Estimating the optimal dynamic antipsychotic treatment regime: evidence from the sequential multiple-assignment randomized Clinical Antipsychotic Trials of Intervention and Effectiveness schizophrenia study

  1. Susan M. Shortreed1,
  2. Erica E. M. Moodie2

Article first published online: 31 MAY 2012

DOI: 10.1111/j.1467-9876.2012.01041.x

Issue

Journal of the Royal Statistical Society: Series C (Applied Statistics)

Journal of the Royal Statistical Society: Series C (Applied Statistics)

Volume 61, Issue 4, pages 577–599, August 2012

Additional Information

How to Cite

Shortreed, S. M. and Moodie, E. E. M. (2012), Estimating the optimal dynamic antipsychotic treatment regime: evidence from the sequential multiple-assignment randomized Clinical Antipsychotic Trials of Intervention and Effectiveness schizophrenia study. Journal of the Royal Statistical Society: Series C (Applied Statistics), 61: 577–599. doi: 10.1111/j.1467-9876.2012.01041.x

Author Information

  1. 1

    McGill University, Montreal, Canada, and Group Health Research Institute, Seattle, USA

  2. 2

    McGill University, Montreal, Canada

*Address for correspondence: Susan M. Shortreed, Biostatistics Unit, School of Computer Science, Group Health Research Institute, Suite 1600, 1730 Minor Avenue, Seattle, WA 98101, USA. E-mail: shortreed.s@ghc.org

Publication History

  1. Issue published online: 23 JUL 2012
  2. Article first published online: 31 MAY 2012
  3. [Received September 2010. Final revision December 2011]

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Keywords:

  • Adaptive treatment strategies;
  • Causal effects;
  • Dynamic treatment regimes;
  • Inverse probability weighting;
  • Marginal structural models;
  • Personalized medicine;
  • Schizophrenia

Summary.  Treatment of schizophrenia is notoriously difficult and typically requires personalized adaption of treatment because of lack of efficacy of treatment, poor adherence or intolerable side effects. The Clinical Antipsychotic Trials in Intervention Effectiveness schizophrenia study is a sequential multiple-assignment randomized trial comparing the typical antipsychotic medication perphenazine with several newer atypical antipsychotics. The paper describes the marginal structural modelling method for estimating optimal dynamic treatment regimes and applies the approach to this schizophrenia study. Missing data and valid estimation of confidence intervals are also addressed.

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