Practical considerations for optimal designs in clinical dose finding studies.

Practical considerations for optimal designs in clinical dose finding studies.
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DOI:
10.1002/sim.3802
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发表时间:
2010-03-30
影响因子:
2
通讯作者:
Pinheiro, Jose C.
Pinheiro, Jose C.
中科院分区:
医学3区
文献类型:
--
作者:
Bretz, Frank;Dette, Holger;Pinheiro, Jose C.

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药物临床开发的一个关键目标是确定适当的剂量水平,更广泛地说,是确定其剂量反应关系的特征。如果剂量设置过高,可能会导致安全性和耐受性问题,而选择过低的剂量则难以在确认阶段建立足够的疗效,可能导致计划失败。因此,剂量发现研究在药物开发中至关重要,需要仔细规划。在本文中,我们着重于实际考虑建立有效的研究设计,以估计相关的目标剂量。我们考虑了估算最小有效剂量和达到最大治疗效果的一定百分比的剂量的最佳设计。这些设计与给定剂量响应模型的d -最优设计进行了比较。对考虑模型不确定性的稳健设计的扩展也进行了讨论。通过一个案例来激励和说明本文的方法。
A key objective in the clinical development of a medicinal drug is the determination of an adequate dose level and, more broadly, the characterization of its dose response relationship. If the dose is set too high, safety and tolerability problems are likely to result, while selecting too low a dose makes it difficult to establish adequate efficacy in the confirmatory phase, possibly leading to a failed program. Hence, dose finding studies are of critical importance in drug development and need to be planned carefully. In this paper we focus on practical considerations for establishing efficient study designs to estimate relevant target doses. We consider optimal designs for estimating both the minimum effective dose and the dose achieving a certain percentage of the maximum treatment effect. These designs are compared with D-optimal designs for a given dose response model. Extensions to robust designs accounting for model uncertainty are also discussed. A case study is used to motivate and illustrate the methods from this paper.
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