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Chapter 1 - Introduction to Clinical Trial Research

from Part I - Introduction and History of Clinical Trial Research

Published online by Cambridge University Press:  20 March 2023

Jay J. H. Park
Affiliation:
McMaster University, Ontario
Edward J. Mills
Affiliation:
McMaster University, Ontario
J. Kyle Wathen
Affiliation:
Cytel, Cambridge, Massachusetts
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Summary

This chapter introduces clinical research concepts and randomised clinical trials, covering the basics and building blocks that are necessary to understand the topics of adaptive trial designs and master protocols. Clinical trials are a type of prospective experimental studies in which human volunteers receive specific interventions according to the research protocol, then are followed longitudinally over time. Clinical trials are typically conducted in a sequence (from phase I, phase IIA, phase IIB, and phase III) that builds on knowledge accumulated from non-clinical and previous clinical studies. Randomisation is a process of random assignment of clinical trial participants to one or more intervention group(s) or control group under comparison. The use of randomisation provides a sound basis for making statistical causal inference when estimating the comparative treatment effects between groups. Fixed sample trial design refers to a type of designs where the trial data is only analysed once when a priori determined sample size has been reached. Fixed sample trial designs are designed with a fixed maximum sample size, a fixed number of interventions, and a defined end to the trial. This is the most common approach to clinical trial research.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Friedman, LM, Furberg, C, DeMets, DL, Reboussin, D, Granger, CB. Fundamentals of Clinical Trials: Springer; 2015.Google Scholar
Yuan, J, Pang, H, Tong, T, et al. Seamless phase IIa/IIb and enhanced dose-finding adaptive design. J Biopharm Stat. 2016;26(5):912–23.Google Scholar
Malay, S, Chung, KC. The choice of controls for providing validity and evidence in clinical research. Plast Reconstr Surg. 2012;130(4):959–65.CrossRefGoogle ScholarPubMed
Viele, K, Berry, S, Neuenschwander, B, et al. Use of historical control data for assessing treatment effects in clinical trials. Pharm Stat. 2014;13(1):4154.CrossRefGoogle ScholarPubMed
Lachin, JM. Statistical properties of randomization in clinical trials. Control Clin Trials. 1988;9(4):289311.Google Scholar
Lachin, JM, Matts, JP, Wei, LJ. Randomization in clinical trials: conclusions and recommendations. Control Clin Trials. 1988;9(4):365–74.Google ScholarPubMed
Cartwright, N. What are randomised controlled trials good for? Philos Stud. 2010;147(1):59.CrossRefGoogle Scholar
Senn, S. Seven myths of randomisation in clinical trials. Stat Med. 2013;32(9):1439–50.Google Scholar
Deaton, A, Cartwright, N. Understanding and misunderstanding randomized controlled trials. Soc Sci Med. 2018;210:221.Google Scholar
Roberts, C, Torgerson, DJ. Understanding controlled trials: baseline imbalance in randomised controlled trials. BMJ. 1999;319(7203):185.CrossRefGoogle ScholarPubMed
Broglio, K. Randomization in clinical trials: permuted blocks and stratification. JAMA. 2018;319(21):2223–4.CrossRefGoogle ScholarPubMed
McPherson, GC, Campbell, MK, Elbourne, DR. Use of randomisation in clinical trials: a survey of UK practice. Trials. 2012;13(1):17.CrossRefGoogle ScholarPubMed
Matts, JP, Lachin, JM. Properties of permuted-block randomization in clinical trials. Control Clin Trials. 1988;9(4):327–44.Google Scholar
Kang, M, Ragan, BG, Park, JH. Issues in outcomes research: an overview of randomization techniques for clinical trials. J Athl Train. 2008;43(2):215–21.CrossRefGoogle ScholarPubMed
Therneau, TM. How many stratification factors are ‘too many’ to use in a randomization plan? Control Clin trials. 1993;14(2):98108.CrossRefGoogle Scholar
Kahan, BC, Morris, TP. Improper analysis of trials randomised using stratified blocks or minimisation. Stat Med. 2012;31(4):328340.CrossRefGoogle ScholarPubMed
Freedman, B. Equipoise and the ethics of clinical research. N Engl J Med. 1987;317(3):141–5.CrossRefGoogle ScholarPubMed
Cook, C, Sheets, C. Clinical equipoise and personal equipoise: two necessary ingredients for reducing bias in manual therapy trials. J Man Manip Ther. 2011;19(1):55–7.CrossRefGoogle ScholarPubMed
Jepson, M, Elliott, D, Conefrey, C, et al. An observational study showed that explaining randomization using gambling-related metaphors and computer-agency descriptions impeded randomized clinical trial recruitment. J Clin Epidemiol. 2018;99:7583.CrossRefGoogle ScholarPubMed
Angus, DC. Optimizing the trade-off between learning and doing in a pandemic. JAMA. 2020;323(19):1895–6.Google Scholar
