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

Lee, KM; Brown, LC; Jaki, T; Stallard, N; Wason, J; (2021) Statistical consideration when adding new arms to ongoing clinical trials: the potentials and the caveats. Trials , 22 (1) , Article 203. 10.1186/s13063-021-05150-7. Green open access

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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.

Type: Article
Title: Statistical consideration when adding new arms to ongoing clinical trials: the potentials and the caveats
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/s13063-021-05150-7
Publisher version: https://doi.org/10.1186/s13063-021-05150-7
Language: English
Additional information: © 2021 BioMed Central Ltd. This article is licensed under a Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).
Keywords: Adding arms, Bias, Error rates, Multiplicity, Platform trials
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10125031
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