Helmut ★★★ ![]() ![]() Vienna, Austria, 2019-10-16 15:14 (2034 d 07:54 ago) Posting: # 20690 Views: 15,347 |
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Dear all, sometimes I see reports with a strange pattern of missing periods, e.g., subjects without the 1st period, subjects with only the 1st and the 4th, etc. Since I have only the statistical part of the report, I have no clue what was going on. For the FDA’s RSABE only subjects with complete data (all periods) are used. But this is not the case for the EMA’s ABEL (all subjects with at least one T and R treatment for the calculation of the CI, all subjects with two R treatments for the calculation of CVwR). I would say:
I saw even cases where a subject in sequence TRTR had data only of periods 1 & 3. Useless. Another case: 44 subjects had two administrations of T and R. However, 15 had two administrations of T and 39 two administrations of R. Chance – or what? — Dif-tor heh smusma 🖖🏼 Довге життя Україна! ![]() Helmut Schütz ![]() The quality of responses received is directly proportional to the quality of the question asked. 🚮 Science Quotes |
ElMaestro ★★★ Denmark, 2019-10-16 17:10 (2034 d 05:58 ago) @ Helmut Posting: # 20693 Views: 12,836 |
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Hi Hötzi, ❝ I would say:
Not a definitive answer, but at some CROs they have SOPs in place to the effect of allowing subjects to come back after they have skipped a period , or fractions of one. This, I think, relates originally to FDA's data driven policies. A subject can walkout on her/his own initiative without even stating a reason, that's how GCP works. There is no clause saying she/he can't come back. I know, this is messy, but that's the way it is in some clinics. The alternative may be worse, depending on how you look at it: If a subject misses an ambulatory pk-sample ("I forgot", "I sat stuck in a traffic jam", "My parrot suffered an anxiety attack", "Don't you fucking ask me what I did yesterday, it's none of your business", "I had to watch Conchita Wurst win the Grand Prix" etc.) should she/he then be considered completely out? — Pass or fail! ElMaestro |
Helmut ★★★ ![]() ![]() Vienna, Austria, 2019-10-17 12:22 (2033 d 10:46 ago) @ ElMaestro Posting: # 20700 Views: 12,692 |
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Hi ElMaestro, ❝ This, I think, relates originally to FDA's data driven policies. A subject can walkout on her/his own initiative without even stating a reason, that's how GCP works. There is no clause saying she/he can't come back. ❝ I know, this is messy, but that's the way it is in some clinics. I see. Since the data are useless for the FDA’s reference-scaling maybe this was a trick-shot of the CRO to milk the sponsor. ❝ The alternative may be worse, depending on how you look at it: If a subject misses an ambulatory pk-sample […] should she/he then be considered completely out? I like your examples! That’s an area of improvement which requires a good amount of intellectual horsepower. Not easy but the idea is to come up with rules specifying how many missings (and where) in the profile will likely lead to unreliable estimates of a given PK metric. — Dif-tor heh smusma 🖖🏼 Довге життя Україна! ![]() Helmut Schütz ![]() The quality of responses received is directly proportional to the quality of the question asked. 🚮 Science Quotes |
M.tareq ☆ 2020-04-09 17:24 (1858 d 05:44 ago) @ Helmut Posting: # 21325 Views: 10,872 |
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❝ I like your examples! That’s an area of improvement which requires a good amount of intellectual horsepower. Not easy but the idea is to come up with rules specifying how many missings (and where) in the profile will likely lead to unreliable estimates of a given PK metric. In one of your lectures, you mentioned comparing the two profile as is, meaning AUC0-12 to AUC0-72, but won't be comparing orange vs apples, mean, if, for example the first AUC0-12 (drug A) covers 50% of the profile while the comparator AUC0-72 (drug B) covers 80%, is this a biased comparison? Other method that was mentioned in the forum/lectures more often; is is doing log-linear regression using the terminal part of the profile with missing points and perform extrapolation to estimate such points, but no mentioned of such methods in any of the guidelines my question is: if comparing AUC0-t as is (missing points are ignored) without doing the extrapolation and the BE criteria not met but when doing the extrapolation the BE is achieved, how such predicament will be handled by the assessor and/or CRO ? Mahmoud |
