A General Form of Covariate Adjustment in Randomized Clinical Trials

Abstract: In randomized clinical trials, adjusting for baseline covariates can improve credibility and efficiency for demonstrating and quantifying treatment effects. This article studies the augmented inverse propensity weighted (AIPW) estimator, which is a general form of covariate adjustment that uses linear, generalized linear, and non-parametric or machine learning models for the conditional mean of the response given covariates. Under covariate-adaptive randomization, we establish general theorems that show a complete picture of the asymptotic normality, {efficiency gain, and applicability of AIPW estimators}. In particular, we provide for the first time a rigorous theoretical justification of using machine learning methods with cross-fitting for dependent data under covariate-adaptive randomization. Based on the general theorems, we offer insights on the conditions for guaranteed efficiency gain and universal applicability {under different randomization schemes}, which also motivate a joint calibration strategy using some constructed covariates after applying AIPW. Our methods are implemented in the R package RobinCar.