Inclusion of non-inferiority analysis in superiority-based clinical trials with single-arm, two-stage Simon's design

Abstract

No inferioridad; Fase II; Brazo único

No inferioritat; Fase II; Braç únic

Non-inferiority; Phase II; Single-arm

Introduction: Non-inferiority (NI) analysis is not usually considered in the early phases of clinical development. In some negative phase II trials, a post-hoc NI analysis justified additional phase III trials that were successful. However, the risk of false positive achievements was not controlled in these early phase analyses. We propose to preplan NI analyses in superiority-based Simon’s two-stage designs to control type I and II error rates. Methods: Simulations have been proposed to assess the control of type I and II errors rates with this method. A total of 12,768 two-stage Simon’s design trials were constructed based on different assumptions of rejection response probability, desired response probability, type I and II errors, and NI margins. P-value and type II error were calculated with stochastic ordering using Uniformly Minimum Variance Unbiased Estimator. Type I and II errors were simulated using the Monte Carlo method. The agreement between calculated and simulated values was analyzed with Bland-Altman plots. Results: We observed the same level of agreement between calculated and simulated type I and II errors from both two-stage Simon’s superiority designs and designs in which NI analysis was allowed. Different examples has been proposed to explain the utility of this method. Conclusion: Inclusion of NI analysis in superiority-based single-arm clinical trials may be useful for weighing additional factors such as safety, pharmacokinetics, pharmacodynamic, and biomarker data while assessing early efficacy. Implementation of this strategy can be achieved through simple adaptations to existing designs for onearm phase II clinical trials

Javier Cortés has received consulting and advisor fees from: Roche, Celgene, Cellestia, AstraZeneca, Biothera Pharmaceutical, Merus, Seattle Genetics, Daiichi Sankyo and Erytech. In addition, Javier Cortés has received honorarias from: Roche, Novartis, Celgene, Eisai, Pfizer and Samsung. Add more, Javier Cortés has received research funding fees to the institution from Roche. Finally, Javier Cortés has stock options, patents and intellectual property from MedSIR.