Dynamic comparison of Kaplan-Meier proportions: monitoring a randomized clinical trial with a long-term binary endpoint.
The approach to early termination for efficacy in a trial where events occur over time but the primary question of interest relates to a long-term binary endpoint is not straightforward. This article considers comparison of treatment groups with Kaplan-Meier (KM) proportions evaluated at increasing times from randomization, at increasing calendar testing times. This strategy is employed to improve the ability to detect important treatment effects and provide critical treatments to patients in a timely manner. This dynamic Kaplan-Meier (DKM) approach is shown to be robust; that is, it produces high power and early termination time across a wide range of circumstances. In contrast, a fixed time KM comparison and the log-rank test are both shown to be more variable in performance. Practical considerations of implementing the DKM method are discussed.
Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA. ebrittain@niaid.nih.gov
Erica
E
Brittain
Dean
D
Follmann
Song
S
Yang
D000465:Algorithms; D001699:Biometry / Q000379:methods*; D003198:Computer Simulation; D003627:Data Interpretation, Statistical; D018572:Disease-Free Survival; D004812:Epidemiologic Methods; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008954:Models, Biological; D015233:Models, Statistical; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D016019:Survival Analysis; D015996:Survival Rate