In this engaging episode of "In the Interim...", host Dr. Scott Berry is joined by Dr. Nick Berry to explore the intriguing statistical parallels between sports and drug development, focusing on the concept of "regression-to-the-mean." Presenting examples that seem clear in sports, they discuss how these insights can illuminate the challenges faced in clinical trials and scientific inferences in medical decision making. Whether you're a statistician, drug developer, or sports enthusiast, this episode offers valuable perspectives on data interpretation and statistical phenomena.

Key Highlights:
• Discussion on how lessons from sports can benefit drug developers, emphasizing the concept of regression-to-the-mean.
• Personal anecdotes from Scott and Nick's experiences, illustrating statistical learning through sports.
• Examination of the regression-to-the-mean phenomenon through examples from baseball and golf.
• Exploration of how misunderstanding the regression-to-the-mean can lead to poor decision-making in clinical trials.
• Insights into placebo effects and how they are often confused with natural statistical phenomena.
• How regression-to-the-mean impacts expectations in financial markets and personal finance decision-making.

In this episode of "In the Interim…", host Dr. Scott Berry is true to the name of the podcast, as he discusses the unblinded world of adaptive clinical trials alongside Dr. Roger Lewis, a renowned expert in both statistical science and clinical medicine. Together, they explore the critical role of Data Safety Monitoring Boards (DSMBs) in safeguarding trial integrity and participant safety specifically for adaptive trials. The discussion navigates the complexities and challenges faced by DSMBs, particularly in adaptive trial contexts, offering valuable insights for anyone involved in clinical trial science.

Key Highlights
• Overview of the fundamental role and responsibilities of DSMBs in clinical trials.
• Discussion on how DSMBs ensure scientific integrity and participant safety in adaptive trials.
• Differences in DSMB involvement between traditional and adaptive trial designs.
• The evolving skillset required for DSMB members in the context of complex, adaptive trials.
• Exploration of the critical collaboration between DSMBs and Statistical Analysis Committees.

Quotes
• "The DSMB is tasked with balancing efficacy and safety at a very fundamental level." — Roger Lewis
• "Adaptive trials expand the role of the DSMB to ensure trials are conducted as intended." — Roger Lewis
• "The DSMB needs to review efficacy and safety to appropriately balance them." — Roger Lewis

In the latest episode of "In the Interim…", Dr. Scott Berry and Dr. Mike Krams sit down with Dr. Husseini Manji, to explore the potential of platform trials in advancing precision medicine within psychiatry. Listen as we discuss how an adaptive platform trial could transform drug development, paving the way for breakthroughs in understanding and treating psychiatric disorders.

Key Highlights:

• Overview of the burden of serious mental illness and the pressing need for innovative treatment approaches.
• Discussion on precision psychiatry and the potential of a platform trial to address the heterogeneity of psychiatric disorders.
• Insights into the advantages of biomarker-based adaptive trials in improving drug development success rates.
• Examination of potential sponsorship models for platform trials, emphasizing patient and industry collaboration.

Quotes:

• "Mental illnesses represent a significant global challenge with a staggering unmet need." – Husseini Manji
• "There's a real excitement about precision psychiatry—moving away from a one-size-fits-all approach." – Husseini Manji
• "The patient perspective is crucial for driving significant advances in psychiatric treatment." – Mike Krams
• "We believe that precision medicine biomarker-based adaptive trials could be game-changing in this space." – Husseini Manji

In Episode 11 of "In the Interim…", we discuss the nuances of implementing adaptive clinical trials with Dr. Anna McGlothlin and Dr. Michelle Detry from Berry Consultants. Both Anna and Michelle, seasoned Directors and Senior Statistical Scientists, shed light on the critical role their team plays in innovative adaptive clinical trials. They describe the frequent challenges and highlight the importance of high-quality trial implementation to ensure accurate and reliable outcomes, making this episode a must-listen for anyone involved in clinical trials.

Key Highlights:

• Insight into the statistical implementation of adaptive clinical trials.
• Logistics of data handling, to running the statistical model, to interactions with Data and Safety Monitoring Boards (DSMBs).
• Preparatory steps required before an adaptive analysis, ensuring the pre-specified design is adhered to and carried out as planned.
• The importance of understanding data in real-time and dealing with interim data idiosyncrasies.

Quotes:

• "We want the adaptive part of the trial to be invisible to sites—analyses might happen in the background without interference." – Scott Berry
• "Our goal is five business days from when we receive the data to when we send the result to the DSMB." – Michelle Detry
• "We always want to make sure that we have time, not just to hit a button and run an analysis and spit out a table, but to think and make sure that the results we’re producing make sense." – Anna McGlothlin

In this episode of "In the Interim..." we revisit the ground-breaking seamless phase 2/3 clinical trial for the GLP-1 agonist, dulaglutide—better known as Trulicity. We discuss the intricacies of the adaptive trial design, and the unique features that helped expedite development by 12-18 months. Listeners will gain insight into how Bayesian algorithms and innovative statistical methods were pivotal in navigating a complex trial design, benefiting Eli Lilly's pipeline and changing the landscape of diabetes treatment.

Key Highlights:

• Outline of the trial design and the barriers faced during its inception in 2007-2008.
• Explanation of the Clinical Utility Index and its role in adaptive randomization.
• The DSMB's role and interaction with Bayesian decision-making models.
• Simulation-based design to optimize development efficiencies.
• Insights into the predictive power of the trial on weight loss outcomes in subsequent trials.

Quotes:

• "The trial was run entirely by Bayesian algorithms." – Scott Berry
• "They believed this utility function was absolutely the right way to go forward." – Scott Berry

In this episode of "In the Interim...," we sit down with Dr. Meredith Buxton to explore the evolution of platform trials from I-SPY 2 to GBM AGILE and Beyond. With a rich history in innovative trial design, Meredith shares the journey from pioneering adaptive clinical trials in breast cancer with I-SPY 2 to her current role at the Global Coalition for Adaptive Research (GCAR). This conversation offers insights into accelerating clinical trial timelines, innovative operational frameworks, and their applications across multiple medical domains, making it a must-listen for anyone involved in clinical development and platform trials.

Key Highlights:

• Meredith Buxton discusses the origins and groundbreaking operations of the I-SPY platform in breast cancer.
• Exploration of how the I-SPY 2 model inspired subsequent platform trials in diverse areas such as glioblastoma and COVID-19.
• GCAR's role as a non-profit entity to foster adaptive trial designs and Meredith’s influential contributions to its formation and success.
• Discover the operational complexities and regulatory considerations essential for modern platform trials.
• Insights into Meredith’s vision for the future of drug development and the ongoing necessity for innovation in trial design.

Quotes:

• “The ideas of this are groundbreaking in many ways.” – Scott Berry
• "The I-SPY2 model could be replicated in other spaces." – Meredith Buxton

In this episode of "In the Interim...," Scott Berry and Kert Viele navigate the nuanced debate surrounding the integration of external data in clinical trials. Discover the implications and potential benefits and pitfalls of leveraging historical and real-world evidence in the analysis of clinical trials.

Key Highlights:

• Exploration of how external data can influence clinical trial analyses and the inherent risks versus rewards.
• Examination of the frequentist versus Bayesian perspectives on data integration.
• Discussion of real-world cases where external data has been used.
• Debate on the conservative nature of current scientific approaches and how they may hinder progress.
• Insight into the future of clinical trials harnessing external data – a step towards better medical science.

Quotes:

• "If prior data isn't generally leading us in the right direction, we ought to reconsider the basis of scientific inquiry." – Kert Viele
• "The industry's hesitance to use existing data slows innovation and limits our ability to bring effective treatments to market." – Scott Berry

In this episode of "In the Interim," Don Berry shares the life and work of Jimmie Savage, his advisor and a legendary figure in Bayesian statistics. Hosted by Scott Berry, the discussion reveals the personal and professional experiences that shaped Savage's groundbreaking contributions. Discover the intricacies of Savage's influence on statistical thought and his profound legacy, from his tragic childhood to a profound effect on Bayesian statistics and scientific thought.

Key Highlights:

• Don Berry shares the personal story of Jimmie Savage's troubled childhood and how it influenced his work and personality.
• Insights into Savage's pioneering role as the father of modern Bayesian statistics.
• Discussion on Savage's varied interests and collaborations with figures like Milton Friedman and John von Neumann.
• Don Berry recounts his academic experiences alongside Savage and his own journey into clinical trial design.
• Exploration of Savage's legacy through his students and his axiomatic approach to subjective probability.

Quotes:

• "I think he's the father of modern Bayesian statistics. How can you argue about that?" – Don Berry
• "The world around you when you're with Savage is tingling with intellect." – Don Berry
• "We probably wouldn't exist... if it were not for him." – Don Berry

In this compelling episode of "In the Interim," Dr. Mike Krams, a seasoned expert in clinical trials and drug development, joins us to discuss the art and slog of innovation in pharmaceutical companies. With over 30 years in the field, Dr. Krams shares insights on leveraging Bayesian statistics and innovative designs to transform development approaches. The conversation explores disruptive approaches to drug development, the importance of having champions for change, and the future of innovation in clinical trials. Mike highlights the necessity of integrating strategic decision-making with statistical expertise to enhance the efficiency and effectiveness of clinical trials.

Key Highlights:

• Discussion on the ASTIN Stroke Trial, a groundbreaking experience with Bayesian methodology in drug trials.
• Examination of how adaptive designs can lead to more efficient learning processes in clinical research.
• Exploration of the cultural and strategic challenges of bringing innovative trial designs to conservative pharmaceutical environments.
• Insight into the vital role of having internal champions to advocate for change and innovation.
• The importance of integrating strategic thinking with statistical expertise to drive innovation forward.

Quotes:

• "Respect is earned, but very good communication skills are a necessary condition for implementing innovation." – Mike Krams
• "Innovation for innovation's sake is not the goal; it's about making better decisions for future patients." – Mike Krams

In this episode of "In the Interim," Dr. Scott Berry discusses the vital topic of ordinal outcomes in clinical trials—a subject as controversial as politics and religion at the dinner table. Using historical examples like James Lind's 1747 scurvy trial and Austin Bradford Hill’s pioneering randomized trial, the episode explores the complexities and ongoing debates about analyzing ordinal endpoints. Berry challenges conventional analysis methods and advocates for more refined, explicit approaches, delivering valuable insights for statisticians, clinicians, and anyone involved in clinical trial designs.

Key Highlights

• Examination of the historical context of ordinal outcomes, starting with James Lind's 1747 scurvy trial.
• Discussion of the first randomized human clinical trial by Austin Bradford Hill and its implications for ordinal endpoint analysis.
• Exploration of the Modified Rankin Score as a current example of ordinal outcomes in stroke trials.
• Critique of conventional methods like dichotomization and proportional odds models for analyzing ordinal data.
• Argument for adopting utility-based approaches in clinical trial analysis for meaningful outcomes.

Quotes

• "Almost every endpoint is ordinal. So you can't escape this." – Dr. Scott Berry
• "My claim is nobody has that weight. But yet, it's very commonly done." – Dr. Scott Berry
• "Hiding behind ad hoc ways to do this, I think just leads us to bad places." – Dr. Scott Berry