Dr. Jo Burke09 November 2021
Over the past forty years the number of statisticians in the pharmaceutical industry has grown enormously. An excellent, though perhaps somewhat dated, summary of the history of pharmaceutical statisticians may be found in Andy Grieve’s Presidential address to the Royal Statistical Society (2005). In his address, Andy pointed out that membership of PSI (Statisticians in the Pharmaceutical Industry - a predominantly UK organisation), grew from 47 in 1977 to over 1100 in 2004. This growth in numbers has been mirrored in other related disciplines such as statistical programming.
It isn’t purely in numbers that things have changed: the role itself has evolved and continues to do so. From the majority being employed historically in drug discovery we now see that the majority are employed in clinical research; but such a simple description does not adequately describe the variety. Today, pharmaceutical statisticians may be found supporting high throughput screening, microarrays, toxicology, formulation and stability testing, assay validation, genomics, pharmacology, pharmacokinetics, pharmacodynamics, clinical research, manufacturing, post marketing studies, safety surveillance and pharmacoeconomics, to name but a few! Many companies also include a team of statisticians dedicated to researching methodology and innovation.
I think it’s fair to say that one of, if not the main factor, in the evolution of the pharmaceutical statistician role has been the changing regulatory landscape. From the 1960s, the number of laws, regulations and guidelines covering applications for new drug products began to increase globally. Eventually, following initial discussions between Europe, Japan and the US, the International Council for Harmonisation of technical requirements for pharmaceuticals for human use (ICH), was conceived. A quick glance at the ICH website today will provide the reader with a set of guidelines that should be followed, with one in particular close to a clinical trial statistician’s heart: ICH E9 Statistical Principles for Clinical Trials. It would be remiss to think that this is the only guideline covering statistical issues. There are many, ranging from adjusting for baseline covariates to the use of Bayesian statistics. Indeed the UK’s own National Institute for Health and Care Excellence (NICE) provides some excellent guidance regarding network meta-analyses. Guidelines also exist covering the standardisation of data collection, datasets, clinical trial reports and the Integrated Summaries of Effectiveness and Integrated Summaries of Safety.
It may appear that with so many standards, much of the work of a pharmaceutical statistician supporting clinical trials could be automated. This is indeed the case for data such as demographics, etc., but along with the increase in regulations governing drug approval, we have seen an explosion in computing power. This has increased the number and complexity of analysis methods available.
It wasn’t too long ago that the imputation of missing data or the use of Bayesian designs and analyses would be unthinkable and yet now in early clinical development, adaptive dose finding studies, health technology assessments and increasingly, medical devices and diseases in rare populations and paediatric populations, the use of Bayesian statistics is becoming commonplace. With so much at our fingertips these days, we should not forget the importance of ensuring the basics are covered: plot the data, understand the models and how the data were collected, the methods, the assumptions and the experimental design. In this era of “Big Data”, “Machine Learning” and “Artificial Intelligence” this is particularly true (yes, these may be encountered in pharmaceutical statistics). One of the consequences of having easy access to often quite complex methods, is a “black box” approach to analysis. Whilst this certainly has its merits, users are sometimes unaware of assumptions underpinning the analyses and so do not present their results with the appropriate caveats. One assumption that is often overlooked and not checked, even by the strongest of theoretical statisticians, is that an iterative method such as those used in many Bayesian analyses, has actually converged to a stable solution.
The need to cover the basics is not only true of the analysis of trial data, but also its design. Many trials use complex adaptive designs which fundamentally rely on the appropriate randomisation, correct doses, population and endpoints. Sometimes what may be considered a simple stratified randomisation needs to be thought about very carefully. Some companies have no, or very little, experience of crossover designs whereas in others, they are very popular. The basics of experimental design can be forgotten and designs are taken from the shelf simply because they had been used by that department for a long time. I would suggest that there is still a lot that can be learnt from Cox’s Design of Experiments, particularly in those designs that are more complex than a simple 2x2 Crossover.
One will see and hear many presentations discussing the ever increasing cost of developing new drugs. One Contract Research Organisation estimates pivotal Phase III trials cost a median of approximately $41,000 per patient. This increasing cost does not appear to be matched with an increase in the number of drugs being approved. In some companies, statisticians will be involved in the drug development plan from the very beginning, making use of utility analyses and decision theory, helping with strategic decisions.
