Analyzing Incomplete Discrete Longitudinal Clinical Trial Data

Commonly used methods to analyze incomplete longitudinal clinical trial data include complete case analysis (CC) and last observation carried forward (LOCF). However, such methods rest on strong assumptions, including missing completely at random (MCAR) for CC and unchanging profile after dropout for LOCF. Such assumptions are too strong to generally hold. Over the last decades, a number of full longitudinal data analysis methods have become available, such as the linear mixed model for Gaussian outcomes, that are valid under the much weaker missing at random (MAR) assumption. Such a method is useful, even if the scientific question is in terms of a single time point, for example, the last planned measurement occasion, and it is generally consistent with the intention-to-treat principle. The validity of such a method rests on the use of maximum likelihood, under which the missing data mechanism is ignorable as soon as it is MAR. In this paper, we will focus on non-Gaussian outcomes, such as binary, categorical or count data. This setting is less straightforward since there is no unambiguous counterpart to the linear mixed model. We first provide an overview of the various modeling frameworks for non-Gaussian longitudinal data, and subsequently focus on generalized linear mixed-effects models, on the one hand, of which the parameters can be estimated using full likelihood, and on generalized estimating equations, on the other hand, which is a nonlikelihood method and hence requires a modification to be valid under MAR. We briefly comment on the position of models that assume missingness not at random and argue they are most useful to perform sensitivity analysis. Our developments are Ivy Jansen is Postdoctoral Researcher, Center for Statistics, Hasselt University, Agoralaan Gebouw D, B-3590 Diepenbeek, Belgium (e-mail: ivy.jansen@ uhasselt.be). Caroline Beunckens is Research Assistant, Center for Statistics, Hasselt University, Agoralaan Gebouw D, B-3590 Diepenbeek, Belgium (e-mail: [email protected]). Geert Molenberghs is Professor, Center for Statistics, Hasselt University, Agoralaan Gebouw D, B-3590 Diepenbeek, Belgium (e-mail: [email protected]). Geert Verbeke is Professor, Biostatistical Centre, Katholieke Universiteit Leuven, Kapucijnenvoer 35, B-3000 Leuven, Belgium (e-mail: geert.verbeke@med. kuleuven.be). Craig Mallinckrodt is Senior Research Fellow, Eli Lilly & Company, Indianapolis, Indiana 46285, USA (e-mail: [email protected]).