Dynamic predictions for longitudinal and time-to-event outcomes have become a versatile tool in precision medicine. Our work is motivated by the application of dynamic predictions in the decision-making process for primary biliary cholangitis patients. For these patients, serial biomarker measurements (e.g., bilirubin and alkaline phosphatase levels) are routinely collected to inform treating physicians of the risk of liver failure and guide clinical decision-making. Two popular statistical approaches to derive dynamic predictions are joint modelling and landmarking. However, recently, machine learning techniques have also been proposed. Each approach has its merits, and no single method exists to outperform all others. Consequently, obtaining the best possible survival estimates is challenging. Therefore, we extend the Super Learner framework to combine dynamic predictions from different models and procedures. Super Learner is an ensemble learning technique that allows users to combine different prediction algorithms to improve predictive accuracy and flexibility. It uses cross-validation and different objective functions of performance (e.g., squared loss) that suit specific applications to build the optimally weighted combination of predictions from a library of candidate algorithms. In our work, we pay special attention to appropriate objective functions for Super Learner to obtain the most optimal weighted combination of dynamic predictions. In our primary biliary cholangitis application, Super Learner presented unique benefits due to its ability to flexibly combine outputs from a diverse set of models with varying assumptions for equal or better predictive performance than any model fit separately.

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