In an attempt to reduce the time to market many companies have used adaptive trial designs combining Phase II and Phase III. Sometimes these fail not because of a lack of efficacy or safety issues, but because of rushing into the trial without enough knowledge of the product. Some companies are beginning to take a different approach and focus on more exploratory trials and/or analyses prior to Phase III in order to maximise their knowledge, often developing predictive models during the earlier stages. These can be remarkably complex to derive. Statisticians involved in pre-clinical and early clinical research bring a wealth of knowledge to the development of these models so perhaps we shall see, if not quite a full circle, a return of more pharmaceutical statisticians to the earlier stages of drug development coupled with more thinking time.
Dr Burke, PhD, CStat, has worked for approximately 30 years as a statistical consultant in the pharmaceutical industry supporting clinical trials from early to late stage development.
Her experience has involved direct clinical trial, regulatory submission and manufacturing support as well as working with statistical research groups. This experience has covered a wide variety of therapeutic areas with trial designs and analyses ranging from the standard to the more novel.
Until December 24, 2021 you can get 50% off our ASReml-R course "Mixed model analysis of medical data". Sign up and use the coupon MEDICAL50.
The VSNi Team04 May 2021
What is a p-value?
A way to decide whether to reject the null hypothesis (H0) against our alternative hypothesis (H1) is to determine the probability of obtaining a test statistic at least as extreme as the one observed under the assumption that H0 is true. This probability is referred to as the “p-value”. It plays an important role in statistics and is critical in most biological research.
P-values are a continuum (between 0 and 1) that provide a measure of the strength of evidence against H0. For example, a value of 0.066, will indicate that there is a probability that we could observe values as large or larger than our critical value with a probability of 6.6%. Note that this p-value is NOT the probability that our alternative hypothesis is correct, it is only a measure of how likely or unlikely we are to observe these extreme events, under repeated sampling, in reference to our calculated value. Also note that this p-value is obtained based on an assumed distribution (e.g., t-distribution for a t-test); hence, p-value will depend strongly on your (correct or incorrect) assumptions.
The smaller the p-value, the stronger the evidence for rejecting H0. However, it is difficult to determine what a small value really is. This leads to the typical guidelines of: p < 0.001 indicating very strong evidence against H0, p < 0.01 strong evidence, p < 0.05 moderate evidence, p < 0.1 weak evidence or a trend, and p ≥ 0.1 indicating insufficient evidence , and a strong debate on what this threshold should be. But declaring p-values as being either significant or non-significant based on an arbitrary cut-off (e.g. 0.05 or 5%) should be avoided. As Ronald Fisher said:
“No scientific worker has a fixed level of significance at which, from year to year, and in all circumstances he rejects hypotheses; he rather gives his mind to each particular case in the light of his evidence and his ideas” .
A very important aspect of the p-value is that it does not provide any evidence in support of H0 – it only quantifies evidence against H0. That is, a large p-value does not mean we can accept H0. Take care not to fall into the trap of accepting H0! Similarly, a small p-value tells you that rejecting H0 is plausible, and not that H1 is correct!
For useful conclusions to be drawn from a statistical analysis, p-values should be considered alongside the size of the effect. Confidence intervals are commonly used to describe the size of the effect and the precision of its estimate. Crucially, statistical significance does not necessarily imply practical (or biological) significance. Small p-values can come from a large sample and a small effect, or a small sample and a large effect.
It is also important to understand that the size of a p-value depends critically on the sample size (as this affects the shape of our distribution). Here, with a very very large sample size, H0 may be always rejected even with extremely small differences, even if H0 is nearly (i.e., approximately) true. Conversely, with very small sample size, it may be nearly impossible to reject H0 even if we observed extremely large differences. Hence, p-values need to also be interpreted in relation to the size of the study.
 Ganesh H. and V. Cave. 2018. P-values, P-values everywhere! New Zealand Veterinary Journal. 66(2): 55-56.
 Fisher RA. 1956. Statistical Methods and Scientific Inferences. Oliver and Boyd, Edinburgh, UK.
