Can Response-Adaptive Randomization Increase Participation in Acute Stroke Trials?

Can response-adaptive randomization increase participation in acute stroke trials?

BACKGROUND AND PURPOSE A response-adaptive randomization (RAR) trial design actively adjusts the ratio of participants assigned to each trial arm, favoring the better performing treatment by using outcome data from participants already in the trial. Compared with a standard clinical trial, an RAR study design has the potential to improve patient participation in acute stroke trials. METHODS T...

Practical Bayesian Adaptive Randomization in Clinical Trials

While randomization is the established method for obtaining scientifically valid treatment comparisons in clinical trials, it sometimes is at odds with what physicians feel is good medical practice. If a physician favors one treatment over another based on personal experience or published data, it may be more appropriate ethically for that physician to use the favored treatment, rather than enr...

Trials of Trials in Acute Ischemic Stroke

Afew years ago, a distinguished colleague and expert in stroke told me, "When we have a treatment for stroke, we will know it" (R. Siekert, personal communication). I agree with this insightful comment, but I also wonder how we will know. Because stroke is a very complex condition with a number of clinical variables that compound care and influence outcome, it is unlikely that any therapy will ...

Randomization in clinical trials: can we eliminate bias?

Randomization plays a fundamental role in clinical trials. While many m­odern­ clinical­ trials­ employ­ restricted,­ stratified­or­ covariate-adaptive­ randomization designs that pursue balance in treatment assignments and­ balance­ across­ important­ covariates,­ some­ clinical­ trials­ call­ for­ response-adaptive­ or­ covariate-adjusted­ response-adaptive­ (CARA)­ randomization­ designs­ to...

Some Caveats for Outcome Adaptive Randomization in Clinical Trials