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Data and Safety Monitoring Committees in Clinical Trials [Kõva köide]

(John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA), (John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA)
  • Formaat: Hardback, 191 pages, kõrgus x laius: 235x156 mm, kaal: 408 g, 50-150 equations - PPI 513 - 4/10 - Book is at PGK; 39 Tables, black and white; 7 Illustrations, black and white, Contains 29 hardbacks
  • Sari: Chapman & Hall/CRC Biostatistics Series
  • Ilmumisaeg: 17-Mar-2009
  • Kirjastus: Chapman & Hall/CRC
  • ISBN-10: 1420070371
  • ISBN-13: 9781420070378
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  • Formaat: Hardback, 191 pages, kõrgus x laius: 235x156 mm, kaal: 408 g, 50-150 equations - PPI 513 - 4/10 - Book is at PGK; 39 Tables, black and white; 7 Illustrations, black and white, Contains 29 hardbacks
  • Sari: Chapman & Hall/CRC Biostatistics Series
  • Ilmumisaeg: 17-Mar-2009
  • Kirjastus: Chapman & Hall/CRC
  • ISBN-10: 1420070371
  • ISBN-13: 9781420070378
Teised raamatud teemal:
Focusing on the practical clinical and statistical issues that arise in pharmaceutical industry trials, this book summarizes the authors experience in serving on many data monitoring committees (DMCs) and in heading up a contract research organization that provided statistical support to nearly seventy-five DMCs. It explains the difference in DMC operations between the pharmaceutical industry and National Institutes of Health (NIH)-sponsored trials. Leading you through the types of reports for adverse events and lab values, the author presents the statistical requirements of data monitoring committees and gives advice on how statisticians can best interact with physician members of these committees. He also shows how physicians think differently about safety data than statisticians, proving that both views are needed.

Arvustused

"I found this book very useful as a clinical biostatistician with little experience with serving on a DMC. But also biostatisticians with more experience in DMCs can profit from this book since it helps in evaluating their own performance. Though the book primarily focuses on pharmaceutical industry trials, it is almost equally useful for those working on investigator-initiated trials." Theo Stijnen, ISCB News, December 2013



"This is an excellent book to stand alongside (primarily) Ellenberg et al. and (to a lesser extent) DeMets et al. an excellent book not only for those who might sit on a DMC but also for the many people who have to set up DMCs, provide reports or data to them and, very importantly, receive their recommendations and have to act on them." Simon Day, Pharmaceutical Statistics, 2011, 10



"Given the authors years of experience as a statistician and as a founder of the first DMC in pharmaceutical industry trials, I highly recommend this booknot only for experts because of its cogent and organized presentation, but more importantly for young investigators who are seeking information about the logistical and philosophical aspects of a DMC. As a junior statistician, I found the end-of-chapter Q&A section to be invaluable, because it gives a behind-the-scenes peek at DMC meetings and interactions with sponsors. the author provides virtually all relevant topics pertaining to a DMC with clarity and insight. some readers with advanced statistical background will find this text nicely complements the book by Proschan, Lan, and Wittes (2009). In summary, audiences ranging from novice clinical research practitioners to biostatisticians will find this comprehensive guide to data and safety monitoring committees a valuable addition." The American Statistician, November 2010, Vol. 64, No. 4



"Jay Herson provides a concise overview of DMCs in a useful and accessible format. For someone new to the area, this text will provide a valuable introduction quickly and effectively. At the same time, the presentation style will allow those with more knowledge to move through the material expeditiously, and they will also benefit. a valuable introduction to DMCs. an excellent overview of a complex subject. The material is presented in a very accessible format and is particularly well suited to new DMC members, or those considering such an opportunity. The material is very useful, the presentation is effective, and a strong recommendation is appropriate." Biometrics, March 2010









"When searching for books about DSMCs, you will find that Ellenburg et al. (2002) published a book with an almost identical title to Hersons. overall I would recommend Hersons book as more readable and detailed. This book would be particularly useful for anyone who becomes a DSMC member for the first time or for sponsors so that they can have a greater understanding of the DSMCs role." Andrea M. Rehman, London School of Hygiene and Tropical Medicine, Journal of the Royal Statistical Society, Series A, 2010