Helmut ★★★ ![]() ![]() Vienna, Austria, 2020-04-09 18:15 (1858 d 04:53 ago) @ M.tareq Posting: # 21327 Views: 10,656 |
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Hi Mahmoud, ❝ In one of your lectures, you mentioned comparing the two profile as is, meaning AUC0-12 to AUC0-72, … Well, that’s extreme. Did I really give such an example somewhere? ❝ … but won't be comparing orange vs apples, mean, if, for example the first AUC0-12 (drug A) covers 50% of the profile while the comparator AUC0-72 (drug B) covers 80%, is this a biased comparison? If we talk about immediate release and the earliest common last sampling time point is at ≤2×tmax, no. In such a case absorption is essentially complete and the later time points are not informative at all (they describe only elimination, which is a property of the drug – not the formulations). See Fisher et al. 20161 My personal PK-guru Les Benet applied it in one of his studies.2 ❝ Other method that was mentioned in the forum/lectures more often; is is doing log-linear regression using the terminal part of the profile with missing points and perform extrapolation to estimate such points, but no mentioned of such methods in any of the guidelines Up to you. As long as you describe the procedure unambiguously in the SAP (which has to be accepted by the agency), fine. That’s my standard procedure for ages. No guideline is that specific. ❝ my question is: if comparing AUC0-t as is (missing points are ignored) without doing the extrapolation and the BE criteria not met but when doing the extrapolation the BE is achieved, how such predicament will be handled by the assessor and/or CRO ? Well, you should evaluate the study according to the SAP, right? Given, “at home” you can perform anything. If any other method will come to a conclusion different from the planned one and you present it as supportive information, I expect that any agency will essential say: “Thank you very much, interesting indeed. We play it safe and reject the study.” Let’s reverse the idea. We know that a comparison of AUC0–t is biased if the last measurable sampling time point in a certain subject differs for T and R (even if true bioavailabilities are identical). That’s not rocket science but basic PK. You followed the GL and the study passes. Would you really try another method afterwards (which fails) and show the result to the agency? I doubt it.
— Dif-tor heh smusma 🖖🏼 Довге життя Україна! ![]() Helmut Schütz ![]() The quality of responses received is directly proportional to the quality of the question asked. 🚮 Science Quotes |
M.tareq ☆ 2020-04-09 18:54 (1858 d 04:14 ago) @ Helmut Posting: # 21328 Views: 10,648 |
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❝ Well, that’s extreme. Did I really give such an example somewhere? Think it was mentioned here: https://bebac.at/lectures/Leuven2013WS1.pdf#page=37 not specifically AUC0-12 vs AUC0-72, but AUC with with different time points ❝ Up to you. As long as you describe the procedure unambiguously in the SAP (which has to be accepted by the agency), fine. That’s my standard procedure for ages. No guideline is that specific. Guess CRO should have accounted for COVID-19 impact on missingness of ambulatory samples ![]() But as always thanks alot for your prompt reply! Stay safe and well! Mahmoud |
d_labes ★★★ Berlin, Germany, 2019-10-17 19:22 (2033 d 03:46 ago) @ Helmut Posting: # 20701 Views: 12,599 |
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Dear Helmut! ❝ sometimes I see reports with a strange pattern of missing periods, e.g., subjects without the 1st period, subjects with only the 1st and the 4th, etc. ... ❝ Did you see cases like this? And if yes, do you know why? Yes, I saw such cases in times I was active. F.i. a subject refuses consent after the 2nd period but came back due to invention of the investigator (by phone) for the 4th period (arguments: "you will not get payed if you refuse, only if you come back" or "Please, please be so kind to continue because otherwise we have not the scientific success we expected" and so on. See ElMaestros post for other examples.) What to do with such data? DUNO exactly. You yourself have described what to do for EMA ABEL or FDA RSABE. Any case left? — Regards, Detlew |
ElMaestro ★★★ Denmark, 2019-10-17 22:17 (2033 d 00:51 ago) @ d_labes Posting: # 20702 Views: 12,591 |
