23: Bayesian Approach in Clinical Trials

This episode of "In the Interim…" features Dr. Scott Berry, Dr. Kert Viele, and Dr. Melanie Quintana of Berry Consultants dissecting the technical and operational landscape of Bayesian statistics in clinical trial design. The episode discussed what is Bayesian statistics, the impact of informative and non-informative priors, and clarifies when and why Bayesian approaches surpass frequentist analyses—especially in adaptive, platform, and rare disease trial settings. The discussion directly challenges the misconception that Bayesian methods “lower the bar," presenting evidence that they often require broader data synthesis and can raise evidentiary standards.

Key regulatory developments at FDA and EMA are reviewed, with attention to updated guidance and increased adoption. Case studies illustrate Bayesian methods in practice, including the prospectively combined phase 2 and 3 analysis for REBYOTA approval; hierarchical modeling in GNE myopathy; shared controls and endpoint integration in the HEALEY ALS Platform Trial; and robust subgroup borrowing in the ROAR basket trial. The team also addresses technical challenges such as multiplicity, subgroup analysis, complexity in endpoint modeling, and appropriate strategies for blending Bayesian and frequentist approaches for maximum regulatory and scientific clarity.

Key Highlights

• Clear explanation and real-world examples of Bayesian analysis in clinical trials.

• Theoretical and practical distinctions from frequentist methods

• Practical breakdown of control sharing, endpoint integration, and subgroup borrowing.

• Regulatory position and the increasing acceptance of Bayesian trial designs and analyses.

• Case examples: REBYOTA, GNE myopathy, HEALY ALS Platform Trial, ROAR basket trial.