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Practical recommendations for implementing a Bayesian adaptive phase I design during a pandemic

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  • S. Ewings
  • G. Saunders
  • T. Jaki
  • P. Mozgunov
Article number25
<mark>Journal publication date</mark>20/01/2022
<mark>Journal</mark>BMC Medical Research Methodology
Issue number1
Number of pages15
Publication StatusPublished
<mark>Original language</mark>English


Background: Modern designs for dose-finding studies (e.g., model-based designs such as continual reassessment method) have been shown to substantially improve the ability to determine a suitable dose for efficacy testing when compared to traditional designs such as the 3 + 3 design. However, implementing such designs requires time and specialist knowledge. Methods: We present a practical approach to developing a model-based design to help support uptake of these methods; in particular, we lay out how to derive the necessary parameters and who should input, and when, to these decisions. Designing a model-based, dose-finding trial is demonstrated using a treatment within the AGILE platform trial, a phase I/II adaptive design for novel COVID-19 treatments. Results: We present discussion of the practical delivery of AGILE, covering what information was found to support principled decision making by the Safety Review Committee, and what could be contained within a statistical analysis plan. We also discuss additional challenges we encountered in the study and discuss more generally what (unplanned) adaptations may be acceptable (or not) in studies using model-based designs. Conclusions: This example demonstrates both how to design and deliver an adaptive dose-finding trial in order to support uptake of these methods.