Althunian Turki A, de Boer Anthonius, Groenwold Rolf H H, Klungel Olaf H
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, P.O.Box 80082, 3508, TB, Utrecht, The Netherlands.
Div. Julius Centrum, UMC Utrecht, Huispost Str. 6.131, P.O.Box 85500, 3508, GA, Utrecht, The Netherlands.
Br J Clin Pharmacol. 2017 Aug;83(8):1636-1642. doi: 10.1111/bcp.13280. Epub 2017 Apr 6.
Noninferiority trials are used to assess whether the effect of a new drug is not worse than an active comparator by more than a noninferiority margin. If the difference between the new drug and the active comparator does not exceed this prespecified margin, noninferiority can be concluded. This margin must be specified based on clinical and statistical reasoning; however, it is considered as one of the most challenging steps in the design of noninferiority trials. Regulators recommend that the margin should be defined based on the historical evidence of the active comparator (the latter is often the well-established standard treatment of the disease), which can be performed by different approaches. There are several factors and assumptions that need to be accounted for during the process of defining the margin and during the analysis of noninferiority. Three methods are commonly used to analyse noninferiority trials: the fixed-margin method; the point-estimate method; and the synthesis method. This article provides an overview of analysing noninferiority and choosing the noninferiority margin.
非劣效性试验用于评估一种新药的效果是否不比活性对照药差超过一个非劣效性界值。如果新药与活性对照药之间的差异不超过这个预先设定的界值,就可以得出非劣效性的结论。这个界值必须基于临床和统计学推理来确定;然而,这被认为是非劣效性试验设计中最具挑战性的步骤之一。监管机构建议,界值应根据活性对照药的历史证据来定义(后者通常是该疾病已确立的标准治疗方法),这可以通过不同的方法来进行。在定义界值的过程以及非劣效性分析过程中,有几个因素和假设需要考虑。通常使用三种方法来分析非劣效性试验:固定界值法;点估计法;以及综合法。本文概述了非劣效性分析和非劣效性界值的选择。