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Noninferiority Trial Design

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Part of the book series: Statistics for Biology and Health ((SBH))

Abstract

Superiority and noninferiority (NI) trials are two common types of clinical trials. Superiority means, in layman’s language, that the test drug is better than the comparative drug (active comparator or active-control), whereas noninferiority suggests that the test drug may not be as good as the comparative drug, but the difference is not clinically significant. If a test drug is noninferior to an active-control, it must be at least superior to a placebo (Fig. 3.1).

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Further Readings and References

  • Brittain, E., Hu, Z.: Noninferiority trial design and analysis with an ordered three-level categorical endpoint. J. Biopharm. Stat. 19, 685–699 (2009)

    Article  MathSciNet  Google Scholar 

  • Chan, I.S.F.: Power and sample size determination for noninferiority trials using an exact method. J. Biopharm. Stat. 12(4), 457–469 (2002)

    Article  Google Scholar 

  • Chang, M.: Multiple-arm superiority and noninferiority designs with various endpoints. Pharm. Stat. 6, 43–52 (2007a)

    Article  Google Scholar 

  • Chang, M.: Adaptive Design Theory and Implementation Using SAS and R. Chapman & Hall/CRC, Boca Raton (2007b)

    Google Scholar 

  • Chang, M.: Monte Carlo Simulation for the Pharmaceutical Industry. Chapman and Hall/CRC, Raton (2010)

    Book  Google Scholar 

  • CHMP: Points to consider on switching between superiority and noninferiority. Br. J. Clin. Pharm. 52, 223–228 (2001)

    Google Scholar 

  • CHMP: Guideline on the choice of the noninferiority margin, EMEA/EWP/2158/99. London, July 27, 2005 (2005)

    Google Scholar 

  • Chow, S.C., Shao, J.: On noninferiority margin and statistical tests in active control trials. Stat. Med. 25, 1101–1113 (2005)

    Article  MathSciNet  Google Scholar 

  • Cook, R.J., Lee, K.A., Li, H.: Noninferiority trial design for recurrent events. Stat. Med. 26, 4563–4577 (2007)

    Article  MathSciNet  Google Scholar 

  • CPMP: Points to consider on switching between superiority and non-inferiority. www.ema. europa.eu (2000). Accessed 18 May 2010

  • D’Agostino, R.B.: Editoral, noninferiority trials: Advances in concepts and methodology. Stat. Med. 22, 165–167 (2003)

    Article  Google Scholar 

  • D’Agostino, R.B., Massaro, J.M., Sullivan, L.M.: Noninferiority trials: Design concepts and issues-the encounters of academic consultants in statistics. Stat. Med. 22, 169–186 (2003)

    Article  Google Scholar 

  • Dunnett, C.W., Gent, M.: An alternative to the use of two-sided tests in clinical trials. Stat. Med. 15, 1729–1738 (1976)

    Article  Google Scholar 

  • Dunnett, C.W., Gent, M.: Significant testing to establish equivalence between treatments with special reference to data in the form of 2 ×2 tables. Biometrics 33, 593–602 (1977)

    Article  Google Scholar 

  • Ellenberg, S.S., Temple, R.: Placebo-controlled trials and active controlled trials in the evaluation of new treatment. Part 2: Practical issues and specific cases. Ann. Intern. Med. 133, 464–470 (2000)

    Google Scholar 

  • Farrington, C.P., Manning, G.: Test statistics and sample size formulae for comparative binomial trials with null hypothesis of non-zero risk difference or non-unity relative risk. Stat. Med. 9, 1447–1454 (1990)

    Article  Google Scholar 

  • FDA: International Conference on Harmonisation. Statistical Principles for Clinical Trials (ICH E 9). Food and Drug Administration, Department of Health and Human Services, Washingtom (1998)

    Google Scholar 

  • FDA: Guidance for Industry Non-Inferiority Clinical Trials (draft). Food and Drug Administration, Department of Health and Human Services, Washingtom (2010)

    Google Scholar 

  • Fleming, T.R.: Current issues in noninferiority trials. Stat. Med. 27, 317–332 (2008)

    Article  MathSciNet  Google Scholar 

  • Hung, H.M., Wang, S.J., O’Neill, R.T.: Issues with statistical risks for testing methods in noninferiority trial without a placebo arm. J. Biopharm. Stat. 17(2), 201–213 (2007)

    Article  MathSciNet  Google Scholar 

  • Ioannidis, J.P.A.: Why most published research findings are false. PLoS Med. 2(8), e124 (2005)

    Article  Google Scholar 

  • Kieser, M., Friede, T.: Planning and analysis of three-arm non-inferiority trials with binary endpoints. Stat. Med. 26, 253–273 (2007)

    Article  MathSciNet  Google Scholar 

  • Liu, J.P., Hsueh, H.M., Hsieh, E., Chen, J.J.: Tests for equivalence or noninferiority for paired binary data. Stat. Med. 21, 231–245 (2002)

    Article  Google Scholar 

  • Koch, G.G.: Commentory, comments on ‘Current issues in noninferiority trials’. Stat. Med. 27, 333–342 (2008)

