Choice of estimand and analysis methods in diabetes trials with rescue medication

Pharmaceutical Statistics
Björn HolzhauerGeorgina Bermann

Abstract

The analysis of clinical trials aiming to show symptomatic benefits is often complicated by the ethical requirement for rescue medication when the disease state of patients worsens. In type 2 diabetes trials, patients receive glucose-lowering rescue medications continuously for the remaining trial duration, if one of several markers of glycemic control exceeds pre-specified thresholds. This may mask differences in glycemic values between treatment groups, because it will occur more frequently in less effective treatment groups. Traditionally, the last pre-rescue medication value was carried forward and analyzed as the end-of-trial value. The deficits of such simplistic single imputation approaches are increasingly recognized by regulatory authorities and trialists. We discuss alternative approaches and evaluate them through a simulation study. When the estimand of interest is the effect attributable to the treatments initially assigned at randomization, then our recommendation for estimation and hypothesis testing is to treat data after meeting rescue criteria as deterministically 'missing' at random, because initiation of rescue medication is determined by observed in-trial values. An appropriate imputation of values after mee...Continue Reading

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Citations

Jun 21, 2017·Pharmaceutical Statistics·Devan V MehrotraThomas Permutt
Sep 7, 2018·European Journal of Clinical Nutrition·Christian Ritz, Birgitte Rønn
Mar 10, 2021·Pharmaceutical Statistics·Steven SunSatrajit Roychoudhury
Jun 30, 2021·Contemporary Clinical Trials·Oliver N KeeneMelanie Wright
Jul 22, 2021·Statistics in Medicine·Jack BowdenFrank Bretz

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