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ACCOUNTING FOR DROPOUT BIAS USING MIXED-EFFECTS MODELS
Abstract
Treatment effects are often evaluated by comparing change over time in outcome measures. However, valid analyses of longitudinal data can be problematic when subjects discontinue (dropout) prior to completing the study. This study assessed the merits of likelihood-based repeated measures analyses (MMRM) compared with fixed-effects analysis of variance where missing values were imputed using the last observation carried forward approach (LOCF) in accounting for dropout bias. Comparisons were made in simulated data and in data from a randomized clinical trial. Subject dropout was introduced in the simulated data to generate ignorable and nonignorable missingness. Estimates of treatment group differences in mean change from baseline to endpoint from MMRM were, on average, markedly closer to the true value than estimates from LOCF in every scenario simulated. Standard errors and confidence intervals from MMRM accurately reflected the uncertainty of the estimates, whereas standard errors and confidence intervals from LOCF underestimated uncertainty.
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“Missing data were managed using LMM, which is based on all observed data and accounts for data missing at random [108-110].”
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“We applied the proposed method based on the model-based and the robust variance estimators with the empirical adjustments, the method proposed by Maruo et al. [6] for the CCA and the LOCF data, and the MMRM methods on the original and log-transformed scale, where the inferences for differences of the treatment effects…”
MethodInfluentialZhang, Y., Golm, G. T., & Liu, G. F. (2020) · Statistics in Biosciences · doi:10.1007/s12561-020-09269-0 · Cited by 13
Abbass, A. A., Bernier, D. C., Kisely, S. R., Town, J. M., & Johansson, R. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.05.056 · Cited by 14
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Frasch, K., Bullacher, C., Jäger, M., Kilian, R., Rink, M., Wittek, R., Becker, T., & Neumann, N.-U. (2009) · Psychopathology · doi:10.1159/000187635 · Cited by 14
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“34 All users in the program were analyzed despite any missingness related to completion status; weight outcomes were predicted from the linear mixed models conducted.”
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“The mixed models repeated measures (MMRM) method of ( 2001 ), ( 2001 ) is particularly attractive because it can be used as a primary analysis; the MMRM approach does not require imputation of missing values.”
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“[13,14] These models take into account all observations taken during the time course of the trial.”
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“LMER using full information maximum likelihood estimators (FIML) allows the inclusion of the total sample by taking into account missing observations under the missing at random (MAR) assumption [40].”
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“A mixed-effect model for repeated measures (MMRM) [21] was used for statistical analysis: MBR was the response variable and age, gender, the drug group (ranibizumab biosimilar or brolucizumab), time, and the drug group by time interaction were treated as fixed effects.”
bcmixed: A Package for Median Inference on Longitudinal Data with the Box–Cox Transformation
Maruo, K., Ishii, R., Yamaguchi, Y., & Gosho, M. (2021) · The R Journal · doi:10.32614/rj-2021-083 · Cited by 6
“Therefore, Maruo et al. (2017) applied the following empirical small sample adjustment for the inferences of the model median differences by referring to the study in Schluchter and Elashoff (1990).”
MethodInfluentialAjnakina, O., Murray, R. M., Steptoe, A., & Cadar, D. (2022) · Psychological Medicine · doi:10.1017/s0033291721004827 · Cited by 6
Points to consider for analyzing efficacy outcomes in long‐term extension clinical trials
Ratitch, B., Lipkovich, I. A., Erickson, J., Zhang, L., & Mallinckrodt, C. H. (2018) · Pharmaceutical Statistics · doi:10.1002/pst.1888 · Cited by 6
Self-citationMaruo, K., Ishii, R., Yamaguchi, Y., Doi, M., & Gosho, M. (2020) · Statistics in Medicine · doi:10.1002/sim.8474 · Cited by 6
“From formula (1), it is derived that yi marginally follows MVNni (Xiβ,Vi), where Vi = WiDW T i + Σi.”
