Dose–response relationship from longitudinal data with response‐dependent dose modification using likelihood methods

In some clinical trials or clinical practice, the therapeutic agent is administered repeatedly, and doses are adjusted in each patient based on repeatedly measured continuous responses, to maintain the response levels in a target range. Because a lower dose tends to be selected for patients with a better outcome, simple summarizations may wrongly show a better outcome for the lower dose, producing an incorrect dose–response relationship. In this study, we consider the dose–response relationship under these situations. We show that maximum‐likelihood estimates are consistent without modeling the dose‐modification mechanisms when the selection of the dose as a time‐dependent covariate is based only on observed, but not on unobserved, responses, and measurements are generated based on administered doses. We confirmed this property by performing simulation studies under several dose‐modification mechanisms. We examined an autoregressive linear mixed effects model. The model represents profiles approaching each patient's asymptote when identical doses are repeatedly administered. The model takes into account the previous dose history and provides a dose–response relationship of the asymptote as a summary measure. We also examined a linear mixed effects model assuming all responses are measured at steady state. In the simulation studies, the estimates of both the models were unbiased under the dose modification based on observed responses, but biased under the dose modification based on unobserved responses. In conclusion, the maximum‐likelihood estimates of the dose–response relationship are consistent under the dose modification based only on observed responses.