MMRM vs. LOCF: A Comprehensive Comparison Based on Simulation Study and 25 NDA Datasets

In recent years, the use of the last observation carried forward (LOCF) approach in imputing missing data in clinical trials has been greatly criticized, and several likelihood-based modeling approaches are proposed to analyze such incomplete data. One of the proposed likelihood-based methods is the Mixed-Effect Model Repeated Measure (MMRM) model. To compare the performance of LOCF and MMRM approaches in analyzing incomplete data, two extensive simulation studies are conducted, and the empirical bias and Type I error rates associated with estimators and tests of treatment effects under three missing data paradigms are evaluated. The simulation studies demonstrate that LOCF analysis can lead to substantial biases in estimators of treatment effects and can greatly inflate Type I error rates of the statistical tests, whereas MMRM analysis on the available data leads to estimators with comparatively small bias, and controls Type I error rates at a nominal level in the presence of missing completely at random (MCAR) or missing at random (MAR) and some possibility of missing not at random (MNAR) data. In a sensitivity analysis of 48 clinical trial datasets obtained from 25 New Drug Applications (NDA) submissions of neurological and psychiatric drug products, MMRM analysis appears to be a superior approach in controlling Type I error rates and minimizing biases, as compared to LOCF ANCOVA analysis. In the exploratory analyses of the datasets, no clear evidence of the presence of MNAR missingness is found.