Using Surrogates in Covariate-adjusted Response-adaptive Randomized Experiments with Delayed Outcomes

Covariate-adjusted response-adaptive randomization (CARA) designs are gaining increasing attention. These designs combine the advantages of randomized experiments with the ability to adaptively revise treatment allocations based on data collected across multiple stages, enhancing estimation efficiency. Yet, CARA designs often assume that primary outcomes are immediately observable, which is not the case in many clinical scenarios where there is a delay in observing primary outcomes. This assumption can lead to significant missingness and inefficient estimation of treatment effects. To tackle this practical challenge, we propose a CARA experimental strategy integrating delayed primary outcomes with immediately observed surrogate outcomes.