Dr. Vanessa Cave10 May 2022
The essential role of statistical thinking in animal ethics: dealing with reduction
Having spent over 15 years working as an applied statistician in the biosciences, I’ve come across my fair-share of animal studies. And one of my greatest bugbears is that the full value is rarely extracted from the experimental data collected. This could be because the best statistical approaches haven’t been employed to analyse the data, the findings are selectively or incorrectly reported, other research programmes that could benefit from the data don’t have access to it, or the data aren’t re-analysed following the advent of new statistical methods or tools that have the potential to draw greater insights from it.
An enormous number of scientific research studies involve animals, and with this come many ethical issues and concerns. To help ensure high standards of animal welfare in scientific research, many governments, universities, R&D companies, and individual scientists have adopted the principles of the 3Rs: Replacement, Reduction and Refinement. Indeed, in many countries the tenets of the 3Rs are enshrined in legislation and regulations around the use of animals in scientific research.
|Use methods or technologies that replace or avoid the use of animals.|
|Limit the number of animals used.|
|Refine methods in order to minimise or eliminate negative animal welfare impacts.|
In this blog, I’ll focus on the second principle, Reduction, and argue that statistical expertise is absolutely crucial for achieving reduction.
The aim of reduction is to minimise the number of animals used in scientific research whilst balancing against any additional adverse animal welfare impacts and without compromising the scientific value of the research. This principle demands that before carrying out an experiment (or survey) involving animals, the researchers must consider and implement approaches that both:
Both these considerations involve statistical thinking. Let’s begin by exploring the important role statistics plays in minimising current animal use.
Reduction requires that any experiment (or survey) carried out must use as few animals as possible. However, with too few animals the study will lack the statistical power to draw meaningful conclusions, ultimately wasting animals. But how do we determine how many animals are needed for a sufficiently powered experiment? The necessary starting point is to establish clearly defined, specific research questions. These can then be formulated into appropriate statistical hypotheses, for which an experiment (or survey) can be designed.
Statistical expertise in experimental design plays a pivotal role in ensuring enough of the right type of data are collected to answer the research questions as objectively and as efficiently as possible. For example, sophisticated experimental designs involving blocking can be used to reduce random variation, making the experiment more efficient (i.e., increase the statistical power with fewer animals) as well as guarding against bias. Once a suitable experimental design has been decided upon, a power analysis can be used to calculate the required number of animals (i.e., determine the sample size). Indeed, a power analysis is typically needed to obtain animal ethics approval - a formal process in which the benefits of the proposed research is weighed up against the likely harm to the animals.
Researchers also need to investigate whether pre-existing sources of information or data could be integrated into their study, enabling them to reduce the number of animals required. For example, by means of a meta-analysis. At the extreme end, data relevant to the research questions may already be available, eradicating the need for an experiment altogether!
An obvious mechanism for minimising future animal use is to ensure we do it right the first time, avoiding the need for additional experiments. This is easier said than done; there are many statistical and practical considerations at work here. The following paragraphs cover four important steps in experimental research in which statistical expertise plays a major role: data acquisition, data management, data analysis and inference.
Above, I alluded to the validity of the experimental design. If the design is flawed, the data collected will be compromised, if not essentially worthless. Two common mistakes to avoid are pseudo-replication and the lack of (or poor) randomisation. Replication and randomisation are two of the basic principles of good experimental design. Confusing pseudo-replication (either at the design or analysis stage) for genuine replication will lead to invalid statistical inferences. Randomisation is necessary to ensure the statistical inference is valid and for guarding against bias.
Another extremely important consideration when designing an experiment, and setting the sample size, is the risk and impact of missing data due, for example, to animal drop-out or equipment failure. Missing data results in a loss of statistical power, complicates the statistical analysis, and has the potential to cause substantial bias (and potentially invalidate any conclusions). Careful planning and management of an experiment will help minimise the amount of missing data. In addition, safe-guards, controls or contingencies could be built into the experimental design that help mitigate against the impact of missing data. If missing data does result, appropriate statistical methods to account for it must be applied. Failure to do so could invalidate the entire study.
It is also important that the right data are collected to answer the research questions of interest. That is, the right response and explanatory variables measured at the appropriate scale and frequency. There are many statistical related-questions the researchers must answer, including: what population do they want to make inference about? how generalisable do they need their findings to be? what controllable and uncontrollable variables are there? Answers to these questions not only affects enrolment of animals into the study, but also the conditions they are subjected to and the data that should be collected.
