Single-arm trials are an important study design for evaluating drug efficacy and safety without enrolling patients into a control arm. Although they do not provide the gold-standard evidence of randomized controlled trials, they are increasingly used in clinical development as they offer an efficient, ethical, and practical alternative. A wide variety of approaches can be used to construct control comparators and estimate treatment effects, from fixed comparators informed by clinical knowledge to data-based and model-based patient-level comparators, also known as synthetic controls. Powerful and flexible machine learning models can allow outcome-model-based synthetic controls to overcome key limitations of direct data-based approaches, yield more robust estimates of treatment effects, and provide a principled way to incorporate corrections or encode additional assumptions when external data are not directly comparable. In this work, we argue that outcome-model-based synthetic control arms are an important tool for single-arm trials. We focus on digital twins, personalized predictions of disease progression generated from machine learning models trained on historical datasets, which naturally leverage these flexible approaches. We review doubly robust estimators, present power and sample size formulas, and discuss trade-offs in selecting historical data for training and analysis. We also outline practical considerations for deploying digital twins within the framework of recent FDA draft guidance on the use of artificial intelligence in drug development. Finally, we reanalyze data from trials in amyotrophic lateral sclerosis and Huntington's disease to demonstrate the proposed methods.

Comparing conditional distributions is a fundamental challenge in statistics and machine learning, with applications across a wide range of domains. While proposed methods for measuring discrepancies using kernel embeddings of distributions in a reproducing kernel Hilbert space (RKHS) provide powerful non-parametric techniques, the existing literature remains fragmented and lacks a unified theoretical treatment. This paper addresses this gap by establishing a coherent framework for studying kernel-based methods to measure divergence between conditional distributions through what we refer to as conditional maximum mean discrepancy (CMMD). The CMMD consists of a family of metrics which we call levels, with three special cases each using a different type of RKHS embedding: CMMD$_0$ (conditional mean operators), CMMD$_1$ (conditional mean embeddings), and CMMD$_2$ (joint mean embeddings). We additionally introduce a general level $s$ CMMD, clarifying the required assumptions, and establishing mathematical connections between the levels through the lens of operator-based smoothing. In addition to reviewing previously proposed estimators, we introduce a novel doubly robust estimator for the CMMD that maintains consistency provided at least one of the underlying models is correctly specified. We provide numerical experiments demonstrating that the CMMD effectively captures complex conditional dependencies for statistical testing.

Neural Information Processing Systems http://nips.cc/

Offline reinforcement learning, wherein one uses off-policy data logged by a fixed behavior policy to evaluate and learn new policies, is crucial in applications where experimentation is limited such as medicine. We study the estimation of policy value and gradient of a deterministic policy from off-policy data when actions are continuous. Targeting deterministic policies, for which action is a deterministic function of state, is crucial since optimal policies are always deterministic (up to ties). In this setting, standard importance sampling and doubly robust estimators for policy value and gradient fail because the density ratio does not exist. To circumvent this issue, we propose several new doubly robust estimators based on different kernelization approaches. We analyze the asymptotic mean-squared error of each of these under mild rate conditions for nuisance estimators. Specifically, we demonstrate how to obtain a rate that is independent of the horizon length.

We study the problem of off-policy policy evaluation (OPPE) in RL.

Neural Information Processing Systems http://nips.cc/

Double robustness is a major selling point of semiparametric and missing data methodology. Its virtues lie in protection against partial nuisance misspecification and asymptotic semiparametric efficiency under correct nuisance specification. However, in many applications, complete nuisance misspecification should be regarded as the norm (or at the very least the expected default), and thus doubly robust estimators may behave fragilely. In fact, it has been amply verified empirically that these estimators can perform poorly when all nuisance functions are misspecified. Here, we first characterize this phenomenon of double fragility, and then propose a solution based on adaptive correction clipping (ACC). We argue that our ACC proposal is safe, in that it inherits the favorable properties of doubly robust estimators under correct nuisance specification, but its error is guaranteed to be bounded by a convex combination of the individual nuisance model errors, which prevents the instability caused by the compounding product of errors of doubly robust estimators. We also show that our proposal provides valid inference through the parametric bootstrap when nuisances are well-specified. We showcase the efficacy of our ACC estimator both through extensive simulations and by applying it to the analysis of Alzheimer's disease proteomics data.

Randomized controlled trials (RCTs) are widely regarded as the gold standard for causal inference in biomedical research. For instance, when estimating the average treatment effect on the treated (ATT), a doubly robust estimation procedure can be applied, requiring either the propensity score model or the control outcome model to be correctly specified. In this paper, we address scenarios where external control data, often with a much larger sample size, are available. Such data are typically easier to obtain from historical records or third-party sources. However, we find that incorporating external controls into the standard doubly robust estimator for ATT may paradoxically result in reduced efficiency compared to using the estimator without external controls. This counterintuitive outcome suggests that the naive incorporation of external controls could be detrimental to estimation efficiency. To resolve this issue, we propose a novel doubly robust estimator that guarantees higher efficiency than the standard approach without external controls, even under model misspecification. When all models are correctly specified, this estimator aligns with the standard doubly robust estimator that incorporates external controls and achieves semiparametric efficiency. The asymptotic theory developed in this work applies to high-dimensional confounder settings, which are increasingly common with the growing prevalence of electronic health record data. We demonstrate the effectiveness of our methodology through extensive simulation studies and a real-world data application.

Surprisingly, applying over 20 established estimators to the dataset produces inconsistent results in evaluating the nonprofit's efficacy.