Powering RCTs for Marginal Effects With GLMs Using Prognostic Score Adjustment

In randomized clinical trials (RCTs), the accurate estimation of marginal treatment effects is crucial for determining the efficacy of interventions. Enhancing the statistical power of these analyses is a key objective for statisticians. The increasing availability of historical data from registries, prior trials, and health records presents an opportunity to improve trial efficiency. However, many methods for historical borrowing compromise strict type I error rate control. Building on the work by Schuler et al. on prognostic score adjustment for linear models, this paper extends the methodology to the plug-in analysis proposed by Rosenblum and van der Laan using generalized linear models (GLMs) to further enhance the efficiency of RCT analyses without introducing bias. Specifically, we train a prognostic model on historical control data and incorporate the resulting prognostic scores as covariates in the plug-in GLM analysis of the trial data. This approach leverages the predictive power of historical data to improve the precision of marginal treatment effect estimates. We demonstrate that this method achieves local semi-parametric efficiency under the assumption of an additive treatment effect on the link scale. We expand the GLM plug-in method to include Negative Binomial regression. Additionally, we provide a straightforward formula for conservatively estimating the asymptotic variance, facilitating power calculations that reflect these efficiency gains. Our simulation study supports the theory. Even without an additive treatment effect, we observe increased power or reduced standard error. While population shifts from historical to trial data may dilute benefits, they do not introduce bias. We demonstrate reductions in the estimated variance through an analysis of clinical trial data provided by Novo Nordisk A/S.