BackgroundMethodInfluentialNguyen, V., Puzo, M., Sánchez‐Monroy, J., Gabrielle, P., Creuzot-Garcher, C. P., Baudin, F., Wolff, B., Castelnovo, L., Michel, G., O’Toole, L., et al. (2020) · Retina · doi:10.1097/iae.0000000000003061 · Cited by 6
Quinn, C. A., Walter, Z. C., de Andrade, D., Dingle, G. A., Haslam, C., & Hides, L. M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192113835 · Cited by 9
Wada, T., Tanishima, S., Kitsuda, Y., Osaki, M., Nagashima, H., Noma, H., & Hagino, H. (2022) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-022-06086-y · Cited by 6
Nakagami, Y., Uwatoko, T., Shimamoto, T., Sakata, M., Toyomoto, R., Yoshida, K., Luo, Y., Shiraishi, N., Tajika, A., Sahker, E., et al. (2024) · JMIR Mental Health · doi:10.2196/56691 · Cited by 5
“In addition, changes in PHQ-9, GAD-7, and CBT Skills Scale were repeatedly measured up to 52 weeks and analyzed with mixed models for repeated measures [23].”
Toshishige, Y., Chatani, N., Kawasaki, S., Goto, S., Yoshida, Y., Takahashi, Y., Shimasaki, M., Okami, T., Sakaguchi, G., Furukawa, T. A., et al. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100838 · Cited by 5
“A mixed-effects repeated-measures (MMRM) analysis will be applied (Mallinckrodt et al., 2001), with the change in PHQ-9 scores from baseline as the response variable.”
Cristini, J., Potvin‐Desrochers, A., Seo, F., Dagher, A., Postuma, R. B., Rosa‐Neto, P., Carrier, J., Amara, A. W., Steib, S., Paquette, C., et al. (2023) · Physical Therapy · doi:10.1093/ptj/pzad073 · Cited by 5
Comparison of Precision and Accuracy of Five Methods to Analyse Total Score Data
Wellhagen, G. J., Karlsson, M. O., & Kjellsson, M. C. (2020) · The AAPS Journal · doi:10.1208/s12248-020-00546-w · Cited by 5
Holtz, L. R., Kroenke, K., Gao, S., Hickman, S. E., Torke, A. M., Johnson, N. M., Pemberton, A., Vrobel, A., Pan, M., & Sachs, G. A. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107217 · Cited by 5
Evaluation of Overall Treatment Effect in MMRM
Song, T., Dong, Q., Sankoh, A. J., & Molenberghs, G. (2013) · Journal of Biopharmaceutical Statistics · doi:10.1080/10543406.2013.834918 · Cited by 5
“Under various scenarios of MNAR, simulation studies have shown that MMRM outperforms many of the traditional methods, including last observation carried forward (LOCF), in terms of bias reduction and control of the type I error rate (Mallinckrodt et al., 2001; Siddiqui et al., 2009).”
MethodDose-Response Mixed Models for Repeated Measures – a New Method for Assessment of Dose-Response
Wellhagen, G. J., Hamrén, B., Kjellsson, M. C., & Åstrand, M. (2020) · Pharmaceutical Research · doi:10.1007/s11095-020-02882-0 · Cited by 5
Urao, Y., Yoshida, M., Sato, Y., & Shimizu, E. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04326-y · Cited by 12
Pangallo, B. A., Zhang, Q., Desaiah, D., David, P., Detke, M. J., & Kennedy, S. H. (2010) · Current Medical Research and Opinion · doi:10.1185/03007995.2010.522157 · Cited by 5
Keene, O. N., Davis, R. L., & Koch, G. G. (2004) · Pharmaceutical Statistics · doi:10.1002/pst.141 · Cited by 5
Calkins, A., Gudin, J., Gidal, B. E., Jaros, M. J., Kim, R., & Shang, G. Y. (2016) · Pain Medicine · doi:10.1093/pm/pnv072 · Cited by 5
du Dot, T. J. (2008) · Open Collections · doi:10.14288/1.0066271 · Cited by 5
Sato, H., Hanazawa, R., Suzuki, K., Hashizume, A., & Hirakawa, A. (2025) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2025.3546020 · Cited by 4
Timm, E., Ko, Y. M., Hundhammer, T., Berlowitz, I., & Wolf, U. (2024) · Frontiers in Integrative Neuroscience · doi:10.3389/fnint.2024.1472562 · Cited by 4
“…(Bell et al., 2013), which is generally difficult to rule out, but for which mixed-effect models are considered a method of choice, given their capacity to minimize dropout bias in longitudinal research with both random or non-random missingness (Mallinckrodt et al., 2001; Bell et al., 2013).”
