Testing a Primary and a Secondary Endpoint in a Group Sequential Design

Summary We consider a clinical trial with a primary and a secondary endpoint where the secondary endpoint is tested only if the primary endpoint is significant. The trial uses a group sequential procedure with two stages. The familywise error rate (FWER) of falsely concluding significance on either endpoint is to be controlled at a nominal level α. The type I error rate for the primary endpoint is controlled by choosing any α‐level stopping boundary, e.g., the standard O'Brien–Fleming or the Pocock boundary. Given any particular α‐level boundary for the primary endpoint, we study the problem of determining the boundary for the secondary endpoint to control the FWER. We study this FWER analytically and numerically and find that it is maximized when the correlation coefficient ρ between the two endpoints equals 1. For the four combinations consisting of O'Brien–Fleming and Pocock boundaries for the primary and secondary endpoints, the critical constants required to control the FWER are computed for different values of ρ. An ad hoc boundary is proposed for the secondary endpoint to address a practical concern that may be at issue in some applications. Numerical studies indicate that the O'Brien–Fleming boundary for the primary endpoint and the Pocock boundary for the secondary endpoint generally gives the best primary as well as secondary power performance. The Pocock boundary may be replaced by the ad hoc boundary for the secondary endpoint with a very little loss of secondary power if the practical concern is at issue. A clinical trial example is given to illustrate the methods.     

Gatekeeping testing via adaptive alpha allocation

In a typical clinical trial, there are one or two primary endpoints, and a few secondary endpoints. When at least one primary endpoint achieves statistical significance, there is considerable interest in using results for the secondary endpoints to enhance characterization of the treatment effect. Because multiple endpoints are involved, regulators may require that the familywise type I error rate be controlled at a pre-set level. This requirement can be achieved by using "gatekeeping" methods. However, existing methods suffer from logical oddities such as allowing results for secondary endpoint(s) to impact the likelihood of success for the primary endpoint(s). We propose a novel and easy-to-implement gatekeeping procedure that is devoid of such deficiencies. A real data example and simulation results are used to illustrate efficiency gains of our method relative to existing methods.     

Simultaneous confidence regions corresponding to Holm's step-down procedure and other closed-testing procedures

Holm's (1979) step-down multiple-testing procedure (MTP) is appealing for its flexibility, transparency, and general validity, but the derivation of corresponding simultaneous confidence regions has remained an unsolved problem. This article provides such confidence regions. In fact, simultanenous confidence regions are provided for any MTP in the class of short-cut consonant closed-testing procedures based on marginal p -values and weighted Bonferroni tests for intersection hypotheses considered by Hommel, Bretz and Maurer (2007). In addition to Holm's MTP, this class includes the fixed-sequence MTP, recently proposed gatekeeping MTPs, and the fallback MTP. The simultaneous confidence regions are generally valid if underlying marginal p -values and corresponding marginal confidence regions (assumed to be available) are valid. The marginal confidence regions and estimated quantities are not assumed to be of any particular kinds/dimensions. Compared to the rejections made by the MTP for the family of null hypotheses H under consideration, the proposed confidence regions provide extra free information. In particular, with Holm's MTP, such extra information is provided: for all nonrejected H s, in case not all H s are rejected; or for certain (possibly all) H s, in case all H s are rejected. In case not all H s are rejected, no extra information is provided for rejected H s. This drawback seems however difficult to overcome. Illustrations concerning clinical studies are given.     

A simple and flexible Holm gatekeeping procedure

Major objectives of a clinical trial are commonly stated in a hierarchical order as primary and secondary. The parallel gatekeeping testing strategy provides an opportunity to assess secondary objectives when all or partial primary objectives are achieved. The current available gatekeeping procedures have different pros and cons so users either need to justify the assumption associated with some procedures or tolerate suboptimal power performance of other procedures. By applying the Holm test with a flexible alpha splitting technique, we propose a procedure which (1) is powerful for assessing the primary objectives, (2) can be used when no assumption can be made on the dependency structure of test statistics, and (3) has the full flexibility to allocate user-preferred alpha to assess the secondary objectives based on the number of primary objectives achieved. A real clinical trial example is used for illustration of the proposed procedure.