The Use of Adaptive Blocks in the Design of Clinical Trials

This paper introduces a class of data-dependent allocation rules for use in sequential clinical trials designed to choose the better of two competing treatments, or to decide that they are of equal efficacy. These readily understood and easily implemented rules are shown to reduce, substantially the number of tests with the poorer treatment for a broad category of experimental situations. Allocation rules of this type are applied both to trials with an instantaneous binomial response and to delayed response trials where interest centers on exponentially distributed survival time. In each case, a comparison of this design with alternative designs given in the literature shows that the proposed design is superior with respect to ease of application and is comparable to the alternatives regarding inferior treatment number and average sample number. In addition, the proposed rules mitigate many of the difficulties generally associated with adaptive assignment rules, such as selection and systematic bias.