A tutorial on pilot studies: the what, why and how

Lehana Thabane, Jinhui Ma, Rong Chu, Ji Cheng, Afisi Ismaila, Lorena P Rios, Reid Robson, Marroon Thabane, Lora Giangregorio, Charles H Goldsmith, Lehana Thabane, Jinhui Ma, Rong Chu, Ji Cheng, Afisi Ismaila, Lorena P Rios, Reid Robson, Marroon Thabane, Lora Giangregorio, Charles H Goldsmith

Abstract

Pilot studies for phase III trials - which are comparative randomized trials designed to provide preliminary evidence on the clinical efficacy of a drug or intervention - are routinely performed in many clinical areas. Also commonly know as "feasibility" or "vanguard" studies, they are designed to assess the safety of treatment or interventions; to assess recruitment potential; to assess the feasibility of international collaboration or coordination for multicentre trials; to increase clinical experience with the study medication or intervention for the phase III trials. They are the best way to assess feasibility of a large, expensive full-scale study, and in fact are an almost essential pre-requisite. Conducting a pilot prior to the main study can enhance the likelihood of success of the main study and potentially help to avoid doomed main studies. The objective of this paper is to provide a detailed examination of the key aspects of pilot studies for phase III trials including: 1) the general reasons for conducting a pilot study; 2) the relationships between pilot studies, proof-of-concept studies, and adaptive designs; 3) the challenges of and misconceptions about pilot studies; 4) the criteria for evaluating the success of a pilot study; 5) frequently asked questions about pilot studies; 7) some ethical aspects related to pilot studies; and 8) some suggestions on how to report the results of pilot investigations using the CONSORT format.