"This book, lively and readable and reflecting real-world experiences and lessons from DMC safety monitoring, is a useful complement to other available texts on this subject." Paul P. Gallo, Novartis Pharmaceuticals, Journal of Biopharmaceutical Statistics, 2009, Issue 6

Preface xv
Introduction
1(16)
What Is a Data Monitoring Committee (DMC)?
1(1)
Some Definitions
2(1)
DMC in Federal Government-Sponsored Clinical Trials versus Pharmaceutical Industry Clinical Trials
3(1)
Stewardship
4(1)
Some Recent History
5(1)
Development of DMCs in the Pharmaceutical Industry
5(1)
Guidances---FDA, NIH, and ICH
5(1)
Other Vehicles for Patient Protection
6(1)
DMCs Place in the Drug Development Cycle
6(6)
Phases of Drug Development
6(1)
Limitations of a Clinical Program for Revealing Safety Issues
6(3)
Postmarket Safety Actions
9(1)
Role of DMCs in Exploratory and Confirmatory Trials
9(2)
Investigator-Sponsored Trials
11(1)
Open Label Extension Studies
11(1)
Pharmaceutical Industry Demographics
12(1)
Size of Companies
12(1)
Public versus Private Companies
12(1)
Conclusion
12(2)
DMCounselor
14(3)
Organization of a Safety Monitoring Program for a Confirmatory Trial
17(14)
Members of the Safety Monitoring Team
17(3)
The Sponsor
17(1)
Data Monitoring Committee
18(1)
Data Analysis Center
19(1)
Institutional Review Board
20(1)
Scope of DMC Authority
20(1)
How Is a DMC Created?
20(2)
Membership
22(3)
Physicians
22(1)
Biostatisticians
22(1)
How Many Members Are Needed?
22(1)
Ad Hoc Consultants
23(1)
Ubiquitous DMC Members
23(1)
Disclosure of DMC Membership
23(2)
Multiple Sponsorship
25(1)
From Where Are DMC Members Recruited?
25(1)
Term
25(1)
Conflicts of Interest
25(1)
Compensation
26(1)
Liability and Indemnification
26(1)
Sponsor DMC Relationship
27(1)
Interdisciplinary Training
27(1)
Conclusion
27(1)
DMCounselor
28(3)
Meetings
31(16)
DMC Charter
31(1)
Types of Meetings
31(2)
Orientation or Organizational Meeting
32(1)
Data Review
33(1)
Ad Hoc
33(1)
Orientation Meeting
33(5)
Chair for Orientation Meeting
33(1)
Introduction of the Safety Monitoring Team
33(1)
Appointment of DMC Secretary
33(1)
Presentation of DMC Charter
34(1)
Masking Policy
34(1)
Investigator Brochure
34(1)
Protocol
35(1)
Informed Consent
35(1)
Data Flow
35(1)
Useful Software
36(1)
Review of Integrated Summary of Safety
36(1)
Policy on Review of Publications and Package Insert
37(1)
Formats for Tables, Listings, and Graphs
37(1)
Schedule First Data Review Meeting
37(1)
Data Review Meetings
38(6)
Attendance
38(1)
Open Session
39(1)
Study Progress
39(1)
Data Quality
39(1)
Update on Pending Action Items
39(1)
Questions for the DMC
39(1)
Sample Agenda for Open Session
40(1)
Closed Session
40(1)
Scheduling of Next Meeting
40(1)
Minutes
40(4)
Ad Hoc Meetings
44(1)
Conclusion
44(1)
DMCounselor
44(3)
Clinical Issues
47(10)
Goals of Safety Analysis
47(1)
Definitions
48(1)
Adverse Event
48(1)
Serious Adverse Event
48(1)
Serious Adverse Event Reporting Requirements
48(1)
Safety Data
49(2)
Pharmacovigilence Group
49(1)
Case Report Forms
49(1)
Adverse Event Dictionary
49(1)
Adverse Event Severity
50(1)
SAE Narratives
51(1)
Titration to Dose
51(1)
Deaths
51(1)
Impact of Multinational Trials
52(2)
Cultural Issues
52(1)
Political Issues
52(1)
Medical/Surgical Practices Issues
