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This page is maintained by the Multiplicity
Advisory Board ( Alex
Dmitrienko).
Multi-stage/gatekeeping testing procedures
Multi-stage testing procedures play an important
role in clinical trials with multiple families of tests (often
termed gatekeepers) that are carried out in a sequential manner.
The families can represent families of endpoints (primary, secondary
and tertiary endpoints), tests (non-inferiority, superiority),
dose levels (higher doses, lower doses) or various combinations
of these.
Papers and books
Bauer, P. (1991). Multiple testings in clinical
trials. Statistics in Medicine. 10, 871-890.
Bauer, P., Rohmel, J., Maurer, W., Hothorn,
L. (1998). Testing strategies in multi-dose experiments including
active control. Statistics in Medicine. 17, 2133-2146.
Chen, X., Luo, X., Capizzi, T. (2005). The
application of enhanced parallel gatekeeping strategies. Statistics
in Medicine. 24, 1385-1397.
This paper introduced Simes-based parallel
gatekeeping procedures and Bonferroni-based parallel gatekeeping
procedures with logical restrictions (with applications to clinical
trials with multiple treatment arms).
Dmitrienko, A., Offen, W., Westfall, P.H.
(2003). Gatekeeping strategies for clinical trials that do not
require all primary effects to be significant. Statistics in Medicine.
22, 2387-2400 [ SAS code and
typographical errors].
This paper described testing procedures for
clinical trials in which the primary family is a parallel gatekeeper,
that is, at least one significant result needs to be found in
the primary family before one can begin testing secondary hypotheses.
The paper discusses parallel gatekeeping procedures based on the
Bonferroni and resampling tests. Software implementation of these
procedures is discussed in Chapter 2 of Dmitrienko, Molenberghs,
Chuang-Stein, and Offen (2005).
Dmitrienko, A., Molenberghs, G., Chuang-Stein,
C., Offen, W. (2005).
Analysis of Clinical Trials Using SAS: A Practical Guide.
SAS Press: Cary, NC.
Chapter 2 gave a detailed overview of gatekeeping
strategies in clinical trials. Clinical trial examples and SAS
code are included. A good way to get started in this area.
Dmitrienko, A., Offen, W., Wang, O., Xiao,
D. (2006). Gatekeeping procedures in dose-response clinical trials
based on the Dunnett test. Pharmaceutical Statistics. 5, 19-28 [ Download
paper] [ Addendum,
SAS code and typographical errors].
The paper introduced parametric gatekeeping
procedures based on the Dunnett test. This approach was applied
to dose-finding clinical trials with multiple endpoints. Dunnett-based
gatekeeping procedures account for the correlation among the dose-placebo
comparisons and multiple endpoints. They are more powerful than
Bonferroni-based gatekeeping procedures described in Dmitrienko,
Offen and Westfall (2003).
Dmitrienko, A., Wiens, B.L., Westfall, P.H.
(2006). Fallback tests in dose-response clinical trials. Journal
of Biopharmaceutical Statistics. 16, 745-755.
This paper extended the fallback testing
method (Wiens, 2003) to the multi-stage case. Multiple testing
procedures proposed in the paper can be used to carry over a predetermined
fraction of the Type I error rate to the next family even if no
significant results are found in the previous family. Applications
included dose-finding studies with multiple endpoints.
Dmitrienko, A., Tamhane, A.C., Wang, X.,
Chen, X. (2006). Stepwise gatekeeping procedures in clinical trial
applications. Biometrical Journal. 48, 984-991.
It was shown in this paper that parallel
gatekeeping procedures (Dmitrienko, Offen and Westfall, 2003)
have a simple stepwise structure that considerably simplifies
their implementation and interpretation of the results.
Dmitrienko, A., Wiens, B.L., Tamhane, A.C.,
Wang, X. (2007). Tree-structured gatekeeping tests in clinical
trials with hierarchically ordered multiple objectives. Statistics
in Medicine. 26, 2465-2478 [ SAS code and
typographical errors].
Tree gatekeeping procedures serve as an extension
of serial and parallel gatekeeping procedures and can be used
in clinical trials with multi-dimensional objectives (multiple
endpoints, doses, tests, etc) and clinical trials with logical
restrictions. Note that the algorithm introduced in this paper
may fail to meet the monotonicity condition, which may cause it
to violate the gatekeeping property. It is shown in Dmitrienko,
Tamhane, Liu and Wiens (2008) how the algorithm can be modified
to rectify this problem.
