Background Randomization is the foundation of any clinical trial involving treatment comparison. It helps mitigate selection bias, promotes similarity of treatment groups with respect to important known and unknown confounders, and contributes to the validity of statistical tests. Various restricted randomization procedures with different probabilistic structures and different statistical properties are available. The goal of this paper is to present a systematic roadmap for the choice and application of a restricted randomization procedure in a clinical trial. Methods We survey available restricted randomization procedures for sequential allocation of subjects in a randomized, comparative, parallel group clinical trial with equal (1:1) allocation. We explore statistical properties of these procedures, including balance/randomness tradeoff, type I error rate and power. We perform head-to-head comparisons of different procedures through simulation under various experimental scenarios, including cases when common model assumptions are violated. We also provide some real-life clinical trial examples to illustrate the thinking process for selecting a randomization procedure for implementation in practice. Results Restricted randomization procedures targeting 1:1 allocation vary in the degree of balance/randomness they induce, and more importantly, they vary in terms of validity and efficiency of statistical inference when common model assumptions are violated (e.g. when outcomes are affected by a linear time trend; measurement error distribution is misspecified; or selection bias is introduced in the experiment). Some procedures are more robust than others. Covariate-adjusted analysis may be essential to ensure validity of the results. Special considerations are required when selecting a randomization procedure for a clinical trial with very small sample size. Conclusions The choice of randomization design, data analytic technique (parametric or nonparametric), and analysis strategy (randomization-based or population model-based) are all very important considerations. Randomization-based tests are robust and valid alternatives to likelihood-based tests and should be considered more frequently by clinical investigators.

Randomization designs for multiarm clinical trials are increasingly used in practice, especially in phase II dose-ranging studies. Many new methods have been proposed in the literature; however, there is lack of systematic, head-to-head comparison of the competing designs. In this paper, we systematically investigate statistical properties of various restricted randomization procedures for multiarm trials with fixed and possibly unequal allocation ratios. The design operating characteristics include measures of allocation balance, randomness of treatment assignments, variations in the allocation ratio, and statistical characteristics such as type I error rate and power. The results from the current paper should help clinical investigators select an appropriate randomization procedure for their clinical trial. We also provide a web-based R shiny application that can be used to reproduce all results in this paper and run simulations under additional user-defined experimental scenarios.

We consider a design problem for a clinical trial with multiple treatment arms and time-to-event primary outcomes that are modeled using the Weibull family of distributions. The D-optimal design for the most precise estimation of model parameters is derived, along with compound optimal allocation designs that provide targeted efficiencies for various estimation problems and ethical considerations. The proposed optimal allocation designs are studied theoretically and are implemented using response-adaptive randomization for a clinical trial with censored Weibull outcomes. We compare the merits of our multiple-objective response-adaptive designs with traditional randomization designs and show that our designs are more flexible, realistic, generally more ethical, and frequently provide higher efficiencies for estimating different sets of parameters.

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Adaptive clinical trials are becoming increasingly popular research designs for clinical investigation. Adaptive designs are particularly useful in phase I cancer studies where clinical data are scant and the goals are to assess the drug dose-toxicity profile and to determine the maximum tolerated dose while minimizing the number of study patients treated at suboptimal dose levels.In the current work we give an overview of adaptive design methods for phase I cancer trials. We find that modern statistical literature is replete with novel adaptive designs that have clearly defined objectives and established statistical properties, and are shown to outperform conventional dose finding methods such as the 3+3 design, both in terms of statistical efficiency and in terms of minimizing the number of patients treated at highly toxic or nonefficacious doses. We discuss statistical, logistical, and regulatory aspects of these designs and present some links to non-commercial statistical software for implementing these methods in practice.