References

    1. Waite M. Concise Oxford Thesaurus. 2. Oxford, England: Oxford University Press; 2002.
    1. Last JM, editor. A Dictionary of Epidemiology. 4. Oxford University Press; 2001.
    1. Everitt B. Medical Statistics from A to Z: A Guide for Clinicians and Medical Students. 2. Cambridge University Press: Cambridge; 2006.
    1. Tavel JA, Fosdick L. ESPRIT Vanguard Group. ESPRIT Executive Committee. Closeout of four phase II Vanguard trials and patient rollover into a large international phase III HIV clinical endpoint trial. Control Clin Trials. 2001;22:42–48. doi: 10.1016/S0197-2456(00)00114-8.
    1. Arnold DM, Burns KE, Adhikari NK, Kho ME, Meade MO, Cook DJ. The design and interpretation of pilot trials in clinical research in critical care. Crit Care Med. 2009;37(Suppl 1):69–74. doi: 10.1097/CCM.0b013e3181920e33.
    1. Computerization of Medical Practice for the Enhancement of Therapeutic Effectiveness. Last accessed August 8, 2009.
    1. Heart Outcomes Prevention Evaluation Study. Last accessed August 8, 2009.
    1. Cardiovascular Health Awareness Program. Last accessed August 8, 2009.
    1. Moher D, Schulz KF, Altman DG. CONSORT Group (Consolidated Standards of Reporting Trials) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. J Am Podiatr Med Assoc. 2001;91:437–442.
    1. Lancaster GA, Dodd S, Williamson PR. Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract. 2004;10:307–12. doi: 10.1111/j..2002.384.doc.x.
    1. Craig N, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. doi: 10.1136/bmj.a1655.
    1. Van Teijlingen ER, Rennie AM, Hundley V, Graham W. The importance of conducting and reporting pilot studies: the example of the Scottish Births Survey. J Adv Nurs. 2001;34:289–295. doi: 10.1046/j.1365-2648.2001.01757.x.
    1. Van Teijlingen ER, Hundley V. The Importance of Pilot Studies. Social Research Update. 2001. p. 35.
    1. Lawrence Gould A. Timing of futility analyses for 'proof of concept' trials. Stat Med. 2005;24:1815–1835. doi: 10.1002/sim.2087.
    1. Fardon T, Haggart K, Lee DK, Lipworth BJ. A proof of concept study to evaluate stepping down the dose of fluticasone in combination with salmeterol and tiotropium in severe persistent asthma. Respir Med. 2007;101:1218–1228. doi: 10.1016/j.rmed.2006.11.001.
    1. Chow SC, Chang M. Adaptive design methods in clinical trials - a review. Orphanet J Rare Dis. 2008;3:11. doi: 10.1186/1750-1172-3-11.
    1. Gould AL. Planning and revising the sample size for a trial. Stat Med. 1995;14:1039–1051. doi: 10.1002/sim.4780140922.
    1. Coffey CS, Muller KE. Properties of internal pilots with the univariate approach to repeated measures. Stat Med. 2003;22:2469–2485. doi: 10.1002/sim.1466.
    1. Zucker DM, Wittes JT, Schabenberger O, Brittain E. Internal pilot studies II: comparison of various procedures. Statistics in Medicine. 1999;18:3493–3509. doi: 10.1002/(SICI)1097-0258(19991230)18:24<3493::AID-SIM302>;2-2.
    1. Kieser M, Friede T. Re-calculating the sample size in internal pilot designs with control of the type I error rate. Statistics in Medicine. 2000;19:901–911. doi: 10.1002/(SICI)1097-0258(20000415)19:7<901::AID-SIM405>;2-L.
    1. Kraemer HC, Mintz J, Noda A, Tinklenberg J, Yesavage JA. Caution regarding the use of pilot studies to guide power calculations for study proposals. Arch Gen Psychiatry. 2006;63:484–489. doi: 10.1001/archpsyc.63.5.484.
    1. Yin Y. Sample size calculation for a proof of concept study. J Biopharm Stat. 2002;12:267–276. doi: 10.1081/BIP-120015748.
    1. Wittes J, Brittain E. The role of internal pilot studies in increasing the efficiency of clinical trials. Stat Med. 1990;9:65–71. doi: 10.1002/sim.4780090113.
    1. Lenth R. Some Practical Guidelines for Effective Sample Size Determination. The American Statistician. 2001;55:187–193. doi: 10.1198/000313001317098149.
    1. Cook DJ, Rocker G, Meade M, Guyatt G, Geerts W, Anderson D, Skrobik Y, Hebert P, Albert M, Cooper J, Bates S, Caco C, Finfer S, Fowler R, Freitag A, Granton J, Jones G, Langevin S, Mehta S, Pagliarello G, Poirier G, Rabbat C, Schiff D, Griffith L, Crowther M. PROTECT Investigators. Canadian Critical Care Trials Group. Prophylaxis of Thromboembolism in Critical Care (PROTECT) Trial: a pilot study. J Crit Care. 2005;20:364–372. doi: 10.1016/j.jcrc.2005.09.010.
    1. Choi PT, Beattie WS, Bryson GL, Paul JE, Yang H. Effects of neuraxial blockade may be difficult to study using large randomized controlled trials: the PeriOperative Epidural Trial (POET) Pilot Study. PLoS One. 2009;4(2):e4644. doi: 10.1371/journal.pone.0004644.
    1. Altman DG, Bland JM. Absence of evidence is not evidence of absence. BMJ. 1995;311:485.
    1. Halpern SD, Karlawish JH, Berlin JA. The continuing unethical conduct of underpowered clinical trials. JAMA. 2002;288:358–362. doi: 10.1001/jama.288.3.358.
    1. The Nuremberg Code, Research ethics guideline 2005. Last accessed August 8, 2009.
    1. The Declaration of Helsinki, Research ethics guideline. Last accessed December 22, 2009.
    1. The Belmont Report, Research ethics guideline. Last accessed August 8, 2009.
    1. The ICH Harmonized Tripartite Guideline-Guideline for Good Clinical Practice. Last accessed August 8, 2009.
    1. The International Ethical Guidelines for Biomedical Research Involving Human Subjects. Last accessed August 8, 2009.
    1. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, Government of Canada. Last accessed August 8, 2009.

Source: PubMed

3
Abonneren