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Statistical consideration when adding new arms to ongoing clinical trials: the potentials and the caveats.

Published version
Peer-reviewed

Type

Article

Change log

Authors

Brown, Louise C 
Jaki, Thomas 
Stallard, Nigel 
Wason, James 

Abstract

BACKGROUND: Platform trials improve the efficiency of the drug development process through flexible features such as adding and dropping arms as evidence emerges. The benefits and practical challenges of implementing novel trial designs have been discussed widely in the literature, yet less consideration has been given to the statistical implications of adding arms. MAIN: We explain different statistical considerations that arise from allowing new research interventions to be added in for ongoing studies. We present recent methodology development on addressing these issues and illustrate design and analysis approaches that might be enhanced to provide robust inference from platform trials. We also discuss the implication of changing the control arm, how patient eligibility for different arms may complicate the trial design and analysis, and how operational bias may arise when revealing some results of the trials. Lastly, we comment on the appropriateness and the application of platform trials in phase II and phase III settings, as well as publicly versus industry-funded trials. CONCLUSION: Platform trials provide great opportunities for improving the efficiency of evaluating interventions. Although several statistical issues are present, there are a range of methods available that allow robust and efficient design and analysis of these trials.

Description

Keywords

Adding arms, Bias, Error rates, Multiplicity, Platform trials, Clinical Trials as Topic, Data Interpretation, Statistical, Humans, Research Design

Journal Title

Trials

Conference Name

Journal ISSN

1745-6215
1745-6215

Volume Title

22

Publisher

Springer Science and Business Media LLC
Sponsorship
Medical Research Council (MR/N028171/1)
NIHR Academy (SRF-2015-08-001)
Medical Research Council (MC_UU_00002/14)