It is essential that the data from the experiment (including meta-data) is appropriately managed and stored to protect its integrity and ensure its usability. If the data get messed up (e.g., if different variables measured on the same animal cannot be linked), is undecipherable (e.g., if the attributes of the variables are unknown) or is incomplete (e.g., if the observations aren’t linked to the structural variables associated with the experimental design), the data are likely worthless. Statisticians can offer invaluable expertise in good data management practices, helping to ensure the data are accurately recorded, the downstream results from analysing the data are reproducible and the data itself is reusable at a later date, by possibly a different group of researchers.
Unsurprisingly, it is also vitally important that the data are analysed correctly, using the methods that draw the most value from it. As expected, statistical expertise plays a huge role here! The results and inference are meaningful only if appropriate statistical methods are used. Moreover, often there is a choice of valid statistical approaches; however, some approaches will be more powerful or more precise than others.
Having analysed the data, it is important that the inference (or conclusions) drawn are sound. Again, statistical thinking is crucial here. For example, in my experience, one all too common mistake in animal studies is to accept the null hypothesis and erroneously claim that a non-significant result means there is no difference (say, between treatment means).
The other important mechanism for minimising future animal use is to share the knowledge and information gleaned. The most basic step here is to ensure that all the results are correctly and non-selectively reported. Reporting all aspects of the trial, including the experimental design and statistical analysis, accurately and completely is crucial for the wider interpretation of the findings, reproducibility and repeatability of the research, and for scientific scrutiny. In addition, all results, including null results, are valuable and should be shared.
Sharing the data (or resources, e.g., animal tissues) also contributes to reduction. The data may be able to be re-used for a different purpose, integrated with other sources of data to provide new insights, or re-analysed in the future using a more advanced statistical technique, or for a different hypothesis.
Another avenue that should also be explored is whether additional data or information can be obtained from the experiment, without incurring any further adverse animal welfare impacts, that could benefit other researchers and/or future studies. For example, to help address a different research question now or in the future. At the outset of the study, researchers must consider whether their proposed study could be combined with another one, whether the research animals could be shared with another experiment (e.g., animals euthanized for one experiment may provide suitable tissue for use in another), what additional data could be collected that may (or is!) of future use, etc.
Statistical thinking clearly plays a fundamental role in reducing the number of animals used in scientific research, and in ensuring the most value is drawn from the resulting data. I strongly believe that statistical expertise must be fully utilised through the duration of the project, from design through to analysis and dissemination of results, in all research projects involving animals to achieving reduction. In my experience, most researchers strive for very high standards of animal ethics, and absolutely do not want to cause unnecessary harm to animals. Unfortunately, the role statistical expertise plays here is not always appreciated or taken advantage of. So next time you’re thinking of undertaking research involving animals, ensure you have expert statistical input!
Dr. Vanessa Cave is an applied statistician interested in the application of statistics to the biosciences, in particular agriculture and ecology, and is a developer of the Genstat statistical software package. She has over 15 years of experience collaborating with scientists, using statistics to solve real-world problems. Vanessa provides expertise on experiment and survey design, data collection and management, statistical analysis, and the interpretation of statistical findings. Her interests include statistical consultancy, mixed models, multivariate methods, statistical ecology, statistical graphics and data visualisation, and the statistical challenges related to digital agriculture.
Vanessa is currently President of the Australasian Region of the International Biometric Society, past-President of the New Zealand Statistical Association, an Associate Editor for the Agronomy Journal, on the Editorial Board of The New Zealand Veterinary Journal and an honorary academic at the University of Auckland. She has a PhD in statistics from the University of St Andrew.
Kanchana Punyawaew and Dr. Vanessa Cave01 March 2021
Mixed models for repeated measures and longitudinal data
The term "repeated measures" refers to experimental designs or observational studies in which each experimental unit (or subject) is measured repeatedly over time or space. "Longitudinal data" is a special case of repeated measures in which variables are measured over time (often for a comparatively long period of time) and duration itself is typically a variable of interest.
In terms of data analysis, it doesn’t really matter what type of data you have, as you can analyze both using mixed models. Remember, the key feature of both types of data is that the response variable is measured more than once on each experimental unit, and these repeated measurements are likely to be correlated.
