Estimating the optimal dynamic antipsychotic treatment regime: Evidence from the sequential multiple-assignment randomized Clinical Antipsychotic Trials of Intervention and Effectiveness schizophrenia study

Abstract

Treatment of schizophrenia is notoriously difficult and typically requires personalized adaption of treatment because of lack of efficacy of treatment, poor adherence or intolerable side effects. The Clinical Antipsychotic Trials in Intervention Effectiveness schizophrenia study is a sequential multiple-assignment randomized trial comparing the typical antipsychotic medication perphenazine with several newer atypical antipsychotics. The paper describes the marginal structural modelling method for estimating optimal dynamic treatment regimes and applies the approach to this schizophrenia study. Missing data and valid estimation of confidence intervals are also addressed. © 2012 Royal Statistical Society.