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Hi d_labes, ❝ "you will not get payed if you refuse, only if you come back" ❝ "Please, please be so kind to continue because otherwise we have not the scientific success we expected" §4.8.3: Neither the investigator, nor the trial staff, should coerce or unduly influence a subject to participate or to continue to participate in a trial. ![]() ![]() ![]() ![]() ![]() — Pass or fail! ElMaestro |
d_labes ★★★ Berlin, Germany, 2019-10-18 13:48 (2032 d 09:20 ago) @ ElMaestro Posting: # 20703 Views: 12,587 |
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Dear ElMaestro, ❝ ... ❝ §4.8.3: Neither the investigator, nor the trial staff, should coerce or unduly influence a subject to participate or to continue to participate in a trial. Was of course not an unduly influence. Only a friendly talk by phone to obtain some informations about the reasons and circumstances of refusing the continuation. — Regards, Detlew |
Helmut ★★★ ![]() ![]() Vienna, Austria, 2019-10-19 16:30 (2031 d 06:38 ago) @ d_labes Posting: # 20706 Views: 12,548 |
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Dear Detlew, ❝ You yourself have described what to do for EMA ABEL or FDA RSABE. Yep. ❝ Any case left? Nope. I was just wondering what could be the cause of such results. — Dif-tor heh smusma 🖖🏼 Довге життя Україна! ![]() Helmut Schütz ![]() The quality of responses received is directly proportional to the quality of the question asked. 🚮 Science Quotes |
Astea ★★ Russia, 2019-10-20 16:46 (2030 d 06:21 ago) @ Helmut Posting: # 20709 Views: 12,585 |
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Dear smart people! I've got two questions on this topic, that could be logically combined into the one philosophical: should we try to keep as much data as possible for the analysis? 1). How would you advice to deal with subjects, who have only one (2,3..) points over LLOQ in one of the periods? According to EMA it is possible to exclude subjects with AUC of reference product less than 5% of geometric mean AUC. Should we exclude all the data of such a subject or can we remain data from other periods? Example: acetylcalycic acid (ASA) in enteric-coated form has a wide-range Tmax in about 2 to 7 hours with extremely rapid conversion to salycic acid. So PK profiles look like "zero-zero-vertical line-zero-zero"... For catching it one has to plan a great number of sample points and use appropriate stabilization procedure. Even in these case there could be the uppermentioned problems. 2). What was the real reason for FDA to develop an algorithm for NTIDs with only complete data? As Helmut mentioned in the post, theoretically it is possible to use all the data even with incomplete data. Why then FDA just throw data of subjects with incomplete data to the bin? Is not it unethical? (I can't understand this point) — "Being in minority, even a minority of one, did not make you mad" |
Helmut ★★★ ![]() ![]() Vienna, Austria, 2019-10-20 17:23 (2030 d 05:45 ago) @ Astea Posting: # 20710 Views: 12,582 |
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Hi Nastia, ❝ Dear smart people! ❝ should we try to keep as much data as possible for the analysis? In principle yes – as long as the outcome is meaningful. ![]() ❝ 1). How would you advice to deal with subjects, who have only one (2,3..) points over LLOQ in one of the periods? […] Tricky – IMHO, case by case (should be laid down in an SOP or the SAP, of course). IIRC, Health Canada had a rule that 1 (one!) concentration is sufficient for Cmax and 3 (oh dear!) fo AUC. Gone with the wind. THX, HC. ❝ 2). What was the real reason for FDA to develop an algorithm for NTIDs with only complete data? No idea. The same is applicable to all RSABE-methods of the FDA. ❝ […] theoretically it is possible to use all the data even with incomplete data. Sure. ❝ Why then FDA just throw data of subjects with incomplete data to the bin? Again – no idea. ❝ Is not it unethical? (I can't understand this point) IMHO, it is and we are not alone with this conclusion.* If SABE is applied, subjects with one missing R observation should be eliminated […]. This is unprecedented in our experience in a regulated bioequivalence setting. Traditionally, one does not exclude data unless there is a scientifically or clinically valid reason to do so. However, with the current draft guidance from FDA for progesterone bioequivalence, this appears to be the immediate approach to be applied for SABE.
