The modern clinical research evaluation system has been increasingly emphasizing the evaluation of individual patients' clinical characteristics, diagnosis and treatment plans, and complex intervention measures. Traditional randomized controlled trial evaluated fixed interventions and non-adaptive treatment plans, which cannot meet the needs of evaluating adaptive interventions. This made researchers more inclined to explore an individualized and adaptive clinical trial design, then sequential multiple assignment randomized trial (SMART) emerged as the time needed. This article introduces the principles, key elements, and implementation points of SMART design, further explores the limitations of the mismatch between traditional Chinese medicine clinical trial design and syndrome differentiation treatment, and proposes that SMART design can meet the needs of traditional Chinese medicine clinical trials to inspire researchers in designing their plans.
In recent years, investment in new drug development in China has surged; however, it faces challenges such as difficulties in efficacy validation, high failure rates, and lengthy, costly clinical trials. The traditional model is insufficient to address these issues, necessitating innovation. Adaptive designs (AD), particularly sequential multiple assignment randomized trials (SMART), have emerged as a flexible and efficient new pathway for drug development. This study focused on the two-stage design of SMART, analyzed its principles, and contrasted it with randomized controlled trials, group sequential designs, and crossover designs. The advantages of SMART were highlighted in terms of its precision in evaluating treatment strategies, minimizing sample wastage, and enhancing the exploration of complex treatment pathways. Through case analyses, we demonstrated that SMART significantly improved clinical trial efficiency and the quality of treatment decisions, representing an innovative solution to the challenges of new drug development. This study aims to provide strategic references for clinical researchers and promote the adoption of adaptive designs in China, thereby facilitating the efficient advancement of new drug development.