Modification and extension of the Bayesian clinical trial design using external data for single-arm and hybrid-controlled trials

Abstract

Limited patient availability complicates sample size determination in pediatric clinical trials. Although Bayesian methods incorporating external data offer a solution, rigorously controlling the type I error rate remains difficult. Psioda and Ibrahim (2019) proposed a simulation-based framework as a practical solution. However, although their framework was designed to relax the type I error control, this relaxation fails when the external data exhibit a large treatment effect, making it difficult to design clinical trials that incorporate external data. Furthermore, restricting the support of sampling priors can cause trial outcomes to fall outside of this support, leading to lower power. Additionally, their analytic prior formulation may induce bias, and their method is not applicable to hybrid-controlled trials involving two-group comparisons. Thus, we propose modifications to both the sampling and analytic prior specifications and extend the framework to hybrid-controlled trials. We redefine the null sampling prior as a normal distribution centered at the null boundary, ensuring a Bayesian type I error evaluation. For the analytic prior, we employ a weakly informative prior for the second component of a robust mixture prior to mitigate bias under prior-data conflict. Furthermore, we extend this methodology to hybrid-controlled trials. Simulation studies and a pediatric case study of cutaneous lupus erythematosus demonstrate that our method substantially reduces the required sample size compared with both frequentist and original Bayesian methods, while maintaining the target operating characteristics and controlling estimation bias under prior-data conflict. This framework provides a reliable and efficient approach for designing clinical trials that incorporate external information.