— Dif-tor heh smusma 🖖🏼 Довге життя Україна! ![]() Helmut Schütz ![]() The quality of responses received is directly proportional to the quality of the question asked. 🚮 Science Quotes |
Astea ★★ Russia, 2019-10-21 03:59 (2029 d 19:09 ago) @ Helmut Posting: # 20711 Views: 12,485 |
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Dear Helmut and other smart people! ❝ Are you talking to me? ❝ Tricky – IMHO, case by case (should be laid down in an SOP or the SAP, of course). IIRC, Health Canada had a rule that 1 (one!) concentration is sufficient for Cmax and 3 (oh dear!) fo AUC. Gone with the wind. THX, HC. Suppose we have only one measurable concentration and it is as high as Cmax of other periods. Even in this case formally we can calculate AUC for linear trapezoidal rule (depending on the rule for BLOQ data of course). And it can be more than 5 percent of geometric mean of other AUC in this period. Leave it or waste it - any choice will be wrong ![]() |
Helmut ★★★ ![]() ![]() Vienna, Austria, 2019-10-21 13:37 (2029 d 09:31 ago) @ Astea Posting: # 20712 Views: 12,598 |
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Dear Nastia, ❝ Suppose we have only one measurable concentration and it is as high as Cmax of other periods. Even in this case formally we can calculate AUC for linear trapezoidal rule […]. And it can be more than 5 percent of geometric mean of other AUC in this period. Leave it or waste it - any choice will be wrong Well, that’s why I wrote above ❝ ❝ […] as long as the outcome is meaningful. We have to go out on a limb to call a triangle a “curve”. — Dif-tor heh smusma 🖖🏼 Довге життя Україна! ![]() Helmut Schütz ![]() The quality of responses received is directly proportional to the quality of the question asked. 🚮 Science Quotes |
Mahmoud ★ Jordan, 2019-11-06 12:41 (2013 d 09:27 ago) @ Helmut Posting: # 20753 Views: 12,139 |
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Dear all ===== For missing data in Be studies in certain period if you need to take into account the missing data use proc mixed in SAS with dffm=Kr otherwise use proc glm in SAS, this procedure do not take into account the missing data |
Helmut ★★★ ![]() ![]() Vienna, Austria, 2019-11-06 13:49 (2013 d 08:19 ago) @ Mahmoud Posting: # 20754 Views: 12,077 |
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Hi Mahmoud, ❝ if you need to take into account the missing data use proc mixed in SAS with dffm=Kr From a theoretical perspective, maybe. The Kenward-Roger approximation recovers more information from the data, higher degrees of freedom and hence, results in a narrower confidence interval than with Satterthwaite’s degrees of freedom. Since the latter is explicitly recommended in the progesterone guidance I have some doubts whether the FDA would accept that. ❝ otherwise use proc glm in SAS, this procedure do not take into account the missing data Sure. — Dif-tor heh smusma 🖖🏼 Довге життя Україна! ![]() Helmut Schütz ![]() The quality of responses received is directly proportional to the quality of the question asked. 🚮 Science Quotes |
PharmCat ★ Russia, 2019-11-06 15:43 (2013 d 06:25 ago) @ Helmut Posting: # 20755 Views: 12,171 |
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❝ From a theoretical perspective, maybe. The Kenward-Roger approximation recovers more information from the data, higher degrees of freedom and hence, results in a narrower confidence interval than with Satterthwaite’s degrees of freedom. Since the latter is explicitely recommended in the progesterone guidance I have some doubts whether the FDA would accept that. I thought that Kenward-Roger provide the same DF as Satterthwaite's for one-dimension effects, so as CI for coefficient is one-dimension hypothesis DF should be the same, as it describes in reference paper, may be SAS make any corrections, I don't know... Is any comparations anywhere? |
Helmut ★★★ ![]() ![]() Vienna, Austria, 2019-11-08 21:57 (2011 d 00:11 ago) @ PharmCat Posting: # 20771 Views: 11,940 |
