Action following the discovery of a global association between the whole genome and adverse event risk in a clinical drug-development programme

Observation of adverse drug reactions during drug development can cause closure of the whole programme. However, if association between the genotype and the risk of an adverse event is discovered, then it might suffice to exclude patients of certain genotypes from future recruitment. Various sequential and non-sequential procedures are available to identify an association between the whole genome, or at least a portion of it, and the incidence of adverse events. In this paper we start with a suspected association between the genotype and the risk of an adverse event and suppose that the genetic subgroups with elevated risk can be identified. Our focus is determination of whether the patients identified as being at risk should be excluded from further studies of the drug. We propose using a utility function to determine the appropriate action, taking into account the relative costs of suffering an adverse reaction and of failing to alleviate the patient's disease. Two illustrative examples are presented, one comparing patients who suffer from an adverse event with contemporary patients who do not, and the other making use of a reference control group. We also illustrate two classification methods, LASSO and CART, for identifying patients at risk, but we stress that any appropriate classification method could be used in conjunction with the proposed utility function. Our emphasis is on determining the action to take rather than on providing definitive evidence of an association

Modeling long-term longitudinal HIV dynamics with application to an AIDS clinical study

A virologic marker, the number of HIV RNA copies or viral load, is currently used to evaluate antiretroviral (ARV) therapies in AIDS clinical trials. This marker can be used to assess the ARV potency of therapies, but is easily affected by drug exposures, drug resistance and other factors during the long-term treatment evaluation process. HIV dynamic studies have significantly contributed to the understanding of HIV pathogenesis and ARV treatment strategies. However, the models of these studies are used to quantify short-term HIV dynamics ($<$ 1 month), and are not applicable to describe long-term virological response to ARV treatment due to the difficulty of establishing a relationship of antiviral response with multiple treatment factors such as drug exposure and drug susceptibility during long-term treatment. Long-term therapy with ARV agents in HIV-infected patients often results in failure to suppress the viral load. Pharmacokinetics (PK), drug resistance and imperfect adherence to prescribed antiviral drugs are important factors explaining the resurgence of virus. To better understand the factors responsible for the virological failure, this paper develops the mechanism-based nonlinear differential equation models for characterizing long-term viral dynamics with ARV therapy. The models directly incorporate drug concentration, adherence and drug susceptibility into a function of treatment efficacy and, hence, fully integrate virologic, PK, drug adherence and resistance from an AIDS clinical trial into the analysis. A Bayesian nonlinear mixed-effects modeling approach in conjunction with the rescaled version of dynamic differential equations is investigated to estimate dynamic parameters and make inference. In addition, the correlations of baseline factors with estimated dynamic parameters are explored and some biologically meaningful correlation results are presented. Further, the estimated dynamic parameters in patients with virologic success were compared to those in patients with virologic failure and significantly important findings were summarized. These results suggest that viral dynamic parameters may play an important role in understanding HIV pathogenesis, designing new treatment strategies for long-term care of AIDS patients.Comment: Published in at http://dx.doi.org/10.1214/08-AOAS192 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

A bivariate quantitative genetic model for a linear Gaussian trait and a survival trait

With the increasing use of survival models in animal breeding to address the genetic aspects of mainly longevity of livestock but also disease traits, the need for methods to infer genetic correlations and to do multivariate evaluations of survival traits and other types of traits has become increasingly important. In this study we derived and implemented a bivariate quantitative genetic model for a linear Gaussian and a survival trait that are genetically and environmentally correlated. For the survival trait, we considered the Weibull log-normal animal frailty model. A Bayesian approach using Gibbs sampling was adopted. Model parameters were inferred from their marginal posterior distributions. The required fully conditional posterior distributions were derived and issues on implementation are discussed. The two Weibull baseline parameters were updated jointly using a Metropolis-Hasting step. The remaining model parameters with non-normalized fully conditional distributions were updated univariately using adaptive rejection sampling. Simulation results showed that the estimated marginal posterior distributions covered well and placed high density to the true parameter values used in the simulation of data. In conclusion, the proposed method allows inferring additive genetic and environmental correlations, and doing multivariate genetic evaluation of a linear Gaussian trait and a survival trait

Multiple imputation inference for multivariate multilevel continuous data with ignorable non-response

Methods specifically targeting missing values in a wide spectrum of statistical analyses are now part of serious statistical thinking due to many advances in computational statistics and increased awareness among sophisticated consumers of statistics. Despite many advances in both theory and applied methods for missing data, missing-data methods in multilevel applications lack equal development. In this paper, I consider a popular inferential tool via multiple imputation in multilevel applications with missing values. I specifically consider missing values occurring arbitrarily at any level of observational units. I use Bayesian arguments for drawing multiple imputations from the underlying (posterior) predictive distribution of missing data. Multivariate extensions of well-known mixed-effects models form the basis for simulating the posterior predictive distribution, hence creating the multiple imputations. The discussion of these topics is demonstrated in an application assessing correlates to unmet need for mental health care among children with special health care needs

Efficiency of Markov chain Monte Carlo algorithms for Bayesian inference in random regression models

A random regression model can be used to fit repeated measurements such as weight gain of an animal over time in order to accommodate the between- and within-individual variations. The Bayesian approach is an alternative to the REML-BLUP approach for drawing inference and often depends on Markov chain Monte Carlo (MCMC) methods. Our studies primarily focus on the efficiency of MCMC methods in models for repeated measurements in time. Efficient methods should make Bayesian methods feasible in studying animal growth traits;With conjugate prior distributions, posterior samples under the random regression model can be obtained with Gibbs sampling algorithm. Orthogonality of parameters can reduce posterior correlations among model parameters and therefore improve convergence rate of MCMC methods. Hierarchical centering can improve the convergence rate of MCMC methods when the variance of the random effects is much larger than the variance of the residuals. Adopting hierarchical centering and orthogonality simultaneously yields the greatest improvement in convergence rate. When there are more than one random component besides random residuals, using a cycling algorithm along with orthogonal polynomials leads to the best performance. In addition, using a batching scheme for drawing correlated parameters can improve convergence rate as well;It is also possible to develop Metropolis-Hastings (M-H) algorithms for nonlinear models. We find that M-H algorithms with a normal jumping distribution, that is centered at the current value and with its variance evaluated either at individual-model-fitting MLE or at the current value, perform best

Sensitive Detection of Chromosomal Segments of Distinct Ancestry in Admixed Populations

Identifying the ancestry of chromosomal segments of distinct ancestry has a wide range of applications from disease mapping to learning about history. Most methods require the use of unlinked markers; but, using all markers from genome-wide scanning arrays, it should in principle be possible to infer the ancestry of even very small segments with exquisite accuracy. We describe a method, HAPMIX, which employs an explicit population genetic model to perform such local ancestry inference based on fine-scale variation data. We show that HAPMIX outperforms other methods, and we explore its utility for inferring ancestry, learning about ancestral populations, and inferring dates of admixture. We validate the method empirically by applying it to populations that have experienced recent and ancient admixture: 935 African Americans from the United States and 29 Mozabites from North Africa. HAPMIX will be of particular utility for mapping disease genes in recently admixed populations, as its accurate estimates of local ancestry permit admixture and case-control association signals to be combined, enabling more powerful tests of association than with either signal alone