A group sequential test for treatment effect based on the Fine-Gray model. Biometrics 2018 Sep;74(3):1006-1013
Date
03/14/2018Pubmed ID
29534294Pubmed Central ID
PMC6146968DOI
10.1111/biom.12871Scopus ID
2-s2.0-85043497709 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
Competing risks endpoints arise when patients can fail therapy from several causes. Analyzing these outcomes allows one to assess directly the benefit of treatment on a primary cause of failure in a clinical trial setting. Regression models can be used in clinical trials to adjust for residual imbalances in patient characteristics, improving the power to detect treatment differences. But, none of the competing risks methods currently available for use in group sequential trials adjust for covariates. We propose a group sequential test for treatment effect that, because it is based on the Fine-Gray model, permits adjustment for covariates. Our derivations show that its sequence of test statistics has an asymptotic distribution with an independent increments structure, which allows standard techniques such as O'Brien-Fleming designs and error spending functions to be employed to meet type I error rate and power specifications. We demonstrate the test in a reanalysis of BMT CTN 0402, a phase III clinical trial that evaluated an experimental treatment for the prevention of adverse outcomes following blood and marrow transplant. Moreover, using a simulation study of randomized group sequential trials, we demonstrate that the proposed method preserves the type I error rate and power at their nominal levels in the presence of influential covariates.
Author List
Martens MJ, Logan BRAuthors
Brent R. Logan PhD Director, Professor in the Institute for Health and Equity department at Medical College of WisconsinMichael Martens PhD Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Bone Marrow TransplantationClinical Trials as Topic
Computer Simulation
Endpoint Determination
Humans
Long Term Adverse Effects
Peripheral Blood Stem Cell Transplantation
Risk
Treatment Failure
Treatment Outcome