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Hi PharmCat, ❝ I thought that Kenward-Roger provide the same DF as Satterthwaite's for one-dimension effects, so as CI for coefficient is one-dimension hypothesis DF should be the same, as it describes in reference paper, may be SAS make any corrections, I don't know... Try this one:
The EMA’s Method B evaluated by lmer() of package lmerTest . Kenward-Roger’s degrees of freedom ≥ Satterthwaite’s.— Dif-tor heh smusma 🖖🏼 Довге життя Україна! ![]() Helmut Schütz ![]() The quality of responses received is directly proportional to the quality of the question asked. 🚮 Science Quotes |
PharmCat ★ Russia, 2019-11-08 23:08 (2010 d 23:00 ago) @ Helmut Posting: # 20773 Views: 12,093 |
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❝ The EMA’s Method B evaluated by May be it's specific of realization in lmer. I can't understand what's under the hood ![]() |
mittyri ★★ Russia, 2019-11-08 23:59 (2010 d 22:09 ago) @ PharmCat Posting: # 20774 Views: 11,927 |
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Hi PharmCat, ❝ I thought that Kenward-Roger provide the same DF as Satterthwaite's for one-dimension effects, so as CI for coefficient is one-dimension hypothesis DF should be the same, as it describes in reference paper, may be SAS make any corrections, I don't know... "KR modify the statistic F to improve the small sample properties by approximating the distribution of F by an Fd,m distribution, and they also provide a method for calculating the denominator degrees of freedom m. The fundamental idea is to calculate the approximate mean and variance of their statistic and then match moments with an F distribution to obtain the denominator degrees of freedom." from here ❝ Is any comparations anywhere? yes, plenty of. For example here Also citing Kuznetsova et al.: "From our practice, we observed that the p values that the approximation methods provide are generally very close to each other. Schaalje, McBride, and Fellingham (2002) performed a number of simulations in order to investigate the appropriateness of the approximation methods. They discovered that complexity of the covariance structures, sample size and imbalance affect the performance of both approximations. However, these factors affect the Satterthwaite’s method more than the Kenward-Roger’s." — Kind regards, Mittyri |
PharmCat ★ Russia, 2019-11-09 01:51 (2010 d 20:17 ago) @ mittyri Posting: # 20775 Views: 11,998 |
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I look this or here. "Lemma 7.2.1 When l = 1, the Satterthwaite, the K-R and the proposed methods give the same estimate of the denominator degrees of freedom" p.98 proof in source. For coefficient estimate l = 1, and thou I thought they should be equal (and the really equal in SAS). But when DDFM=KENWARDROGER is set - variance-covariance matrix of the fixed effects is corrected too and resulting CI would be differ - this I didn’t take it into account. |
Helmut ★★★ ![]() ![]() Vienna, Austria, 2019-11-09 17:22 (2010 d 04:46 ago) @ mittyri Posting: # 20778 Views: 12,626 |
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Hi mittyri and all other nerds, a rant from Douglas Bates (maintainer of lme4 ) reproduced in all of its beauty:Users are often surprised and alarmed that the summary of a linear mixed model fit by — Dif-tor heh smusma 🖖🏼 Довге життя Україна! ![]() Helmut Schütz ![]() The quality of responses received is directly proportional to the quality of the question asked. 🚮 Science Quotes |
PharmCat ★ Russia, 2019-11-09 20:11 (2010 d 01:57 ago) @ Helmut Posting: # 20779 Views: 11,839 |
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❝ Hi mittyri and all other nerds, Hi all again ![]() ![]() I really love how Douglas writes and this is one more of his explanation. And I fully support this point of view and concept of statistical purity (lme4, MixedModels.jl ets): you have modeling results and then do what you want. Problem is that we have real "degrees of freedom police" ![]() I think that more compromised and more conservative is a "contain" DF = N - rank(XZ), but FDA wrote Satterthwaite. |