title: Enriched analgesic efficacy studies: an assessment by clinical trial simulation.
abstract: OBJECTIVE
  Enrichment strategies which select subjects who appear to respond to the drug have been used in drug studies to demonstrate clinical efficacy. We have used clinical trial simulation techniques to examine factors that are relevant in clinical trial design based on enrichment where poor responders are excluded from the double-blind phase of the study.
  
  
  METHODS
  Simulations were performed for an analgesic trial design involving an open-dose titration phase (enrichment phase) followed by a double-blind, randomized, placebo-controlled maintenance phase. Enrichment was examined by excluding subjects above a predefined pain score (cutoff) from analysis of efficacy for the maintenance phase. Cutoff pain scores ranging from 4 to 7 on a 0 to 10 categorical scale were examined. A database consisting of chronic pain patients who participated in studies with a new formulation of buprenorphine was used to build the simulation model. Since no data were available for the key model variable "correlation between treatment and placebo response", values of 0.25, 0.5, and 0.75 were used for the simulations.
  
  
  RESULTS
  A correlation between treatment and placebo effect ranging from 0.75 to 0.25 will cause the likelihood of trial success to vary from 50% to 95%. This model also shows that recruitment efficiency will decrease with the use of lower cutoff pain scores.
  
  
  CONCLUSIONS
  Prior to using enrichment techniques, investigators must consider the correlation between treatment effect and placebo response to optimize clinical trial design.
authors.affiliation: Department of Anesthesia, Stanford University, Medical Center 300 Pasteur Drive, Stanford, CA, 94305-5640, USA. hlemmens@leland.stanford.edu
authors.forename: Hendrikus J M
authors.initials: HJ
authors.lastname: Lemmens
authors.forename: D Russell
authors.initials: DR
authors.lastname: Wada
authors.forename: Catherine
authors.initials: C
authors.lastname: Munera
authors.forename: Ahmed
authors.initials: A
authors.lastname: Eltahtawy
authors.forename: Donald R
authors.initials: DR
authors.lastname: Stanski
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001416:Back Pain / Q000188:drug therapy; D002047:Buprenorphine / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D015233:Models, Statistical; D010003:Osteoarthritis / Q000188:drug therapy
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine