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." – Scott Berry
• "My claim is nobody has that weight. But yet, it's very commonly done." – Scott Berry
• "Hiding behind ad hoc ways to do this, I think just leads us to bad places." – Scott Berry

In this episode of the podcast, we sit down with Dr. Merit Cudkowicz and Dr. Melanie Quintana to discuss the inception and execution of the Healy ALS Platform Trial, a revolutionary approach designed for efficiency and impactful data collection. With insights from both medical and statistical perspectives, this episode offers a comprehensive understanding of the trial's structure and outcomes, shedding light on its potential to reshape neuro-therapeutics research.

Key Highlights

• Dr. Merit Cudkowicz discusses the motivation behind adopting master platform trials for ALS and the collaboration that brought it to life.
• Dr. Melanie Quintana explains the statistical design of the trial, emphasizing the sharing of control groups and Bayesian methods for efficiency.
• Insights into the FDA's enthusiastic support and the iterative process to align on innovative statistical approaches.
• The dual roles of the trial: significant patient engagement and industry collaboration as facilitating factors for successful trial implementation.
• Discussion on the future adaptation of trial designs based on collected data and emerging biomarkers.

Quotes

• "There was such an energy about your group... everybody had really done their homework." – Dr. Melanie Quintana
• "ALS is a very complex disorder, and we actually did learn a lot." – Dr. Merit Cudkowicz
• "We're adapting with learnings." – Dr. Merit Cudkowicz