53(1)
Conclusion
54(1)
DMCounselor
55(2)
Statistical Issues
57(32)
Goals of Statistical Analysis
57(1)
Useful Data Displays
58(7)
Enrollment by Center
59(1)
Graph of Cumulative Patient Enrollment by Month
59(1)
Graph of Cumulative Patient Exposure to Study Drug
59(2)
Treatment Emergent Adverse Events
61(1)
Classification
61(1)
An Example
61(1)
Incidence Calculation
62(1)
Incidence and Exposure Time Calculation
62(1)
Kaplan-Meier Time to First Occurrence
63(1)
Incidence at a Time Point after Treatment Start---Landmark Estimate
63(1)
Other Ways of Looking at Incidence
64(1)
Laboratory Data
65(1)
Analysis Methods---Frequentist
65(7)
What Is Frequentist Analysis?
65(1)
Hypothesis Tests
65(3)
Confidence Intervals
68(1)
Incidence
68(1)
Rate per 100 Patient Years
68(1)
Odds Ratio
69(1)
Poisson Rate Ratio
70(2)
Inference with Kaplan-Meier Landmark Estimates of Incidence
72(1)
Data Analysis without Statistics
72(1)
Power
72(2)
Multiplicity
74(3)
Analysis Methods---Likelihood
77(5)
Analysis Methods---Bayesian
82(1)
Conclusion
82(4)
DMCounselor
86(3)
Bias and Pitfalls
89(12)
What Is Bias?
89(1)
Sources of Bias
90(1)
Knowledge of Treatment Assignment
90(2)
By Sponsor Staff
90(1)
By the DMC
91(1)
Reporting Bias
92(4)
Investigator Level
92(1)
Knowledge of Treatment Assignment
92(1)
Incomplete Follow-Up
93(1)
Spontaneous versus Solicited Adverse Event Collection
93(1)
Analysis Level
94(1)
Early Termination Due to Efficacy
94(1)
Granularity Bias
94(2)
Competing Risks
96(2)
Conclusion
98(1)
DMCounselor
98(3)
Data Monitoring Committee Decisions
101(18)
Types of DMC Decisions
101(1)
Decision-Making Environment
102(1)
Risk versus Benefit Analyses
102(1)
When a Safety Issue Arises
103(5)
Unmasking
104(1)
``Dear Investigator'' Letter
105(1)
Modification of Informed Consent
106(1)
Protocol Modification
106(1)
Trial Termination
106(2)
Unmasking the Sponsor
108(1)
Information beyond the Present Trial
108(2)
Meta-Analysis
110(2)
Final Meeting
112(1)
Special Problems with Infant Pharma Companies
112(1)
Conclusion
113(1)
DMCounselor
113(6)
Emerging Issues
119(16)
Introduction
119(1)
Issues in Technology
120(6)
Adaptive Designs
120(1)
Dropping a Dose or Treatment Group
120(1)
Adaptive Assignment to Treatment Group
121(1)
Changing Objectives: Superiority to Noninferiority
121(1)
Seamless Transition: Phase II to Phase III
122(1)
Change in Effect Size of Interest
122(1)
Further Thoughts on Adaptive Designs
123(1)
Real-Time SAE Reporting via the Internet
124(1)
Causal Inference
125(1)
Biomarkers
125(1)
Exciting Times Ahead
126(1)
Issues Due to Maturing of DMC Processes and Evolution of the Pharmaceutical Industry
126(4)
Training of DMC Members
126(1)
Cost Control
127(1)
DMC Audit
128(1)
Internal Safety Review Committee
128(1)
Mergers and Licensing
129(1)
Journal Policies Regarding Independent Review
129(1)
Resignation from a DMC
130(1)
Conclusion
130(1)
DMCounselor
131(4)
Appendix 135(6)
Glossary 141(12)
List of Abbreviations 153(2)
References 155(12)
Index 167
John Hopkins University, Baltimore, Maryland, USA Pfizer Research & Development, Kent, UK National Taiwan University, Taipei, Taiwan National Taiwan University, Taipei Duke University School of Medicine, Durham, North Carolina, Georgia Southern University, Statesboro, USA