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2017 ; 18
(1
): 107
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Methods of defining the non-inferiority margin in randomized, double-blind
controlled trials: a systematic review
#MMPMID28270184
Althunian TA
; de Boer A
; Klungel OH
; Insani WN
; Groenwold RH
Trials
2017[Mar]; 18
(1
): 107
PMID28270184
show ga
BACKGROUND: There is no consensus on the preferred method for defining the
non-inferiority margin in non-inferiority trials, and previous studies showed
that the rationale for its choice is often not reported. This study investigated
how the non-inferiority margin is defined in the published literature, and
whether its reporting has changed over time. METHODS: A systematic PubMed search
was conducted for all published randomized, double-blind, non-inferiority trials
from January 1, 1966, to February 6, 2015. The primary outcome was the number of
margins that were defined by methods other than the historical evidence of the
active comparator. This was evaluated for a time trend. We also assessed the
under-reporting of the methods of defining the margin as a secondary outcome, and
whether this changed over time. Both outcomes were analyzed using a Poisson
log-linear model. Predictors for better reporting of the methods, and the use of
the fixed-margin method (one of the historical evidence methods) were also
analyzed using logistic regression. RESULTS: Two hundred seventy-three articles
were included, which account for 273 non-inferiority margins. There was no
statistically significant difference in the number of margins that were defined
by other methods compared to those defined based on the historical evidence
(ratio 2.17, 95% CI 0.86 to 5.82, p?=?0.11), and this did not change over time.
The number of margins for which methods were unreported was similar to those with
reported methods (ratio 1.35, 95% CI 0.76 to 2.43, p?=?0.31), with no change over
time. The method of defining the margin was less often reported in journals with
low-impact factors compared to journals with high-impact factors (OR 0.20; 95% CI
0.10 to 0.37, p?0.0001). The publication of the FDA draft guidance in 2010 was
associated with increased reporting of the fixed-margin method (after versus
before 2010) (OR 3.54; 95% CI 1.12 to 13.35, p?=?0.04). CONCLUSIONS:
Non-inferiority margins are not commonly defined based on the historical evidence
of the active comparator, and they are poorly reported. Authors, reviewers, and
editors need to take notice of reporting this critical information to allow for
better judgment of non-inferiority trials.
|*Equivalence Trials as Topic
[MESH]
|*Research Design/statistics & numerical data
[MESH]