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Optimal design for dose-finding studies
Stockholm University, Faculty of Social Sciences, Department of Statistics.ORCID iD: 0000-0002-2629-5033
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

One of the most complex tasks during the clinical development of a new drug is to find a correct dose. Optimal experimental design has as a goal to find the best ways to perform an experiment considering the available resources and the statistical model. Optimal designs have already been used to determine the design of dose-finding studies. In this thesis, optimal designs are considered for the simultaneous response of efficacy and safety in a bivariate model, for the drug combination trials, and for general regression problems, including but not limited to dose-finding analysis.

The thesis consists of four papers: In Paper I, the dose that maximizes the clinical utility index based on an efficacy-safety Emax model gives us the desirable balance between effects and side effects. In order to make use of a symmetry property, we use a log-transformed dose scale. The geometric characterization of the multivariate Elfving method is used to derive c-optimal points and weights for arbitrary c-vectors. The second paper is an extension of the first one. We still use the log-transformed dose scale bivariate model and consider now also the placebo effect and side-effect. Fedorov’s exchange algorithm is applied in order to derive locally D-optimal designs numerically. 

Optimal experimental design for dose-finding studies often focuses on one drug only. Paper III calculates D-optimal designs for the efficacy Emax model of two drugs that might interact. Three conditions can occur in drug combination trials. When there is a positive interaction, we deal with synergy; when it is negative, we have antagonism; and when the interaction is zero, it is called additivity.

Finally, in Paper IV, we present a low dimensional regression model with a distortion term. The distortion term, which in our case is a stochastic process, contributes to the regression. Thus, we estimate the combined model, which is a mixed effect model. Optimal designs for this model are derived by applying the Fedorov Algorithm.

Place, publisher, year, edition, pages
Stockholm: Department of Statistics, Stockholm University , 2021. , p. 34
Keywords [en]
bivariate model, distortion, drug combination, Elfving set, Emax model, Fedorov algorithm, mixed effects models, optimal experimental design
National Category
Probability Theory and Statistics Pharmaceutical Sciences
Research subject
Statistics
Identifiers
URN: urn:nbn:se:su:diva-198271ISBN: 978-91-7911-686-6 (print)ISBN: 978-91-7911-687-3 (electronic)OAI: oai:DiVA.org:su-198271DiVA, id: diva2:1608045
Public defence
2021-12-17, hörsal 11, hus F, Universitetsvägen 10 F, Stockholm, 13:00 (English)
Opponent
Supervisors
Available from: 2021-11-24 Created: 2021-11-02 Last updated: 2022-02-25Bibliographically approved
List of papers
1. Optimal dose-finding for efficacy-safety models
Open this publication in new window or tab >>Optimal dose-finding for efficacy-safety models
2021 (English)In: Biometrical Journal, ISSN 0323-3847, E-ISSN 1521-4036, Vol. 63, no 6, p. 1185-1201Article in journal (Refereed) Published
Abstract [en]

Dose-finding is an important part of the clinical development of a new drug. The purpose of dose-finding studies is to determine a suitable dose for future development based on both efficacy and safety. Optimal experimental designs have already been used to determine the design of this kind of studies, however, often that design is focused on efficacy only. We consider an efficacy-safety model, which is a simplified version of the bivariate Emax model. We use here the clinical utility index concept, which provides the desirable balance between efficacy and safety. By maximizing the utility of the patients, we get the estimated dose. This desire leads us to locally c-optimal designs. An algebraic solution for c-optimal designs is determined for arbitrary c vectors using a multivariate version of Elfving's method. The solution shows that the expected therapeutic index of the drug is a key quantity determining both the number of doses, the doses itself, and their weights in the optimal design. A sequential design is proposed to solve the complication of parameter dependency, and it is illustrated in a simulation study.

Keywords
bivariate model, dose-finding, Elfving´s method, optimal design, sequential design
National Category
Pharmaceutical Sciences Probability Theory and Statistics
Identifiers
urn:nbn:se:su:diva-194263 (URN)10.1002/bimj.202000181 (DOI)000637704200001 ()33829555 (PubMedID)
Available from: 2021-06-17 Created: 2021-06-17 Last updated: 2022-02-25Bibliographically approved
2. Optimal dose-finding for efficacy-safety-models with placebo effects
Open this publication in new window or tab >>Optimal dose-finding for efficacy-safety-models with placebo effects
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The knowledge of how good or optimal designs look like is essential for dose-finding trials. In many cases, dose-finding trials consider both efficacy and safety. We analyse, therefore, a bivariate model for these two outcomes. In contrast to earlier research, we consider a model also having placebo effects to see the impact on the optimal design. We calculate D-optimal designs algebraically and numerically. We see that one more design point is necessary, but that otherwise, the optimal design has a similar structure compared to the model without placebo effects. We confirm that the drug's therapeutic index has a significant impact on the shape of the optimal design.

Keywords
Bivariate model, Dose-finding, Fedorov Algorithm, Optimal design, Placebo Effect
National Category
Probability Theory and Statistics Pharmaceutical Sciences
Research subject
Statistics
Identifiers
urn:nbn:se:su:diva-198268 (URN)
Available from: 2021-11-02 Created: 2021-11-02 Last updated: 2022-02-25
3. Optimal dose-finding for drug combinations
Open this publication in new window or tab >>Optimal dose-finding for drug combinations
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Optimal experimental designs are an essential part of clinical development of a drug and are used to determine the design of dose-finding studies. However, often, these designs for dose-finding aim on one drug. We consider an efficacy Emax model for the combination of two drugs. The interaction is characterized as synergy if it is positive, antagonism when it is negative and additive when there is no interaction between the two drugs. We calculate D-optimal designs algebraically and numerically. The solutions show that the number of doses, the doses itself, and their weights in the D-optimal design depend on the parameter values in the model, ED50x, ED50y and the interaction term γ.

Keywords
Additivity, Antagonism, Fedorov Algorithm, Optimal Design, Synergy
National Category
Pharmaceutical Sciences Probability Theory and Statistics
Research subject
Statistics
Identifiers
urn:nbn:se:su:diva-198269 (URN)
Available from: 2021-11-02 Created: 2021-11-02 Last updated: 2022-02-25
4. Optimal designs for distorted regression models
Open this publication in new window or tab >>Optimal designs for distorted regression models
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Much of traditional optimal design theory relies on specifying a model with only a small number of parameters. In many applications, such models will give reasonable approximations. However, they will often be found not to be entirely correct when enough data are at hand. We consider a low-dimensional model with a distortion term. Our objective is to estimate the combined model, including the distortion. In our situation, the low-dimensional model can be viewed as a fixed effect and the distortion term as a random effect in a mixed-effects model. Since we are interested in estimating the combination of fixed and random effects, our aim is to predict within the mixed model. We describe how we minimize the prediction error using an optimal design by constructing the Best Linear Unbiased Estimator and Predictor in our model. Many algorithms can be used in order to construct an optimal design. We apply here the Fedorov algorithm, which exchanges observations between the design points. By performing the algorithm built on the distorted model, we present the optimal design in different cases. The results indicate that the optimal design depends strongly on the sample size. In low-information situations, optimal designs are sufficient, while distorted terms produce better designs in data-rich cases.

Keywords
Brownian Bridge, Fedorov Algorithm, Mixed effect model, Optimal design
National Category
Probability Theory and Statistics
Research subject
Statistics
Identifiers
urn:nbn:se:su:diva-198082 (URN)
Available from: 2021-10-26 Created: 2021-10-26 Last updated: 2022-02-25

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Tsirpitzi, Renata Eirini

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