A modified combination test for the analysis of a clinical trial when a protocol amendment changed the inclusion criteria

Abstract

Protocol amendments are often necessary in clinical trials. They can change the entry criteria and, therefore, the population. Simply analysing the pooled data is not acceptable. Instead, each phase should be analysed separately and a combination test such as Fisher's test should be applied to the resulting p-values. In this situation, an asymmetric decision rule is not appropriate. Therefore, we propose a modification of Bauer and Köhne's test. We compare this new test with the tests of Liptak, Fisher, Bauer/Köhne and Edgington. In case of differences in variance only or only small differences in mean, Liptak's Z-score approach is the best, and the new test keeps up with the rest and is in most cases slightly superior. In other situations, the new test and the Z-score approach are not preferable. But no big differences in populations are usually to be expected due to amendments. Then, the new method is a recommendable alternative.

Keywords:

• clinical trial
• combination test
• amendment

Acknowledgements

The authors acknowledge the support provided for this research by the Deutsche Forschungsgemeinschaft (DFG) under Grant NE 1170/3-2.