Bayesian optimal design for phase II screening trials

Summary .   Most phase II screening designs available in the literature consider one treatment at a time. Each study is considered in isolation. We propose a more systematic decision-making approach to the phase II screening process. The sequential design allows for more efficiency and greater learning about treatments. The approach incorporates a Bayesian hierarchical model that allows combining information across several related studies in a formal way and improves estimation in small data sets by borrowing strength from other treatments. The design incorporates a utility function that includes sampling costs and possible future payoff. Computer simulations show that this method has high probability of discarding treatments with low success rates and moving treatments with high success rates to phase III trial.     

A comparison of methods for adaptive treatment selection

Traditionally drug development is generally divided into three phases which have different aims and objectives. Recently so-called adaptive seamless designs that allow combination of the objectives of different development phases into a single trial have gained much interest. Adaptive trials combining treatment selection typical for Phase II and confirmation of efficacy as in Phase III are referred to as adaptive seamless Phase II/III designs and are considered in this paper. We compared four methods for adaptive treatment selection, namely the classical Dunnett test, an adaptive version of the Dunnett test based on the conditional error approach, the combination test approach, and an approach within the classical group-sequential framework. The latter two approaches have only recently been published. In a simulation study we found that no one method dominates the others in terms of power apart from the adaptive Dunnett test that dominates the classical Dunnett by construction. Furthermore, scenarios under which one approach outperforms others are described.     

The potential of artemether for the control of schistosomiasis

Schistosomiasis continues to rank – following malaria – at the second position of the world's parasitic diseases in terms of the extent of endemic areas and the number of infected people. There is yet no vaccine available and the current mainstay of control is chemotherapy with praziquantel used as the drug of choice. In view of concern about the development of tolerance and/or resistance to praziquantel, there is a need for research and development of novel drugs for the prevention and cure of schistosomiasis. Interestingly, derivatives of artemisinin, which are already effectively used in the treatment of malaria, also exhibit antischistosomal properties. Significant advances have been made with artemether, the methyl ether derivative of artemisinin. We review the discovery of the antischistosomal activity of artemether by Chinese scientists two decades ago; the detailed laboratory studies of the susceptibility of, and effect on, the different developmental stages of Schistosoma japonicum, Schistosoma mansoni and Schistosoma haematobium to artemether; the possible mechanism of action and the potential long-term toxicity. Finally, we look at the effect of combined treatment with artemether and praziquantel; and clinical findings thus far obtained from randomised controlled trials with oral artemether for the prevention of patent infections and morbidity. The review intends to create a forum for strategic discussion of how these laboratory and clinical findings could be translated into public health actions. We conclude that artemether – as part of integrated current control measures and adapted to specific socio-ecological and epidemiological settings – has considerable potential to significantly reduce the current burden of schistosomiasis in many parts of the world.     

Stratified or Multicentre Analysis with Extended Mantel–Haenszel Statistics

Since its introduction in 1959 the ability of the classical Mantel-Haenszel (M–H) procedure for combining the odds ratios of a set of I 2 × 2 tables has led to its use also in stratified or multicentre type clinical trials. A familiar application is the M–H logrank test in survival analysis. An extension of the M–H procedure covering the case of 2 × K contingency tables (MANTEL , 1963) with ordered levels retains the essential property of pooling the results of I homogeneous tables (i.e. in absence of qualitative interactions). The assignment of some score for the K columns of a table is essential for the use of the method (in comparing 2 treatments). Some possibilities of score assignment are discussed: for clinical outcome variables such as the degree of severity of a disease, pain and so on, the score is at hand in a natural way. A less well-known type of scoring consists in ranking the observations of a continuous variable, leading to cell sizes of 1 or 0. In this case, however, if equidistant ranking was used, the E–M–H procedure appears as an extension of Wilcoxon's rank sum test and represents a powerful non-parametric approach in stratified or multicentre type designs with non normally distributed outcome variables. The results of some Monte-Carlo simulations for 2 possible equidistant ranking procedures are presented, which indicate only a moderate gain in power as compared to Wilcoxon's rank sum test under the common situation of centre effects not exceeding treatment effects. Use of the E–M–H pro?edure is also recommended as a simple method to overcome the potential bias due to unequally distributed prognostic factors among treatment groups.     

Seed quality effects in bulb onions (Allium cepa L.)

The nature and persistence of seed quality effects produced by a range of seed production treatments was investigated in the autumn-sown onion crop. Genotypically equivalent seed lots raised in different glasshouses within the same year were found to germinate at significantly different rates. The seed lot which emerged earlier produced larger seedlings and this difference in size persisted throughout the growing period. In a comparison between the effects of hand crossing and self-pollination techniques the hand crossing method produced a much lower total seed yield but heavier seeds and larger plants. The induced effects persisted throughout the year but were not significant in the mature bulb characters. The implications of these results upon the control of seed production for plant breeding and genetical experiments is discussed.     

Regression Models for Clinical Trials with Correlated Categorical Responses

Regression models for correlated categorical data are presented in which the covariance is a function of measured effects. The regression and covariance parameters are estimated by extended least square methods. A numerical example of a clinical trial comparing two antiemetic treatment regimes for patients receiving chemotherapy is given to illustrate the approach.