized in the field of toxicology due to the stimulating effects of some toxic compounds at low exposure levels. Therefore, it is desirable that experimental designs for toxicological studies be flexible enough to aid in the detection of hormetic effects. Current designs may still not have enough power to do this. METHODS: A simulation study was conducted to determine teratological study designs that would yield more power over standard designs in detecting hormesis. Developmental toxicity endpoints of interest are the number of dead/resorbed or malformed fetuses in a litter. The simulation designs mimic teratological experiments in terms of sample size and number of dose levels. Modified designs with even dose spacing at low levels and reallocated litters are investigated to determine the power of hormetic detection. RESULTS: Designs with reallocated litters (with more litters at low exposure levels than at high levels) and even dose spacing have more power than those with equal litters per group and uneven dose spacing. CONCLUSIONS: Through appropriate modifications of current experimental designs, such as reallocation of litters and even dose spacing, we can better detect hormetic effects.     

基于药物毒性反应等级的Up-and-Down设计

Ⅰ期临床试验主要关心毒性,通常划分毒性为五个水平．简单起见,同时兼顾伦理问题,Ⅰ期临床试验通常采用up-and-down序贯设计(例如BCDⅠ,BCDⅡ,K-in-a-row,Narayana,Improved Narayana)．然而,在分配剂量水平时,该设计没有区分已经试验了的病人的严重毒性水平等级,从而有可能分配给病人更高毒性的剂量水平．因此,本文提出了基于药物毒性等级确定最大耐受剂量的up-and-down设计方法,并进一步研究了该设计方法在各种变化的剂量—毒性关系下的运作特征,并且和标准的up-and-down设计作模拟比较,结果表明该设计方法对Ⅰ期临床试验设计的剂量建议具有重要意义．     

Dose Response for Amphetamine-Induced Changes in Dopamine Levels in Push-Pull Perfusates of Rat Striatum

Levels of dopamine were determined in push-pull perfusates of striatum in chloral hydrate-anesthetized rats as a function of increasing systemic doses of amphetamine over the range 0.5-5.0 mg/kg. In the absence of amphetamine administration, basal dopamine levels remained stable for at least 6 h. Perfusate levels of dopamine responded in a quantitatively predictable fashion to increasing doses of amphetamine: (1) the maximal increase in perfusate levels of dopamine after amphetamine, relative to predrug levels, was directly proportional to the dose of the drug up to 3 mg/kg (fivefold after 0.5 mg/kg to 30-fold after 3 mg/kg); (2) the duration over which perfusate levels of dopamine were significantly elevated, with respect to preamphetamine levels, was proportional to the dose of amphetamine up to 5 mg/kg; and (3) each successively higher dose of amphetamine significantly increased the perfusate level of dopamine over that observed at the next lower dose up to 3 mg/kg amphetamine. However, maximal levels of dopamine in striatal perfusates were achieved following 3 mg/kg amphetamine and were not increased further at higher doses of the drug. The data suggest that, at higher doses of amphetamine, extraneuronal metabolism of dopamine may be of sufficient capacity to limit increases in synaptic levels of dopamine. The absence of further increases in perfusate levels of dopamine as the dose of amphetamine is increased beyond 3 mg/kg is discussed in terms of potential relevance to mechanisms of amphetamine-induced stereotyped behaviors.     

A parallel phase I/II clinical trial design for combination therapies

The use of multiple drugs in a single clinical trial or as a therapeutic strategy has become common, particularly in the treatment of cancer. Because traditional trials are designed to evaluate one agent at a time, the evaluation of therapies in combination requires specialized trial designs. In place of the traditional separate phase I and II trials, we propose using a parallel phase I/II clinical trial to evaluate simultaneously the safety and efficacy of combination dose levels, and select the optimal combination dose. The trial is started with an initial period of dose escalation, then patients are randomly assigned to admissible dose levels. These dose levels are compared with each other. Bayesian posterior probabilities are used in the randomization to adaptively assign more patients to doses with higher efficacy levels. Combination doses with lower efficacy are temporarily closed and those with intolerable toxicity are eliminated from the trial. The trial is stopped if the posterior probability for safety, efficacy, or futility crosses a prespecified boundary. For illustration, we apply the design to a combination chemotherapy trial for leukemia. We use simulation studies to assess the operating characteristics of the parallel phase I/II trial design, and compare it to a conventional design for a standard phase I and phase II trial. The simulations show that the proposed design saves sample size, has better power, and efficiently assigns more patients to doses with higher efficacy levels.     

Ordered multiple comparisons with the best and their applications to dose-response studies

This article considers the problem of comparing several treatments (dose levels, interventions, etc.) with the best, where the best treatment is unknown and the treatments are ordered in some sense. Order relations among treatments often occur quite naturally in practice. They may be ordered according to increasing risks, such as tolerability or safety problems with increasing dose levels in a dose-response study, for example. We tackle the problem of constructing a lower confidence bound for the smallest index of all treatments being at most marginally less effective than the (best) treatment having the largest effect. Such a bound ensures at confidence level 1 -alpha that all treatments with lower indices are relevantly less effective than the best competitor. We derive a multiple testing strategy that results in sharp confidence bounds. The proposed lower confidence bound is compared with those derived from other testing strategies. We further derive closed-form expressions for power and sample size calculations. Finally, we investigate several real data sets to illustrate various applications of our methods.