Design Considerations for a Phase II platform trial in Major Depressive Disorder

TL;DR

This paper explores the design of a platform trial for Major Depressive Disorder, emphasizing efficiency improvements through shared controls, interim analyses, and strategic randomisation to evaluate multiple treatments rapidly.

Contribution

It provides detailed design considerations and simulation results for implementing a platform trial in MDD, highlighting methods to optimize treatment evaluation and trial efficiency.

Findings

Interim futility analyses help eliminate ineffective treatments.

Different randomisation strategies impact trial operating characteristics.

Platform trials offer advantages over traditional RCTs in MDD treatment evaluation.

Abstract

Major Depressive Disorder (MDD) is one of the most common causes of disability worldwide. Unfortunately, about one-third of patients do not benefit sufficiently from available treatments and not many new drugs have been developed in this area in recent years. We thus need better and faster ways to evaluate many different treatment options quickly. Platform trials are a possible remedy - they facilitate the evaluation of more investigational treatments in a shorter period of time by sharing controls, as well as reducing clinical trial activation and recruitment times. We discuss design considerations for a platform trial in MDD, taking into account the unique disease characteristics, and present the results of extensive simulations to investigate the operating characteristics under various realistic scenarios. To allow the testing of more treatments, interim futility analyses should be performed to eliminate treatments that have either no or negligible treatment effect. Furthermore, we investigate different randomisation and allocation strategies as well as the impact of the per-treatment arm sample size. We compare the operating characteristics of such platform trials to those of traditional randomised controlled trials and highlight the potential advantages of platform trials.