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Increasing emphasis on the use of real-world evidence (RWE) to support clinical policy and regulatory decision-making has led to a proliferation of guidance, advice, and frameworks from regulatory agencies, academia, professional societies, and industry. A broad spectrum of studies use real-world data (RWD) to produce RWE, ranging from randomized controlled trials with outcomes assessed using RWD to fully observational studies. Yet many RWE study proposals lack sufficient detail to evaluate adequacy, and many analyses of RWD suffer from implausible assumptions, other methodological flaws, or inappropriate interpretations. The Causal Roadmap is an explicit, itemized, iterative process that guides investigators to pre-specify analytic study designs; it addresses a wide range of guidance within a single framework. By requiring transparent evaluation of causal assumptions and facilitating objective comparisons of design and analysis choices based on pre-specified criteria, the Roadmap can help investigators to evaluate the quality of evidence that a given study is likely to produce, specify a study to generate high-quality RWE, and communicate effectively with regulatory agencies and other stakeholders. This paper aims to disseminate and extend the Causal Roadmap framework for use by clinical and translational researchers, with companion papers demonstrating application of the Causal Roadmap for specific use cases., Comment: 51 pages, 2 figures, 4 tables

Causal mediation analysis with random interventions has become an area of significant interest for understanding time-varying effects with longitudinal and survival outcomes. To tackle causal and statistical challenges due to the complex longitudinal data structure with time-varying confounders, competing risks, and informative censoring, there exists a general desire to combine machine learning techniques and semiparametric theory. In this manuscript, we focus on targeted maximum likelihood estimation (TMLE) of longitudinal natural direct and indirect effects defined with random interventions. The proposed estimators are multiply robust, locally efficient, and directly estimate and update the conditional densities that factorize data likelihoods. We utilize the highly adaptive lasso (HAL) and projection representations to derive new estimators (HAL-EIC) of the efficient influence curves of longitudinal mediation problems and propose a fast one-step TMLE algorithm using HAL-EIC while preserving the asymptotic properties. The proposed method can be generalized for other longitudinal causal parameters that are smooth functions of data likelihoods, and thereby provides a novel and flexible statistical toolbox.

Augmenting the control arm of a randomized controlled trial (RCT) with external data may increase power at the risk of introducing bias. Existing data fusion estimators generally rely on stringent assumptions or may have decreased coverage or power in the presence of bias. Framing the problem as one of data-adaptive experiment selection, potential experiments include the RCT only or the RCT combined with different candidate real-world datasets. To select and analyze the experiment with the optimal bias-variance tradeoff, we develop a novel experiment-selector cross-validated targeted maximum likelihood estimator (ES-CVTMLE). The ES-CVTMLE uses two bias estimates: 1) a function of the difference in conditional mean outcome under control between the RCT and combined experiments and 2) an estimate of the average treatment effect on a negative control outcome (NCO). We define the asymptotic distribution of the ES-CVTMLE under varying magnitudes of bias and construct confidence intervals by Monte Carlo simulation. In simulations involving violations of identification assumptions, the ES-CVTMLE had better coverage than test-then-pool approaches and an NCO-based bias adjustment approach and higher power than one implementation of a Bayesian dynamic borrowing approach. We further demonstrate the ability of the ES-CVTMLE to distinguish biased from unbiased external controls through a re-analysis of the effect of liraglutide on glycemic control from the LEADER trial. The ES-CVTMLE has the potential to improve power while providing relatively robust inference for future hybrid RCT-RWD studies., Comment: 27 pages, 4 figures