MethodOptimal Powder Deposition Process to Develop a New Direct-Write Additive Manufacturing System
Chung, H., Lee, N., Ko, J., Lee, T., Lee, P.-H., & Choi, J. Y. (2019) · International Journal of Precision Engineering and Manufacturing · doi:10.1007/s12541-019-00129-6 · Cited by 4
Gosho, M., & Maruo, K. (2020) · Pharmaceutical Statistics · doi:10.1002/pst.2058 · Cited by 4
“All parameters in (2) can also be estimated using the REML method in the same manner as MMRM analysis.”
BackgroundMethodInfluentialSawano, F., Kamei, N., Miyahara, M., Kobuke, K., Nakanishi, S., Nagano, C., Nojima, H., Maeda, S., Watanabe, H., Kishimoto, R., et al. (2021) · Diabetology International · doi:10.1007/s13340-021-00492-8 · Cited by 4
“The mixed effect models for repeated measures [6] was used to compare changes over time within each group (baseline vs 12 w, 24 w, 36 w, 52 w), and multiplicity was adjusted with the Dunnett method [7].”
MethodOwada, Y., Murata, Y., Hamaguchi, Y., Yamada, K., Inomata, S., Ogawa, K., Ohara, Y., Akashi, Y., Enomoto, T., Maruo, K., et al. (2023) · Asian Journal of Endoscopic Surgery · doi:10.1111/ases.13180 · Cited by 4
“NRS scores at rest and on coughing were analyzed with the mixed effect models for repeated measures (MMRM) method.(13) Then, noninferiority would be declared if the 95% upper confidence limit of least square mean differences between groups (RSB-TEA) for the NRS score on coughing at 24 hours would be lower than one.”
MethodChandler, J., Georgieva, M. V., Desai, U. S., Done, N., Gómez-Liévano, A., Ye, W., Zhao, A., Eid, D., Hilts, A., Kirson, N. Y., et al. (2024) · The Journal of Prevention of Alzheimer s Disease · doi:10.14283/jpad.2024.28 · Cited by 4
“While no statistical technique can fully protect against attrition, longitudinal analysis using mixed-effects modeling has been shown to be robust to the presence of nonignorable data missingness in both observational studies and clinical trials (23, 24).”
THE EFFECTS OF MISSING DATA TREATMENT ON PERSON ABILITY ESTIMATES USING IRT MODELS
Enciso, S., & Mariel, S. (2016) · Cited by 4
Metadata
- Authors
- Mallinckrodt, C. H., Clark, W. S., & David, S. R.
- Affiliations
- Eli Lilly (United States) (US)
- Venue
- Journal of Biopharmaceutical Statistics
- Publisher
- Informa UK Limited
- Published
- 2001-01-01
- Volume
- 11
- Issue
- 1-2
- Pages
- 9-21
- ISSN
- 1054-3406 (ISSN-L)
- 1520-5711
- OpenAlex
- W2073155558
- Cited by
- 398
- References
- 14
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 21 · 2023: 12 · 2022: 27 · 2021: 19 · 2020: 20 · 2019: 13 · 2018: 14 · 2017: 14 · 2016: 18 · 2015: 21 · 2014: 16 · 2013: 23 · 2012: 19
- FWCI
- 11.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Biopharmaceutical Statistics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods and Bayesian Inference
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Keywords
- mixed models, last observation carried forward, missing data, non-ignorable missingness, treatment effect estimation, longitudinal data, randomized controlled trials, standard error estimation
- MeSH terms
- Analysis of Variance, Humans, Longitudinal Studies, Patient Dropouts, Models, Statistical, Bias, Confidence Intervals, Randomized Controlled Trials as Topic
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