General multistage gatekeeping procedures.

Summary A general multistage (stepwise) procedure is proposed for dealing with arbitrary gatekeeping problems including parallel and serial gatekeeping. The procedure is very simple to implement since it does not require the application of the closed testing principle and the consequent need to test all nonempty intersections of hypotheses. It is based on the idea of carrying forward the Type I error rate for any rejected hypotheses to test hypotheses in the next ordered family. This requires the use of a so-called separable multiple test procedure (MTP) in the earlier family. The Bonferroni MTP is separable, but other standard MTPs such as Holm, Hochberg, Fallback and Dunnett are not. Their truncated versions are proposed which are separable and more powerful than the Bonferroni MTP. The proposed procedure is illustrated by a clinical trial example

Recent advances in methodology for clinical trials in small populations : the InSPiRe project

Where there are a limited number of patients, such as in a rare disease, clinical trials in these small populations present several challenges, including statistical issues. This led to an EU FP7 call for proposals in 2013. One of the three projects funded was the Innovative Methodology for Small Populations Research (InSPiRe) project. This paper summarizes the main results of the project, which was completed in 2017. The InSPiRe project has led to development of novel statistical methodology for clinical trials in small populations in four areas. We have explored new decision-making methods for small population clinical trials using a Bayesian decision-theoretic framework to compare costs with potential benefits, developed approaches for targeted treatment trials, enabling simultaneous identification of subgroups and confirmation of treatment effect for these patients, worked on early phase clinical trial design and on extrapolation from adult to pediatric studies, developing methods to enable use of pharmacokinetics and pharmacodynamics data, and also developed improved robust meta-analysis methods for a small number of trials to support the planning, analysis and interpretation of a trial as well as enabling extrapolation between patient groups. In addition to scientific publications, we have contributed to regulatory guidance and produced free software in order to facilitate implementation of the novel methods

Mixtures of multiple testing procedures for gatekeeping applications in clinical trials

This paper proposes a general framework for constructing gatekeeping procedures for clinical trials with hierarchical objectives. Such problems frequently exhibit complex structures including multiple families of hypotheses and logical restrictions. The proposed framework is based on combining multiple procedures across families. It enables the construction of powerful and flexible gatekeeping procedures that account for general logical restrictions among the hypotheses of interest. A clinical trial in patients with schizophrenia is used to illustrate the approach for parallel gatekeeping, whereas another clinical trial in patients with hypertension is used to illustrate the approach for gatekeeping with general logical restrictions

General theory of mixture procedures for gatekeeping

The paper introduces a general approach to constructing mixture-based gatekeeping procedures in multiplicity problems with two or more families of hypotheses. Mixture procedures serve as extensions of and overcome limitations of some previous gatekeeping approaches such as parallel gatekeeping and tree-structured gatekeeping. This paper offers a general theory of mixture procedures constructed from nonparametric (p-value based) to parametric (normal theory based) procedures and studies their properties. It is also shown that the mixture procedure for parallel gatekeeping is equivalent to the multistage gatekeeping procedure. A clinical trial example is used to illustrate the mixture approach and the implementation of mixture procedures