Adding dose modifications into Phase II and Phase II/III seamless trials
John Spivack1, Bin Cheng2, Bruce Levin2
1Department of Environmental Medicine and Public Health, Mount Sinai Medical Center, New York, NY, USA.
Abstract:
We present a technique for adding dose modifications into seamless Phase II and Phase II/III trials featuring dose selection at an interim analysis. The method is convenient to apply and can be used either in a fully prespecified, structured way or as a response to new considerations that emerge at interim. Strong control of the familywise error rate regarding false declarations of efficacy versus control is maintained. Two examples are given. One illustrates how the method could potentially "save" a trial performed in a Phase II context. The other is a seamless Phase II/III trial that uses an adaptive exploration strategy for an assumed nonmonotonic dose-response curve. It can result in greatly improved efficiency over a standard "promote the winner" rule.
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