• Communications for Statistical Applications and Methods
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• 제22권5호
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• pp.401-413
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• 2015

In this article, we review the statistical methods and theory for dose finding in early phase clinical trials, where the primary objective is to identify an acceptable dose for further clinical investigation. The dose finding literature is initially motivated by applications in phase I clinical trials, in which dose finding is often formulated as a percentile estimation problem. We will present some important phase I methods and give an update on new theoretical developments since a recent review by Cheung (2010), with an aim to cover a broader class of dose finding problems and to illustrate how the general dose finding theory may be applied to evaluate and improve a method. Specifically, we will illustrate theoretical techniques with some numerical results in the context of a phase I/II study that uses trinary toxicity/efficacy outcomes as basis of dose finding.

• Communications for Statistical Applications and Methods
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• 제29권4호
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• pp.421-439
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• 2022

Phase I dose-finding trials are essential in drug development. By finding the maximum tolerated dose (MTD) of a new drug or treatment, a Phase I trial establishes the recommended doses for later-phase testing. The primary toxicity endpoint of interest is often a binary variable, which describes an event of a patient who experiences dose-limiting toxicity. However, there is a growing interest in dose-finding studies regarding non-binary outcomes, defined by either the weighted sum of rates of various toxicity grades or a continuous outcome. Although several novel methods have been proposed in the literature, accessible software is still lacking to implement these methods. This study introduces a newly developed R package, UnifiedDoseFinding, which implements three phase I dose-finding methods with non-binary outcomes (Quasi- and Robust Quasi-CRM designs by Yuan et al. (2007) and Pan et al. (2014), gBOIN design by Mu et al. (2019), and by a method by Ivanova and Kim (2009)). For each of the methods, UnifiedDoseFinding provides corresponding functions that begin with next that determines the dose for the next cohort of patients, select, which selects the MTD defined by the non-binary toxicity endpoint when the trial is completed, and get oc, which obtains the operating characteristics. Three real examples are provided to help practitioners use these methods. The R package UnifiedDoseFinding, which is accessible in R CRAN, provides a user-friendly tool to facilitate the implementation of innovative dose-finding studies with nonbinary outcomes.

• 응용통계연구
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• 제33권2호
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• pp.137-145
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• 2020

'투약용량 발견 시험(Dose Finding Study)'라고도 불리는 제 1상 임상시험은 동물 실험 혹은 시험관 실험을 통하여 개발된 신약물질을 사람에게 실시하는 첫 단계이다. 제1상 임상시험의 가장 주요한 목적은 환자에게 허용할 수 있고 최대의 효능을 가진 복용량을 결정하는 것이다. 본 논문에서는 이를 고려하여 최대허용용량(MTD)를 결정할 수 있는 적절한 추정방법을 제안하였다. 이 방법은 Biased coin design과 멈춤규칙을 이용하여 MTD를 추정한다. 제안하는 방법은 모의실험을 통해 기존의 방법들과 비교하였다.

• 응용통계연구
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• 제35권2호
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• pp.251-263
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• 2022

제1상 임상시험은 '투약 용량 발견 시험(dose finding study)'라고도 불리는데 동물 실험 또는 시험관 실험을 통하여 개발된 신약 물질을 사람에게 시험하는 첫 단계이다. 제 1상 임상시험의 목적 중 하나는 환자에게 허용할 수 있으면서 최대의 효능을 가진 복용량인 최대허용용량(maximum tolerated dose, MTD)을 결정하는 것이다. 본 논문에서는 다양한 멈춤 규칙을 이용한 MTD 추정법들을 소개한다. 또한 모의실험을 통해 SM3, NM, Rim, J3, BSM 방법을 비교하고 효율적인 MTD 추정법에 대해 고찰한다. 모의실험 결과 BSM방법이 목표독성확률에 가장 가깝게 MTD를 추정하는 것으로 나타났다. 또한 J3방법의 피험자 수가 가장 적었다. 이러한 결과는 두 방법의 멈춤 규칙의 특성 때문이라고 판단되는데 BSM방법은 독성 반응이 있을 때 같은 용량에 피험자를 2명 또는 1명을 추가한다. 또한 J3방법은 동일한 용량에 할당되는 최대 피험자 수가 다른 방법에 비해 적다. 이러한 특성들을 결합하여 추정법을 개선한다면 더 효율적으로 MTD를 추정할 수 있을 것이다. 특히 BSM방법의 멈춤 규칙을 이용하면서 총 피험자 수를 줄일 수 있다면 적은 수의 피험자로 정확한 추정이 가능할 것이다.

