A reflection on the possibility of finding a good surrogate

Surrogate endpoints need to be statistically evaluated before they can be used as substitutes of true endpoints in clinical studies. However, even though several evaluation methods have been introduced over the last decades, the identification of good surrogate endpoints remains practically and conceptually challenging. In the present work, the question regarding the existence of a good surrogate is addressed using information-theoretic concepts, within a causal-inference framework. The methodology can help practitioners to assess, given a clinically relevant true endpoint and a treatment of interest, the chances of finding a good surrogate endpoint in the first place. The methodology focuses on binary outcomes and is illustrated using data from the Initial Glaucoma Treatment Study. Furthermore, a newly developed and user friendly R package Surrogate is provided to carry out the necessary calculations.