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Response-adaptive designs have been extensively studied and used in clinical trials. However, there is a lack of a comprehensive study of response-adaptive designs that include covariates, despite their importance in clinical experiments. Because the allocation scheme and the estimation of parameters are affected by both the responses and the covariates, covariate-adjusted response-adaptive (CARA) designs are very complex to formulate. In this paper, we overcome the technical hurdles and lay out a framework for general CARA designs for the allocation of subjects to K(≥ 2) treatments. The asymptotic properties are studied under certain widely satisfied conditions. The proposed CARA designs can be applied to generalized linear models. Two important special cases, the linear model and the logistic regression model, are considered in detail.

A general doubly adaptive biased coin design is proposed for the allocation of subjects to K treatments in a clinical trial. This design follows the same spirit as Efron's biased coin design and applies to the cases where the desired allocation proportions are unknown, but estimated sequentially. Strong consistency, a law of the iterated logarithm and asymptotic normality of this design are obtained under some widely satisfied conditions. For two treatments, a new family of designs is proposed and shown to be less variable than both the randomized play-the-winner rule and the adaptive randomized design. Also the proposed design tends toward a randomization scheme (with a fixed target proportion) as the size of the experiment increases.

Balancing treatment allocation for influential covariates is critical in clinical trials. This has become increasingly important as more and more biomarkers are found to be associated with different diseases in translational research (genomics, proteomics and metabolomics). Stratified permuted block randomization and minimization methods [Pocock and Simon Biometrics 31 (1975) 103-115, etc.] are the two most popular approaches in practice. However, stratified permuted block randomization fails to achieve good overall balance when the number of strata is large, whereas traditional minimization methods also suffer from the potential drawback of large within-stratum imbalances. Moreover, the theoretical bases of minimization methods remain largely elusive. In this paper, we propose a new covariate-adaptive design that is able to control various types of imbalances. We show that the joint process of within-stratum imbalances is a positive recurrent Markov chain under certain conditions. Therefore, this new procedure yields more balanced allocation. The advantages of the proposed procedure are also demonstrated by extensive simulation studies. Our work provides a theoretical tool for future research in this area.Comment: Published in at http://dx.doi.org/10.1214/12-AOS983 the Annals of Statistics (http://www.imstat.org/aos/) by the Institute of Mathematical Statistics (http://www.imstat.org

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