London, AJ. Equipoise in research: integrating ethics and science in human research. JAMA. 2017;317(5):525–6.Google Scholar
Parmar, MK, Carpenter, J, Sydes, MR. More multiarm randomised trials of superiority are needed. Lancet. 2014;384(9940):283–4.CrossRefGoogle ScholarPubMed
Box, GE, Hunter, J, Hunter, W. Statistics for Experimenters. Design, Innovation and Discovery, 2nd ed. John Wiley; 2005.Google Scholar
Montgomery, AA, Peters, TJ, Little, P. Design, analysis and presentation of factorial randomised controlled trials. BMC Med Res Methodol. 2003;3:26.Google Scholar
Ondra, T, Dmitrienko, A, Friede, T, et al. Methods for identification and confirmation of targeted subgroups in clinical trials: a systematic review. J Biopharm Stat. 2016;26(1):99119.Google Scholar
Thorlund, K, Haggstrom, J, Park, JJ, Mills, EJ. Key design considerations for adaptive clinical trials: a primer for clinicians. BMJ. 2018;360:k698.Google Scholar
Park, JJ, Thorlund, K, Mills, EJ. Critical concepts in adaptive clinical trials. Clin Epidemiol. 2018;10:343–51.Google Scholar
Dimairo, M, Pallmann, P, Wason, J et al. The Adaptive designs CONSORT Extension (ACE) statement: a checklist with explanation and elaboration guideline for reporting randomised trials that use an adaptive design. BMJ. 2020;369:m115.Google Scholar
Dimairo, M, Pallmann, P, Wason, J, et al. The Adaptive designs CONSORT extension (ACE) statement: a checklist with explanation and elaboration guideline for reporting randomised trials that use an adaptive design. Trials. 2020;21(1):528.Google Scholar
Adaptive Platform Trials Coalition. Adaptive platform trials: definition, design, conduct and reporting considerations. Nat Rev Drug Discov 2019;18(10):797807.Google Scholar
Woodcock, J, LaVange, LM. Master protocols to study multiple therapies, multiple diseases, or both. N Engl J Med. 2017;377(1):6270.Google Scholar
Chan, AW, Tetzlaff, JM, Gotzsche, PC, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586.Google Scholar
International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use. Addendum on Estimands and Sensitivity Analysis in Clinical Trials to the Guideline on Statistical Principles for Clinical Trials E9(R1); 2019. https://database.ich.org/sites/default/files/E9-R1_Step4_Guideline_2019_1203.pdfGoogle Scholar
Bell, J, Hamilton, A, Sailer, O, Voss, F. The detailed clinical objectives approach to designing clinical trials and choosing estimands. Pharm Stat. 2021;20(6):1112–24.CrossRefGoogle ScholarPubMed
Ratitch, B, Goel, N, Mallinckrodt, C, et al. Defining efficacy estimands in clinical trials: examples illustrating ICH E9(R1) guidelines. Ther Innov Regul Sci. 2020;54(2):370–84.Google Scholar
Smith, VA, Coffman, CJ, Hudgens, MG. Interpreting the results of intention-to-treat, per-protocol, and as-treated analyses of clinical trials. JAMA. 2021;326(5):433–4.Google Scholar
Sussman, JB, Hayward, RA. An IV for the RCT: using instrumental variables to adjust for treatment contamination in randomised controlled trials. BMJ (Clinical Res Ed). 2010;340:c2073.Google Scholar
Parra, CO, Daniel, RM, Bartlett, JW. Hypothetical estimands in clinical trials: a unification of causal inference and missing data methods. arXiv preprint arXiv:210704392. 2021.Google Scholar
Bornkamp, B, Rufibach, K, Lin, J, et al. Principal stratum strategy: potential role in drug development. Pharm Stat. 2021;20(4):737–51.CrossRefGoogle ScholarPubMed
Burton, A, Altman, DG, Royston, P, Holder, RL. The design of simulation studies in medical statistics. Stat Med. 2006;25(24):4279–92.Google Scholar
Holford, N, Ma, SC, Ploeger, BA. Clinical trial simulation: a review. Clin Pharm Therap. 2010;88(2):166–82.CrossRefGoogle ScholarPubMed
U.S. Food and Drug Administration. Adaptive Designs for Medical Device Clinical Studies Guidance for Industry and Food and Drug Administration Staff. United States Department of Health and Human Services; 2016.Google Scholar
Hummel, J, Wang, S, Kirkpatrick, J. Using simulation to optimize adaptive trial designs: applications in learning and confirmatory phase trials. Clin Investig. 2015;5(4):401–13.Google Scholar
Bland, JM, Altman, DG. Bayesians and frequentists. BMJ. 1998;317(7166):1151–60.Google Scholar
Berry, DA. Bayesian clinical trials. Nat Rev Drug Discov. 2006;5(1):2736.Google Scholar
Wasserstein, RL, Lazar, NA. The ASA Statement on p-Values: Context, Process, and Purpose. Taylor & Francis; 2016. pp. 129–33.Google Scholar
Greenland, S, Senn, SJ, Rothman, KJ, et al. Statistical tests, P values, confidence intervals, and power: a guide to misinterpretations. Eur J Epidemiol. 2016;31(4):337–50.Google Scholar
Gill, CJ, Sabin, L, Schmid, CH. Why clinicians are natural Bayesians. BMJ. 2005;330(7499):1080–3.Google ScholarPubMed

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