Biometrical Journal

There is sometimes a clear evidence of a strong secular trend in the treatment effect of studies included in a meta-analysis. In such cases, estimating the present-day treatment effect by meta-regression is both reasonable and straightforward. We however consider the more common situation where a secular trend is suspected, but is not strongly statistically significant. Typically, this lack of significance is due to the small number of studies included in the analysis, so that a meta-regression could give wild point estimates. We introduce an empirical Bayes meta-analysis methodology, which shrinks the secular trend toward zero. This has the effect that treatment effects are adjusted for trend, but where the evidence from data is weak, wild results are not obtained. We explore several frequentist approaches and a fully Bayesian method is also implemented. A measure of trend analogous to I2 is described, and exact significance tests for trend are given. Our preferred method is one based on penalized or h-likelihood, which is computationally simple, and allows invariance of predictions to the (arbitrary) choice of time origin. We suggest that a trendless standard random effects meta-analysis should routinely be supplemented with an h-likelihood analysis as a sensitivity analysis.

We consider a regression model where the error term is assumed to follow a type of asymmetric Laplace distribution. We explore its use in the estimation of conditional quantiles of a continuous outcome variable given a set of covariates in the presence of random censoring. Censoring may depend on covariates. Estimation of the regression coefficients is carried out by maximizing a non-differentiable likelihood function. In the scenarios considered in a simulation study, the Laplace estimator showed correct coverage and shorter computation time than the alternative methods considered, some of which occasionally failed to converge. We illustrate the use of Laplace regression with an application to survival time in patients with small cell lung cancer.

We consider an extension of linear mixed models by assuming a multivariate skew t distribution for the random effects and a multivariate t distribution for the error terms. The proposed model provides flexibility in capturing the effects of skewness and heavy tails simultaneously among continuous longitudinal data. We present an efficient alternating expectation-conditional maximization (AECM) algorithm for the computation of maximum likelihood estimates of parameters on the basis of two convenient hierarchical formulations. The techniques for the prediction of random effects and intermittent missing values under this model are also investigated. Our methodologies are illustrated through an application to schizophrenia data.

In epidemiology, capture–recapture models are commonly used to estimate the size of an unknown population based on several incomplete lists of individuals. The method operates under two main assumptions: independence between the lists (local independence) and homogeneity of capture probabilities of individuals. In practice, these assumptions are rarely satisfied. We introduce a multinomial latent class model that can account for both list dependence and heterogeneity. Parameter estimation is performed by maximizing the conditional likelihood function with the use of the EM algorithm. In addition, a new approach for evaluating the standard errors of the parameter estimates is discussed, which considerably reduces the computational burden associated with the evaluation of the variance of the population size estimate.

Studies on HIV dynamics in AIDS research are very important in understanding the pathogenesis of HIV-1 infection and also in assessing the effectiveness of antiretroviral (ARV) treatment. Viral dynamic models can be formulated through a system of nonlinear ordinary differential equations (ODE), but there has been only limited development of statistical methodologies for inference. This article, motivated by an AIDS clinical study, discusses a hierarchical Bayesian nonlinear mixed-effects modeling approach to dynamic ODE models without a closed-form solution. In this model, we fully integrate viral load, medication adherence, drug resistance, pharmacokinetics, baseline covariates and time-dependent drug efficacy into the data analysis for characterizing long-term virologic responses. Our method is implemented by a data set from an AIDS clinical study. The results suggest that modeling HIV dynamics and virologic responses with consideration of time-varying clinical factors as well as baseline characteristics may be important for HIV/AIDS studies in providing quantitative guidance to better understand the virologic responses to ARV treatment and to help the evaluation of clinical trial design in response to existing therapies.

In Cox proportional hazard models with censored survival data, estimates of treatment effects with some important covariates omitted will be biased toward zero (Gail et al., Biometrika71: 431–444). This can be especially problematic in meta-analyses that combine estimates of parameters from studies where different covariate adjustments are made. Presently, few constructive solutions have been provided to address this issue. In this paper, we review the existing meta-analysis methodologies for aggregated patient data (APD) and propose two meta-regression models (meta-ANOVA model and meta-polynomial model) with indicators of different covariates in Cox proportional hazard models to adjust the heterogeneity of treatment effects due to omitted covariates across studies. Both parametric and nonparametric estimators for the pooled treatment effect and the heterogeneity variance are presented and compared. We illustrate the advantages of our proposed analytic procedures over the existing methodologies by simulation studies and real data analysis. The existing methodologies yield large estimation bias in the presence of an “incomparability” issue, whereas our proposed models can adjust the bias and thus provide an accurate estimation.

The three-arm design with a test treatment, an active control and a placebo group is the gold standard design for non-inferiority trials if it is ethically justifiable to expose patients to placebo. In this paper, we first use the closed testing principle to establish the hierarchical testing procedure for the multiple comparisons involved in the three-arm design. For the effect preservation test we derive the explicit formula for the optimal allocation ratios. We propose a group sequential type design, which naturally accommodates the hierarchical testing procedure. Under this proposed design, Monte Carlo simulations are conducted to evaluate the performance of the sequential effect preservation test when the variance of the test statistic is estimated based on the restricted maximum likelihood estimators of the response rates under the null hypothesis. When there are uncertainties for the placebo response rate, the proposed design demonstrates better operating characteristics than the fixed sample design.

The internal pilot study design enables to estimate nuisance parameters required for sample size calculation on the basis of data accumulated in an ongoing trial. By this, misspecifications made when determining the sample size in the planning phase can be corrected employing updated knowledge. According to regulatory guidelines, blindness of all personnel involved in the trial has to be preserved and the specified type I error rate has to be controlled when the internal pilot study design is applied. Especially in the late phase of drug development, most clinical studies are run in more than one centre. In these multicentre trials, one may have to deal with an unequal distribution of the patient numbers among the centres. Depending on the type of the analysis (weighted or unweighted), unequal centre sample sizes may lead to a substantial loss of power. Like the variance, the magnitude of imbalance is difficult to predict in the planning phase. We propose a blinded sample size recalculation procedure for the internal pilot study design in multicentre trials with normally distributed outcome and two balanced treatment groups that are analysed applying the weighted or the unweighted approach. The method addresses both uncertainty with respect to the variance of the endpoint and the extent of disparity of the centre sample sizes. The actual type I error rate as well as the expected power and sample size of the procedure is investigated in simulation studies. For the weighted analysis as well as for the unweighted analysis, the maximal type I error rate was not or only minimally exceeded. Furthermore, application of the proposed procedure led to an expected power that achieves the specified value in many cases and is throughout very close to it.

Bivariate mixed effects models are often used to jointly infer upon covariance matrices for both random effects (u) and residuals (e) between two different phenotypes in order to investigate the architecture of their relationship. However, these (co)variances themselves may additionally depend upon covariates as well as additional sets of exchangeable random effects that facilitate borrowing of strength across a large number of clusters. We propose a hierarchical Bayesian extension of the classical bivariate mixed effects model by embedding additional levels of mixed effects modeling of reparameterizations of u-level and e-level (co)variances between two traits. These parameters are based upon a recently popularized square-root-free Cholesky decomposition and are readily interpretable, each conveniently facilitating a generalized linear model characterization. Using Markov Chain Monte Carlo methods, we validate our model based on a simulation study and apply it to a joint analysis of milk yield and calving interval phenotypes in Michigan dairy cows. This analysis indicates that the e-level relationship between the two traits is highly heterogeneous across herds and depends upon systematic herd management factors.