title: Statistical methods in recent HIV noninferiority trials: reanalysis of 11 trials.
abstract: BACKGROUND
  In recent years the "noninferiority" trial has emerged as the new standard design for HIV drug development among antiretroviral patients often with a primary endpoint based on the difference in success rates between the two treatment groups. Different statistical methods have been introduced to provide confidence intervals for that difference. The main objective is to investigate whether the choice of the statistical method changes the conclusion of the trials.
  
  
  METHODS
  We presented 11 trials published in 2010 using a difference in proportions as the primary endpoint. In these trials, 5 different statistical methods have been used to estimate such confidence intervals. The five methods are described and applied to data from the 11 trials. The noninferiority of the new treatment is not demonstrated if the prespecified noninferiority margin it includes in the confidence interval of the treatment difference.
  
  
  RESULTS
  Results indicated that confidence intervals can be quite different according to the method used. In many situations, however, conclusions of the trials are not altered because point estimates of the treatment difference were too far from the prespecified noninferiority margins. Nevertheless, in few trials the use of different statistical methods led to different conclusions. In particular the use of "exact" methods can be very confusing.
  
  
  CONCLUSIONS
  Statistical methods used to estimate confidence intervals in noninferiority trials have a strong impact on the conclusion of such trials.
authors.affiliation: INSERM UMR-S 943, University Pierre and Marie Curie Paris VI and Department of Virology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France. pflandre@ccde.chups.jussieu.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Flandre
mesh_terms: D016001:Confidence Intervals; D015658:HIV Infections; D006801:Humans; D015233:Models, Statistical; D016032:Randomized Controlled Trials as Topic; D012107:Research Design