# Models

A progression model for repeated measures (PMRM) is a longitudinal continuous-time nonlinear model of a progressive disease. The `pmrm` package implements PMRMs from Raket (2022). This vignette defines the models in the package.

# 1 Common elements

This section defines the notation and assumptions common to all models in the package.

## 1.1 Data

Let the scalar \(y_{ij}\) be the continuous measure of disease severity of patient \(i\) (\(i = 1, \ldots, I\)) at clinical visit \(j\) (\(j = 1, \ldots, J\)). For a progressive disease, we generally expect \(y_{ij}\) to worsen from visit to visit. The goal of treatment is usually to minimize this worsening over time.

Some \(y_{ij}\) values may be missing due to dropout or other intercurrent events. We assume these outcomes are missing at random (MAR). Except for the outcomes \(y_{ij}\), all values in the data must be non-missing.

\(t_{ij}\) is continuous time since the baseline visit of \(j = 1\). At baseline, we assume treatment has not been administered yet, so all study arms should have the same expected outcome if randomization is conducted properly.1

The model may include optional covariates such as age and biomarker status.

## 1.2 Likelihood

Let \(y_i = (y_{i1}, \ldots, y_{iJ})\) be the vector of outcomes of patient \(i\). For each pair of different patients \(i\) and \(i^*\), we assume \(y_i\) is independent of \(y_{i^*}\) and \(\text{Var}(y_i) = \text{Var}(y_{i^*})\) . For each \(i\), define \(\mu_i = E(y_i) = (\mu_{i1}, \ldots, \mu_{iJ})\) and \(\Sigma = \text{Var}(y_i)\).

We assign a multivariate normal likelihood to each whole patient:

\[ \begin{aligned} y_i \sim \text{MVN}(\mu_i, \Sigma) \end{aligned} \]

To account for intercurrent events such as dropout, we integrate out missing outcomes. This gives us marginal likelihoods for patients whose outcomes are partially missing. To construct the marginal likelihood for patient \(i\), let \(Q_i\) be the \(q \times I\) matrix such that \(Q_i y_i\) is the chronologically ordered vector of all \(q\) non-missing values of \(y_i\). The marginal likelihood of the observed values \(Q_i y_i\) is just a multivariate normal on a subset of \(\mu_i\) and \(\Sigma\):

\[ \begin{aligned} Q_i y_i \sim \text{MVN}(Q_i \mu_i, Q_i \Sigma Q_i^T) \end{aligned} \]

The model is fit by maximizing the product of these independent marginal likelihoods over the parameters that define \(\mu_i\) (\(i = 1, \ldots, I\)) and \(\Sigma\). These parameters are \(\alpha\), \(\theta\), \(\gamma\), \(\phi\), and \(\rho\), and they are all defined in subsequent sections of this vignette.

## 1.3 Variance

Recall that \(\Sigma\) is defined as \(\text{Var}(y_i)\) (\(i = 1, \ldots, I\)). We parameterize \(\Sigma\) as follows:

\[ \begin{aligned} \Sigma &= D \Lambda D \end{aligned} \]

\(D\) is a \(J \times J\) diagonal matrix with diagonal \(\sigma = (\sigma_1, \ldots, \sigma_J)\) (the visit-specific standard deviation parameters). To constrain \(\sigma_j \ge 0\), we define a latent parameter vector \(\phi = (\phi_1, \ldots, \phi_J)\) such that \(\phi_j = \log(\sigma_j)\) for \(j = 1, \ldots, J\). The model estimates \(\phi\) with maximum likelihood.

\(\Lambda\) is the \(J \times J\) correlation matrix among visits within a patient. Define:

\[ \begin{aligned} \Lambda &= L L^T \end{aligned} \]

\(L\) is a lower triangular Cholesky factor of the correlation matrix \(\Lambda\), and it is expressed in terms of a vector \(\rho = (\rho_1, \ldots, \rho_{J(J - 1) / 2})\) of \(\frac{J (J - 1)}{2}\) latent parameters.2 The model estimates \(\rho\) with maximum likelihood.