Dmitrienko, A., Tamhane, A.C. (2007). Gatekeeping
procedures with clinical trial applications. Pharmaceutical Statistics.
6, 171-180.
This paper gave a review of recent developments
in the world of gatekeeping procedures, inclucing serial, parallel
and tree gatekeeping procedures, with clinical trial examples.
Dmitrienko, A., Tamhane, A., Wiens, B. (2007).
General multistage gatekeeping procedures. Northwestern University.
Department of Industrial Engineering and Management Sciences.
Working Paper No. 07-06 [ Download
paper].
This working paper introduced a class of
general gatekeeping procedures that have an attractive multistage
form (it extends the method proposed by Guilbaud (2007) who focused
only on Bonferroni-based gatekeeping procedures). These procedures
do not not require the application of the closed testing principle
and are easy to implement. A modified version of the working paper
will be published in Biometrical Journal (Dmitrienko, Tamhane
and Wiens, 2008).
Dmitrienko, A., Tamhane, A.C., Liu, L., Wiens,
B.L. (2008). A note on tree gatekeeping procedures in clinical
trials. Statistics in Medicine. 27, 3446-3451 [ Download
paper].
It was shown in this paper that the algorithm
for constructing tree gatekeeping procedures used in Dmitrienko,
Wiens, Tamhane and Wang (2007) may fail to satisfy the gatekeeping
property. A general algorithm based on the monotonicity condition
introduced by Hommel, Bretz and Maurer (2007) was proposed to
rectify this problem.
Dmitrienko, A., Tamhane, A., Wiens, B. (2008).
General multistage gatekeeping procedures. Biometrical Journal. To appear
[ Download
paper].
Guilbaud, O. (2007). Bonferroni parallel
gatekeeping: Transparent generalizations, adjusted p-values, and
short direct proofs. Biometrical Journal. 49, 917-927.
This paper proposed a straightforward approach
for setting up multistage/stepwise gatekeeping procedures based
on the Bonferroni test. This method was later extended in Dmitrienko,
Tamhane and Wiens (2007) to construct a general class of gatekeeping
procedures based on arbitrary separable tests.
Hommel, G., Bretz, F., Maurer, W. (2007).
Powerful short-cuts for multiple testing procedures with special
reference to gatekeeping strategies. Statistics in Medicine. 26,
4063-4073.
This paper introduced a class of Bonferroni-based
gatekeeping procedures that includes popular tests (e.g., Holm
and fallback tests) and gatekeeping procedures (e.g., Bonferroni-based
parallel gatekeeping procedure, Dmitrienko, Offen and Westfall,
2003).
Maurer, W., Hothorn, L., Lehmacher, W. (1995).
Multiple comparisons in drug clinical trials and preclinical assays:
a-priori ordered hypotheses. Biometrie in der chemisch-pharmazeutischen
Industrie. Vollmar, J. (editor). Fischer Verlag: Stuttgart, Vol.
6, 3-18.
The paper discussed serial gatekeeping strategies
in clinical trials.
Westfall, P.H., Krishen, A. (2001). Optimally
weighted, fixed sequence, and gatekeeping multiple testing procedures.
Journal of Statistical Planning and Inference. 99, 25-40.
The paper described the fixed-sequence test
which serves as an example of a serial gatekeeping procedure (all
tests must be significant in the primary family before one can
perform secondary analyses).
Presentations
Dmitrienko, A., Wiens, B.L., Tamhane, A.C.,
Wang, X. Tree-structured gatekeeping procedures in clinical trials
with multiple objectives. JSM. August 2006. Based on Dmitrienko,
Wiens, Tamhane and Wang (2007) [ Download
slides].
Dmitrienko, A., Tamhane, A.C. Gatekeeping
procedures based on Simes test with clinical trial applications.
ENAR meeting. March 2007. Based on Dmitrienko, Tamhane and Wiens
(2007) [ Download
slides].
Dmitrienko, A., Tamhane, A.C. Multi-stage
gatekeeping procedures with clinical trial applications. MCP conference.
July 2007. Based on Dmitrienko, Tamhane and Wiens (2007) [ Download
slides].
Dmitrienko, A., Choi, S., Tamhane, A.C.,
Johns, D. Reverse fixed-sequence procedures in clinical trials.
JSM conference. August 2008 [ Download
slides].
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