To illustrate the use of mixed model approaches for analyzing repeated measures, we’ll examine a data set from Landau and Everitt’s 2004 book, “A Handbook of Statistical Analyses using SPSS”. Here, a double-blind, placebo-controlled clinical trial was conducted to determine whether an estrogen treatment reduces post-natal depression. Sixty three subjects were randomly assigned to one of two treatment groups: placebo (27 subjects) and estrogen treatment (36 subjects). Depression scores were measured on each subject at baseline, i.e. before randomization (predep) and at six two-monthly visits after randomization (postdep at visits 1-6). However, not all the women in the trial had their depression score recorded on all scheduled visits.
In this example, the data were measured at fixed, equally spaced, time points. (Visit is time as a factor and nVisit is time as a continuous variable.) There is one between-subject factor (Group, i.e. the treatment group, either placebo or estrogen treatment), one within-subject factor (Visit or nVisit) and a covariate (predep).
Using the following plots, we can explore the data. In the first plot below, the depression scores for each subject are plotted against time, including the baseline, separately for each treatment group.
In the second plot, the mean depression score for each treatment group is plotted over time. From these plots, we can see variation among subjects within each treatment group that depression scores for subjects generally decrease with time, and on average the depression score at each visit is lower with the estrogen treatment than the placebo.
The simplest approach for analyzing repeated measures data is to use a random effects model with subject fitted as random. It assumes a constant correlation between all observations on the same subject. The analysis objectives can either be to measure the average treatment effect over time or to assess treatment effects at each time point and to test whether treatment interacts with time.
In this example, the treatment (Group), time (Visit), treatment by time interaction (Group:Visit) and baseline (predep) effects can all be fitted as fixed. The subject effects are fitted as random, allowing for constant correlation between depression scores taken on the same subject over time.
The code and output from fitting this model in ASReml-R 4 follows;
The output from summary() shows that the estimate of subject and residual variance from the model are 15.10 and 11.53, respectively, giving a total variance of 15.10 + 11.53 = 26.63. The Wald test (from the wald.asreml() table) for predep, Group and Visit are significant (probability level (Pr) ≤ 0.01). There appears to be no relationship between treatment group and time (Group:Visit) i.e. the probability level is greater than 0.05 (Pr = 0.8636).
In practice, often the correlation between observations on the same subject is not constant. It is common to expect that the covariances of measurements made closer together in time are more similar than those at more distant times. Mixed models can accommodate many different covariance patterns. The ideal usage is to select the pattern that best reflects the true covariance structure of the data. A typical strategy is to start with a simple pattern, such as compound symmetry or first-order autoregressive, and test if a more complex pattern leads to a significant improvement in the likelihood.
Note: using a covariance model with a simple correlation structure (i.e. uniform) will provide the same results as fitting a random effects model with random subject.
In ASReml-R 4 we use the corv() function on time (i.e. Visit) to specify uniform correlation between depression scores taken on the same subject over time.
Here, the estimate of the correlation among times (Visit) is 0.57 and the estimate of the residual variance is 26.63 (identical to the total variance of the random effects model, asr1).
Specifying a heterogeneous first-order autoregressive covariance structure is easily done in ASReml-R 4 by changing the variance-covariance function in the residual term from corv() to ar1h().
When the relationship of a measurement with time is of interest, a random coefficients model is often appropriate. In a random coefficients model, time is considered a continuous variable, and the subject and subject by time interaction (Subject:nVisit) are fitted as random effects. This allows the slopes and intercepts to vary randomly between subjects, resulting in a separate regression line to be fitted for each subject. However, importantly, the slopes and intercepts are correlated.
The str() function of asreml() call is used for fitting a random coefficient model;
The summary table contains the variance parameter for Subject (the set of intercepts, 23.24) and Subject:nVisit (the set of slopes, 0.89), the estimate of correlation between the slopes and intercepts (-0.57) and the estimate of residual variance (8.38).
Brady T. West, Kathleen B. Welch and Andrzej T. Galecki (2007). Linear Mixed Models: A Practical Guide Using Statistical Software. Chapman & Hall/CRC, Taylor & Francis Group, LLC.
Brown, H. and R. Prescott (2015). Applied Mixed Models in Medicine. Third Edition. John Wiley & Sons Ltd, England.
Sabine Landau and Brian S. Everitt (2004). A Handbook of Statistical Analyses using SPSS. Chapman & Hall/CRC Press LLC.