Analysis of Randomized Dose-Finding-Studies: Closure Test Modifications Based on Multiple Contrast Tests

The power of single contrast tests strongly depends on the a priori unknown shape of the dose response relationship. Two approaches can be used to overcome this major disadvantage: the likelihood ratio test for order restriction or multiple contrast tests. Within the closure principle, the shape for the different hyptheses varies. Therefore multiple contrast tests are used as trend tests. Based on a simulation study the power advantage of this approach in comparison with single contrast tests is demonstrated.     

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.     

Two-stage designs for dose-finding trials with a biologic endpoint using stepwise tests

Summary.   We deal with the design problem of early phase dose-finding clinical trials with monotone biologic endpoints, such as biological measurements, laboratory values of serum level, and gene expression. A specific objective of this type of trial is to identify the minimum dose that exhibits adequate drug activity and shifts the mean of the endpoint from a zero dose to the so-called minimum effective dose. Stepwise test procedures for dose finding have been well studied in the context of nonhuman studies where the sampling plan is done in one stage. In this article, we extend the notion of stepwise testing to a two-stage enrollment plan in an attempt to reduce the potential sample size requirement by shutting down unpromising doses in a futility interim. In particular, we examine four two-stage designs and apply them to design a statin trial with four doses and a placebo in patients with Hodgkin's disease. We discuss the calibration of the design parameters and the implementation of these proposed methods. In the context of the statin trial, a calibrated two-stage design can reduce the average total sample size up to 38% (from 125 to 78) from a one-stage step-down test, while maintaining comparable error rates and probability of correct selection. The price for the reduction in the average sample size is the slight increase in the maximum total sample size from 125 to 130.     

Dose finding - a challenge in statistics

A good understanding and characterization of the dose response relationship of any new compound is an important and ubiquitous problem in many areas of scientific investigation. This is especially true in the context of pharmaceutical drug development, where it is mandatory to launch safe drugs which demonstrate a clinically relevant effect. Selecting a dose too high may result in unacceptable safety problems, while selecting a dose too low may lead to ineffective drugs. Dose finding studies thus play a key role in any drug development program and are often the gate-keeper for large confirmatory studies. In this overview paper we focus on definitive and confirmatory dose finding studies in Phase II or III, reviewing relevant statistical design and analysis methods. In particular, we describe multiple comparison procedures, modeling approaches, and hybrid methods combining the advantages of both. An outlook to adaptive dose finding methods is also given. We use a real data example to illustrate the methods, together with a brief overview of relevant software.