## 1.4 Expected value of the control group

Recall that \(\mu_{ij}\) is the expected mean outcome of patient \(i\) at visit \(j\). If patient \(i\) is part of the control group, then we define:

\[ \begin{aligned} \mu_{ij} = f(t_{ij} | \xi, \alpha) + W_i \gamma - \langle \overline{W}_i, \gamma \rangle \end{aligned} \]

Each model expresses the expected outcomes differently, but all models reduce to the above equation for the control arm.

Above, \(W_i\) is the \(J \times V\) sparse model matrix of constant non-missing covariates from the data, \(\overline{W}_i\) is \(V\)-length vector of the column means of \(W_i\), and \(\langle \overline{W}_i, \gamma \rangle\) is the inner product of \(\overline{W}_i\) with model coefficient parameter vector \(\gamma\).3 The model estimates \(\gamma\) with maximum likelihood.

The mean function \(f(t_{ij} | \xi, \alpha)\) is the expected clinical outcome at time \(t_{ij}\) of the control arm prior to covariate adjustment. It is a spline with knots \(\xi = (\xi_1, \ldots, \xi_S)\) and vertical anchor points \(\alpha = (\alpha_1, \ldots, \alpha_S)\).4 The knots in \(\xi\) are fixed and supplied by the user, and they are usually the scheduled visit times specified in the study protocol.5 The model estimates \(\alpha\) with maximum likelihood.

# 2 The decline models

In progressive disease, we usually expect patient health to decline after baseline. The models in this section measure how well treatment reduces this decline. Therapeutic benefit is expressed as a pointwise reduction on the clinical outcome scale.

## 2.1 The non-proportional decline model

We express the expected value \(\mu_{ij}\) as follows:

\[ \begin{aligned} \mu_{ij} &= (1 - \beta_{b(i)j}) \left ( f(t_{ij} | \xi, \alpha) - f(0 | \xi, \alpha) \right ) + f(0 | \xi, \alpha) + W_i \gamma - \langle \overline{W}_i, \gamma \rangle \end{aligned} \]

where \(b(i)\) is the study arm of patient \(i\), and \(\beta_{kj}\) is the reduction in decline of study arm \(k\) (\(k = 1, \ldots, K\)) relative to the control arm \(k = 1\).

To appropriately constrain the parameter space, we express the \(\beta_{kj}\) parameters in terms of latent \(\theta_{(k - 1)(j - 1)}\) parameters as follows:

\[ \begin{aligned} \beta_{kj} = \begin{cases} 0 & k = 1 \text{ or } j = 1 \\ \theta_{(k-1)(j-1)} & k \in \{2, \ldots, K\} \text{ and } j \in \{2, \ldots, J\} \end{cases} \end{aligned} \]

The model estimates the latent parameters \(\theta_{11}, \ldots, \theta_{(K - 1)(J - 1)}\) with maximum likelihood.

## 2.2 The proportional decline model

The proportional decline model is the same as the non-proportional variant except the treatment effects are now \(\beta_1, \ldots, \beta_K\), which no longer depend on the visit. In other words, we assume that the reduction in decline due to treatment is proportional to time. We express the expectation \(\mu_{ij}\) as:

\[ \begin{aligned} \mu_{ij} &= (1 - \beta_{b(i)}) \left ( f(t_{ij} | \xi, \alpha) - f(0 | \xi, \alpha) \right ) + f(0 | \xi, \alpha) + W_i \gamma - \langle \overline{W}_i, \gamma \rangle \end{aligned} \]

To appropriately constrain the parameter space, we introduce latent parameters \(\theta_1, \ldots, \theta_{k - 1}\) as follows:

\[ \begin{aligned} \beta_k = \begin{cases} 0 & k = 1 \\ \theta_{k - 1} & k = 2, \ldots, K \end{cases} \end{aligned} \]

The latent parameters \(\theta_1, \dots, \theta_{K - 1}\) are estimated with maximum likelihood.

# 3 The slowing models

In these models, we assume that treatment slows the passage of time along the disease progression trajectory. All study arms share a common disease trajectory, and treated patients may progress more slowly on that same path than control patients. The treatment effect is on the time scale, not the clinical outcome scale.

