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Borrowing of information across patient subgroups in a basket trial based on distributional discrepancy.

ABSTRACT: Basket trials have emerged as a new class of efficient approaches in oncology to evaluate a new treatment in several patient subgroups simultaneously. In this article, we extend the key ideas to disease areas outside of oncology, developing a robust Bayesian methodology for randomized, placebo-controlled basket trials with a continuous endpoint to enable borrowing of information across subtrials with similar treatment effects. After adjusting for covariates, information from a complementary subtrial can be represented into a commensurate prior for the parameter that underpins the subtrial under consideration. We propose using distributional discrepancy to characterize the commensurability between subtrials for appropriate borrowing of information through a spike-and-slab prior, which is placed on the prior precision factor. When the basket trial has at least three subtrials, commensurate priors for point-to-point borrowing are combined into a marginal predictive prior, according to the weights transformed from the pairwise discrepancy measures. In this way, only information from subtrial(s) with the most commensurate treatment effect is leveraged. The marginal predictive prior is updated to a robust posterior by the contemporary subtrial data to inform decision making. Operating characteristics of the proposed methodology are evaluated through simulations motivated by a real basket trial in chronic diseases. The proposed methodology has advantages compared to other selected Bayesian analysis models, for (i) identifying the most commensurate source of information and (ii) gauging the degree of borrowing from specific subtrials. Numerical results also suggest that our methodology can improve the precision of estimates and, potentially, the statistical power for hypothesis testing.

SUBMITTER: Zheng H

PROVIDER: S-EPMC8759447 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundClinical trial investigators may need to evaluate treatment effects in a specific subgroup (or subgroups) of participants in addition to reporting results of the entire study population. Such subgroups lack power to detect a treatment effect, but there may be strong justification for borrowing information from a larger patient group within the same trial, while allowing for differences between populations. Our aim was to develop methods for eliciting expert opinions about differences in treatment effect between patient populations, and to incorporate these opinions into a Bayesian analysis.MethodsWe used an interaction parameter to model the relationship between underlying treatment effects in two subgroups. Elicitation was used to obtain clinical opinions on the likely values of the interaction parameter, since this parameter is poorly informed by the data. Feedback was provided to experts to communicate how uncertainty about the interaction parameter corresponds with relative weights allocated to subgroups in the Bayesian analysis. The impact on the planned analysis was then determined.ResultsThe methods were applied to an ongoing non-inferiority trial designed to compare antiretroviral therapy regimens in 707 children living with HIV and weighing ≥ 14 kg, with an additional group of 85 younger children weighing < 14 kg in whom the treatment effect will be estimated separately. Expert clinical opinion was elicited and demonstrated that substantial borrowing is supported. Clinical experts chose on average to allocate a relative weight of 78% (reduced from 90% based on sample size) to data from children weighing ≥ 14 kg in a Bayesian analysis of the children weighing < 14 kg. The total effective sample size in the Bayesian analysis was 386 children, providing 84% predictive power to exclude a difference of more than 10% between arms, whereas the 85 younger children weighing < 14 kg provided only 20% power in a standalone frequentist analysis.ConclusionsBorrowing information from a larger subgroup or subgroups can facilitate estimation of treatment effects in small subgroups within a clinical trial, leading to improved power and precision. Informative prior distributions for interaction parameters are required to inform the degree of borrowing and can be informed by expert opinion. We demonstrated accessible methods for obtaining opinions.

Project description:Ecological niche models (ENMs) have increasingly been used to estimate the potential effects of climate change on species' distributions worldwide. Recently, predictions of species abundance have also been obtained with such models, though knowledge about the climatic variables affecting species abundance is often lacking. To address this, we used a well-studied guild (temperate North American quail) and the Maxent modeling algorithm to compare model performance of three variable selection approaches: correlation/variable contribution (CVC), biological (i.e., variables known to affect species abundance), and random. We then applied the best approach to forecast potential distributions, under future climatic conditions, and analyze future potential distributions in light of available abundance data and presence-only occurrence data. To estimate species' distributional shifts we generated ensemble forecasts using four global circulation models, four representative concentration pathways, and two time periods (2050 and 2070). Furthermore, we present distributional shifts where 75%, 90%, and 100% of our ensemble models agreed. The CVC variable selection approach outperformed our biological approach for four of the six species. Model projections indicated species-specific effects of climate change on future distributions of temperate North American quail. The Gambel's quail (Callipepla gambelii) was the only species predicted to gain area in climatic suitability across all three scenarios of ensemble model agreement. Conversely, the scaled quail (Callipepla squamata) was the only species predicted to lose area in climatic suitability across all three scenarios of ensemble model agreement. Our models projected future loss of areas for the northern bobwhite (Colinus virginianus) and scaled quail in portions of their distributions which are currently areas of high abundance. Climatic variables that influence local abundance may not always scale up to influence species' distributions. Special attention should be given to selecting variables for ENMs, and tests of model performance should be used to validate the choice of variables.

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Borrowing of information across patient subgroups in a basket trial based on distributional discrepancy.

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