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mmrm

Mixed models for repeated measures (MMRM) are a popular choice for analyzing longitudinal continuous outcomes in randomized clinical trials and beyond; see Cnaan, Laird and Slasor (1997) for a tutorial and Mallinckrodt, Lane and Schnell (2008) for a review. This package implements MMRM based on the marginal linear model without random effects using Template Model Builder (TMB) which enables fast and robust model fitting. Users can specify a variety of covariance matrices, weight observations, fit models with restricted or standard maximum likelihood inference, perform hypothesis testing with Satterthwaite or Kenward-Roger adjustment, and extract least square means estimates by using emmeans.

Scope:

  • Continuous responses with normal (but potentially heteroscedastic) residuals.
  • Marginal linear models (no individual-level random effects).

Main Features:

  • Flexible covariance specification:
    • Structures: unstructured, Toeplitz, AR1, compound symmetry, ante-dependence, and spatial exponential.
    • Groups: shared covariance structure for all subjects or group-specific covariance estimates.
    • Variances: homogeneous or heterogeneous across time points.
  • Inference:
    • Supports REML and ML.
    • Supports weights.
  • Hypothesis testing:
  • C++ backend:
    • Fast implementation using C++ and automatic differentiation to obtain precise gradient information for model fitting.
    • Model fitting algorithm details used in mmrm.
  • Package ecosystems integration:
    • Integration with tidymodels package ecosystem
      • Dedicated parsnip engine for linear regression
      • Integration with recipes
    • Integration with tern package ecosystems
      • The tern.mmrm package can be used to run the mmrm fit and generate tabulation and plots of least square means per visit and treatment arm, tabulation of model diagnostics, diagnostic graphs, and other standard model outputs.

Installation

Release

You can install the current release version from CRAN with:

Development

You can install the current development version from R-Universe with:

install.packages(
  "mmrm",
  repos = c("https://openpharma.r-universe.dev", "https://cloud.r-project.org")
)

This is preferred, because for Windows and MacOS systems you can install pre-compiled binary versions of the packages, avoiding the need for compilation.

Alternatively, you can install the current development version from GitHub with:

if (!require("remotes")) {
  install.packages("remotes")
}
remotes::install_github("openpharma/mmrm")

Note that this installation from source can take a substantial amount of time, because compilation of the C++ sources is required.

Getting Started

See also the introductory vignette or get started by trying out the example:

library(mmrm)
fit <- mmrm(
  formula = FEV1 ~ RACE + SEX + ARMCD * AVISIT + us(AVISIT | USUBJID),
  data = fev_data
)

The code specifies an MMRM with the given covariates and an unstructured covariance matrix for the timepoints (also called visits in the clinical trial context, here given by AVISIT) within the subjects (here USUBJID). While by default this uses restricted maximum likelihood (REML), it is also possible to use ML, see ?mmrm.

Printing the object will show you output which should be familiar to anyone who has used any popular modeling functions such as stats::lm(), stats::glm(), glmmTMB::glmmTMB(), and lme4::nlmer(). From this print out we see the function call, the data used, the covariance structure with number of variance parameters, as well as the likelihood method, and model deviance achieved. Additionally the user is provided a printout of the estimated coefficients and the model convergence information:

fit
#> mmrm fit
#> 
#> Formula:     FEV1 ~ RACE + SEX + ARMCD * AVISIT + us(AVISIT | USUBJID)
#> Data:        fev_data (used 537 observations from 197 subjects with maximum 4 
#> timepoints)
#> Covariance:  unstructured (10 variance parameters)
#> Inference:   REML
#> Deviance:    3386.45
#> 
#> Coefficients: 
#>                   (Intercept) RACEBlack or African American 
#>                   30.77747548                    1.53049977 
#>                     RACEWhite                     SEXFemale 
#>                    5.64356535                    0.32606192 
#>                      ARMCDTRT                    AVISITVIS2 
#>                    3.77423004                    4.83958845 
#>                    AVISITVIS3                    AVISITVIS4 
#>                   10.34211288                   15.05389826 
#>           ARMCDTRT:AVISITVIS2           ARMCDTRT:AVISITVIS3 
#>                   -0.04192625                   -0.69368537 
#>           ARMCDTRT:AVISITVIS4 
#>                    0.62422703 
#> 
#> Model Inference Optimization:
#> Converged with code 0 and message: convergence: rel_reduction_of_f <= factr*epsmch

The summary() method then provides the coefficients table with Satterthwaite degrees of freedom as well as the covariance matrix estimate:

summary(fit)
#> mmrm fit
#> 
#> Formula:     FEV1 ~ RACE + SEX + ARMCD * AVISIT + us(AVISIT | USUBJID)
#> Data:        fev_data (used 537 observations from 197 subjects with maximum 4 
#> timepoints)
#> Covariance:  unstructured (10 variance parameters)
#> Method:      Satterthwaite
#> Vcov Method: Asymptotic
#> Inference:   REML
#> 
#> Model selection criteria:
#>      AIC      BIC   logLik deviance 
#>   3406.4   3439.3  -1693.2   3386.4 
#> 
#> Coefficients: 
#>                                Estimate Std. Error        df t value Pr(>|t|)
#> (Intercept)                    30.77748    0.88656 218.80000  34.715  < 2e-16
#> RACEBlack or African American   1.53050    0.62448 168.67000   2.451 0.015272
#> RACEWhite                       5.64357    0.66561 157.14000   8.479 1.56e-14
#> SEXFemale                       0.32606    0.53195 166.13000   0.613 0.540744
#> ARMCDTRT                        3.77423    1.07415 145.55000   3.514 0.000589
#> AVISITVIS2                      4.83959    0.80172 143.88000   6.037 1.27e-08
#> AVISITVIS3                     10.34211    0.82269 155.56000  12.571  < 2e-16
#> AVISITVIS4                     15.05390    1.31281 138.47000  11.467  < 2e-16
#> ARMCDTRT:AVISITVIS2            -0.04193    1.12932 138.56000  -0.037 0.970439
#> ARMCDTRT:AVISITVIS3            -0.69369    1.18765 158.17000  -0.584 0.559996
#> ARMCDTRT:AVISITVIS4             0.62423    1.85085 129.72000   0.337 0.736463
#>                                  
#> (Intercept)                   ***
#> RACEBlack or African American *  
#> RACEWhite                     ***
#> SEXFemale                        
#> ARMCDTRT                      ***
#> AVISITVIS2                    ***
#> AVISITVIS3                    ***
#> AVISITVIS4                    ***
#> ARMCDTRT:AVISITVIS2              
#> ARMCDTRT:AVISITVIS3              
#> ARMCDTRT:AVISITVIS4              
#> ---
#> Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
#> 
#> Covariance estimate:
#>         VIS1    VIS2    VIS3    VIS4
#> VIS1 40.5537 14.3960  4.9747 13.3867
#> VIS2 14.3960 26.5715  2.7855  7.4745
#> VIS3  4.9747  2.7855 14.8979  0.9082
#> VIS4 13.3867  7.4745  0.9082 95.5568

Citing mmrm

To cite mmrm please see here.