• Biomolecules & Therapeutics
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• 제11권3호
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• pp.178-182
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• 2003

The clinical use of once daily aminoglycoside (ODA) dosing has been increased because of the potential therapeutic advantages of this dosing regimen. To evaluate the optimal sampling times of ODA dosing method in a clinical setting, the study was prospectively conducted in a total of 28 patients with UTI. All of the patients were intravenously administered gentamicin at a dose of 7 mg/kg over 60 minutes and randomly divided into two groups. Blood was collected at 0, 2, and 6 hours in Group A and at 1, 2, and 6 hours in Group B after the end of 1-hour infusion. The pharmacokinetic parameters (Ke, Vd and Cmax) obtained using the 0, 6 hour levels and 2, 6 hour levels in Group A were statistically different while those of 1, 6 hour levels and 2, 6 hour levels in Group B were similar. This finding indicated that the distributional phase of ODA is completed within 1 hour following the end of the I-hour infusion. If we are allowed to collect only two blood samples in ODA considering patients comfort and the analytical cost of drug, the first one should be drawn after 1 hour following the end of infusion to obtain adequate pharmacokinetic information.

• Clinical and Experimental Reproductive Medicine
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• 제25권2호
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• pp.115-122
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• 1998

The maintenance of a viable pregnancy has long been viewed as an immunological paradox. The deveolping embryo and trophoblast are immunologically foreign to the maternal immune system due to their maternally inherited genes products and tissue-specific differentiation antigens (Hill & Anderson, 1988). Therefore, speculation has arisen that spontaneous abortion may be caused by impaired maternal immune tolerance to the semiallogenic conceptus (Hill, 1990). Loss of recall antigen has been reported in immunosuppressed transplant recipients and is associated with graft survival (Muluk et al., 1991; Schulik et al., 1994). Progesterone $(10^{-5}M)$ has immunosuppressive capabilities (Szekeres-Bartho et al., 1985). Previous study showed that fertile women, but not women with unexplained recurrent abortion (URA), lose their immune response to recall antigens when pregnant (Bermas & Hill, 1997). Therefore, we hypothesized that immunosuppressive doses of progesterone may affect proliferative response of lymphocytes to trophoblast antigen and alloantigen. Proliferative responses using $^3H$-thymidine ($^3H$-TdR) incorporation of peripheral blood mononuclear cells (PBMCs) to the irradiated allogeneic periperal blood mononuclear cells as alloantigen, trophoblast extract and Flu as recall antigen, and PHA as mitogen were serially checked in 9 women who had experienced unexplained recurrent miscarriage. Progesterone vaginal suppositories (100mg b.i.d; Utrogestan, Organon) beginning 3 days after ovulation were given to 9 women with unexplained RSA who had prior evidence of Th1 immunity to trophoblast. We checked proliferation responses to conception cycle before and after progesterone supplementation once a week through the first 7 weeks of pregnancy. All patients of alloantigen and PHA had a positive proliferation response that occmed in the baseline phase. But 4 out of 9 patients (44.4%) of trophoblast antigen and Flu antigen had a positive proliferative response. The suppression of proliferation response to each antigen were started after proliferative phase and during pregnancy cycles. Our data demonstrated that since in vivo progesterone treated PBMCs suppressed more T-lymphocyte activation and $^3H$-TdR incorporation compare to PBMCs, which are not influenced by progesterone. This data suggested that it might be influenced by immunosuppressive effect of progesterone. In conclusion, progesterone may play an important immunological role in regulating local immune response in the fetal-placental unit. Furthermore, in the 9 women given progesterone during a conception cycle, Only two (22%) repeat pregnancy losses occured in these 9 women despite loss of antigen responsiveness (one chemical pregnancy loss and one loss at 8 weeks of growth which was karyotyped as a Trisomy 4). These finding suggested that pregnancy loss due to fetal aneuploidy is not associated with immunological phenomena.