alexa Non-inferiority trials: the 'at least as good as' criterion.
Mathematics

Mathematics

Journal of Biometrics & Biostatistics

Author(s): Laster LL, Johnson MF

Abstract Share this page

Abstract To demonstrate in a clinical trial that a new or experimental therapy (et) is 'at least as good as' a standard therapy (st), a statistical test or confidence interval procedure must rule out clinical inferiority with a high probability. The term 'at least as good as' implies equivalent but not necessarily superior efficacy. As it is statistically impossible to demonstrate equivalence (that is, prove the null hypothesis of no difference), Blackwelder proposed a one-sided significance test to reject the null hypothesis that standard therapy is better than experimental therapy by a clinically acceptable amount, delta(BW). In this paper, Blackwelder's approach is redefined in terms of the ratio of two means (R(True)= mu(et)/mu(st)) based on a continuous variate with higher values denoting greater improvement. The ratio-based equivalents to Blackwelder's hypotheses will be shown. The ratio parameter has the benefit of being available as a dimensionless percentage, not tied to a specified difference in means. Thus, a study can be sized to assure, with high probability, that the experimental therapy is 'at least' (R(LB)x100) per cent 'as effective as' the standard therapy, where R(LB) is the selected lower bound on the percentage effectiveness. A practical rationale is given for defining non-inferiority as a high fraction or percentage of the standard drug's efficacy, both in terms of statistical efficiency and medical relevance. For most typical 'at least as good as' applications (when R(LB) or = delta(BW), thereby requiring smaller sample sizes to detect the directionally based non-null alternatives contained in H(1): mu(et)/mu(st)>R(LB) or, equivalently, mu(st) - mu(et)R(LB), is shown to be more efficient than excluding R(LB) from the lower limit of a 100(1-2alpha) per cent two-sided symmetric confidence interval centred by R. Relevant examples will be presented. Copyright 2003 John Wiley & Sons, Ltd. This article was published in Stat Med and referenced in Journal of Biometrics & Biostatistics

Relevant Expert PPTs

Relevant Speaker PPTs

Recommended Conferences

Relevant Topics

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

agrifoodaquavet@omicsonline.com

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

clinical_biochem@omicsonline.com

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

business@omicsonline.com

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

chemicaleng_chemistry@omicsonline.com

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

environmentalsci@omicsonline.com

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

engineering@omicsonline.com

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

generalsci_healthcare@omicsonline.com

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

genetics_molbio@omicsonline.com

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

immuno_microbio@omicsonline.com

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

omics@omicsonline.com

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

materialsci@omicsonline.com

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

mathematics_physics@omicsonline.com

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

medical@omicsonline.com

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

neuro_psychology@omicsonline.com

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

pharma@omicsonline.com

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

social_politicalsci@omicsonline.com

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version