    Article  MathSciNet  Google Scholar 

  • Kong, L., Kohberger, R.C., Koch, G.G.: Type I error and power in noninferiority/equivalence trials with correlated multiple endpoints: An example from vaccine development trials. J. Biopharm. Stat. 14, 893–907 (2004)

    Article  MathSciNet  Google Scholar 

  • Koyama, T., Westfall, P.H.: Decision-theoretic views on simultaneous testing of superiority and noninferiority. J. Biopharm. Stat. 15, 943–955 (2005)

    Article  MathSciNet  Google Scholar 

  • Lu, Y., Jin, H., Genant, H.K.: On the noninferiority of a diagnostic test based on paired observations. Stat. Med. 22, 3029–3044 (2003)

    Article  Google Scholar 

  • Morikawa, T., Yoshida, M.: A useful testing strategy in phase III trials: Combined test of superiority and test of equivalence. J. Biopharm. Stat. 5, 297–306 (1995)

    Article  Google Scholar 

  • Nam, J.: Establishing equivalence of two treatments and sample size requirements in matched-pairs design. Biometrics 53, 1422–1430 (1997)

    Article  MATH  Google Scholar 

  • Nam, J., Kwon, D.: Noninferiority tests for clustered matched-pair data. Stat. Med. 28, 1668–1679 (2009)

    Article  MathSciNet  Google Scholar 

  • Ng, T.H.: Issues of simultaneous tests for noninferiority and superiority, with discussions. J. Biopharm. Stat. 13, 629–639 (2003)

    Article  MATH  Google Scholar 

  • Ng, T.H.: Simultaneous testing of noninferiority and superiority increases the false discovery rate. J. Biopharm. Stat. 17, 259–264 (2007)

    Article  Google Scholar 

  • PAREXEL: Parexel’s Bio/Pharmaceutical R&D Statistical Sourcebook 2007/2008. PAREXEL, Waltham (2008)

    Google Scholar 

  • Pearlman, J.B.: The commercialization of medicine. http://www.google.com (2007). Accessed 10 Sep 2009

  • Pigeot, I., Schäfer, J., Röhmel, J., Hauschke, D.: Assessing noninferiority of a new treatment in a three-arm clinical trial including a placebo. Stat. Med. 22, 883–899 (2003)

    Article  Google Scholar 

  • Rothmann, M., Li, N., Chen, G., Chi1, G.Y.H., Temple, R., Tsou, H.H.: Design and analysis of noninferiority mortality trials in oncology. Stat. Med. 22, 239–264 (2003)

    Google Scholar 

  • Shao, J.: Mathematical Statistics. Springer, New York, NY (2003)

    Book  MATH  Google Scholar 

  • Sidik, K.: Exact unconditional tests for testing noninferiority in matched-pairs design. Stat. Med. 22, 265–278 (2003)

    Article  Google Scholar 

  • Siqueira, A.L., Whitehead, A., Todd, S.: Active-control trials with binary data: A comparison of methods for testing superiority or noninferiority using the odds ratio, with comments. Stat. Med. 27, 353–370 (2008)

    Article  MathSciNet  Google Scholar 

  • Snapinn, S., Jiang, Q.: Correction. Stat. Med. 27, 4855–4856 (2008)

    Article  MathSciNet  Google Scholar 

  • Tang, M.L., Tang, N.S.: Tests of noninferiority via rate difference for three-arm clinical trials with placebo. J. Biopharm. Stat. 14, 337–347 (2004)

    Article  Google Scholar 

  • Tango, T.: Equivalence test and confidence interval for the difference in proportions for the paired-sample design. Stat. Med. 17, 891–908 (1998)

    Article  Google Scholar 

  • Temple, R.: Active control noninferiority studies: Theory, assay sensitivity, choice of margin. FDA presentation. www.FDA.gov (2002). Accessed 19 Feb 2002

  • Temple, R., Ellenberg, S.S.: Placebo-controlled trials and active-controlled trials in the evaluation of new treatments. Part 1: Ethical and scientific issues. Ann. Intern. Med. 133, 455–463 (2000)

    Google Scholar 

  • Tsong, Y., Chen, W.J.: Noninferiority testing beyond simple two-sample comparison. J. Biopharm. Stat. 17, 289–308 (2007)

    Article  MathSciNet  Google Scholar 

  • Wang, Y.C., Chen, G., Chi, G.Y.H.: A ratio test in active control non-inferiority trials with time-to-event endpoint. J. Biopharm. Stat. 16, 151–164 (2006)

    Article  MathSciNet  Google Scholar 

  • Wang, S.J., Hung, H.M., Tsong, Y., Cui, L.: Group sequential test strategies for superiority and noninferiority hypotheses in active controlled clinical trials. Stat. Med. 20, 1903–1912 (2001)

    Article  Google Scholar 

  • Wiens, B.L., Heyes, J.F.: Testing for interactions in studies of noninferiority. J. Biopharm. Stat. 13, 103–115 (2003)

    Article  MATH  Google Scholar 

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Chang, M. (2011). Noninferiority Trial Design. In: Modern Issues and Methods in Biostatistics. Statistics for Biology and Health. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-9842-2_3

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