## 3.1 The non-proportional slowing model

The expected value is:

\[ \begin{aligned} \mu_{ij} &= f \left ( u_{ij} | \xi, \alpha \right) + W_{i}\gamma - \langle \overline{W}_i, \gamma \rangle \end{aligned} \]

where \(u_{ij}\) is shifted time along the disease progression trajectory:

\[ \begin{aligned} u_{ij} = (1 - \beta_{b(i)j}) t_{ij} \end{aligned} \]

and \(\beta_{kj}\) is the relative time shift due treatment \(k\) at visit \(j\).

To appropriately constrain the parameter space, we express the \(\beta_{kj}\) parameters in terms of latent \(\theta_{(k - 1)(j - 1)}\) parameters as follows:

\[ \begin{aligned} \beta_{kj} = \begin{cases} 0 & k = 1 \text{ or } j = 1 \\ \theta_{(k-1)(j-1)} & k \in \{2, \ldots, K\} \text{ and } j \in \{2, \ldots, J\} \end{cases} \end{aligned} \]

The model estimates the latent parameters \(\theta_{11}, \ldots, \theta_{(K - 1)(J - 1)}\) with maximum likelihood.

## 3.2 The proportional slowing model

The proportional slowing model is the same as the non-proportional variant except the time shifts are now \(\beta_1, \ldots, \beta_K\), which no longer depend on the visit. In other words, we assume that the slowing of disease progression due to to treatment is proportional to time. We express the expectation \(\mu_{ij}\) the same as before:

\[ \begin{aligned} \mu_{ij} &= f \left ( u_{ij} | \xi, \alpha \right) + W_{i}\gamma - \langle \overline{W}_i, \gamma \rangle \end{aligned} \]

but the time shift uses \(\beta_{b(i)}\):

\[ \begin{aligned} u_{ij} = (1 - \beta_{b(i)}) t_{ij} \end{aligned} \]

To appropriately constrain the parameter space, we introduce latent parameters \(\theta_1, \ldots, \theta_{k - 1}\) as follows:

\[ \begin{aligned} \beta_k = \begin{cases} 0 & k = 1 \\ \theta_{k - 1} & k = 2, \ldots, K \end{cases} \end{aligned} \]

The latent parameters \(\theta_1, \dots, \theta_{K - 1}\) are estimated with maximum likelihood.

# References

Donohue, Michael C, Oliver Langford, Philip S. Insel, et al. 2023. “Natural Cubic Splines for the Analysis of Alzheimer’s Clinical Trials.” Pharmaceutical Statistics 22 (3): 508–19. https://doi.org/10.1002/pst.2285.
Raket, Lars Lau. 2022. “Progression Models for Repeated Measures: Estimating Novel Treatment Effects in Progressive Diseases.” Statistics in Medicine 41 (28): 5537–57. https://doi.org/10.1002/sim.9581.
Wang, Guoqiao, Lei Liu, Yan Li, et al. 2022. “Proportional Constrained Longitudinal Data Analysis Models for Clinical Trials in Sporadic Alzheimer’s Disease.” Alzheimer’s and Dementia 8 (1). https://doi.org/10.1002/trc2.12286.

1. This is constrained longitudinal data analysis (cLDA) as explained by Wang et al. (2022).↩︎

2. In R, `RTMB::unstructured(J)$corr(rho)` maps latent parameter vector \(\rho\) to the \(J \times J\) correlation matrix \(L L^T\).↩︎

3. We express the covariate adjustment terms as \(W_i \gamma - \langle \overline{W}_i, \gamma \rangle\) to improve computational efficiency when dealing with sparse matrices.↩︎

4. In other words, \(f(\xi_s | \xi, \alpha) = \alpha_s\) for \(s = 1, \ldots, S\).↩︎

5. However, both the discrete visit designations in the data and the spline knots in the model may need adjustment if many visits occurred off-schedule, as was the case for neurodegeneration studies during the COVID-19 pandemic. (See Donohue et al. (2023)).↩︎