title: Unbalanced rather than balanced randomized controlled trials are more often positive in favor of the new treatment: an exposed and nonexposed study.
abstract: OBJECTIVE
  We aimed to assess whether the clinical equipoise principle is satisfied in unbalanced randomized controlled trials (RCTs) (i.e., with an unequal probability of subjects being allocated to one group than another).
  
  
  METHODS
  Observational and comparative study between unbalanced and balanced RCTs. We searched the "core clinical journals" of MEDLINE to identify reports of two-parallel group superiority unbalanced RCTs published between January 2009 and December 2010. For each unbalanced RCT, we identified a maximum of four reports (to maximize power) of matched balanced RCTs dealing with the same population. Our primary outcome was the proportion of positive RCTs [i.e., with statistically significant results for the primary outcome (P < 0.05), showing greater efficacy with the new treatment than the control treatment].
  
  
  RESULTS
  We selected 46 reports of unbalanced RCTs and 164 of balanced RCTs; 65.2% unbalanced RCTs and 43.9% of balanced RCTs were positive (odds ratio, 2.38; 95% confidence interval: 1.23, 4.63). As compared with balanced RCTs, unbalanced RCTs were more often industry funded and their control treatments were more often inactive. Adjusting for these latter variables did not modify the results.
  
  
  CONCLUSIONS
  This result questions the respect of clinical equipoise in unbalanced RCTs.
authors.affiliation: INSERM U 1153, Hôtel-Dieu, 1 place du parvis Notre-Dame, 75004 Paris, France; INSERM CIC 1415, Hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, 60 rue du Plat d'Etain, 37020 Tours cedex 1, France; Département Universitaire de Médecine Générale, Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, 10 boulevard Tonnellé, BP 3223, 37044 Tours cedex 1, France. Electronic address: clarisse.dibao-dina@univ-tours.fr.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Dibao-Dina
authors.affiliation: INSERM U 1153, Hôtel-Dieu, 1 place du parvis Notre-Dame, 75004 Paris, France; INSERM CIC 1415, Hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, 60 rue du Plat d'Etain, 37020 Tours cedex 1, France; CHRU de Tours, 2 boulevard Tonnellé, 37044 Tours cedex 9, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Caille
authors.affiliation: INSERM U 1153, Hôtel-Dieu, 1 place du parvis Notre-Dame, 75004 Paris, France; INSERM CIC 1415, Hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, 60 rue du Plat d'Etain, 37020 Tours cedex 1, France; CHRU de Tours, 2 boulevard Tonnellé, 37044 Tours cedex 9, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Giraudeau
mesh_terms: D003627:Data Interpretation, Statistical; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D057212:Therapeutic Equipoise; D035703:Therapies, Investigational
keywords: Clinical equipoise; Ethics; Meta-study; P-value; Randomized controlled trials; Unbalanced randomization