An Empirical Comparison of Statistical Methods for Missing Data in Randomized, Double-Blind, Placebo-Controlled, Phase 3 Clinical Trials for Chronic Pain and Lipid-Lowering Products.

Background: Missing data are uncollected data but meaningful for the statistical analysis due to clinical relevancy of the data for properly specified estimands in clinical trials. Meanwhile the efforts to prevent or minimize missing data are commonly applied in clinical trials, in practice, missing data still occurs. Choosing a statistical method for imputation that deals with missing data targeting specified estimands provides the more reliable estimates of treatment effects.

Methods: We considered longitudinal clinical settings that have different degrees of missing data and treatment effects, and simulated different missing mechanisms using data from randomized, double-blind, placebo-controlled phase 3 confirmatory clinical trials of approved drugs. We compared four commonly used statistical methods to deal with missing data in clinical trials.

Results: We find that, when the data are missing not at random (MNAR) with higher missing rates, mixed model for repeated measurements (MMRM) method overestimates treatment difference. Pattern-mixture model estimates were seen to be more conservative in our studies than MMRM given MNAR assumptions, which are more realistic with missing data in clinical trials.

Conclusions: We emphasize the importance of prevention of missing data and specifying the estimand based on trial objectives beforehand. The specified proper estimand and the proper statistical method might be key features to value the clinical trial results despite missing data.