Testing noninferiority in three-armed clinical trials based on likelihood ratio statistics

Abstract

Clinical noninferiority trials with at least three groups have received much attention recently, perhaps due to the fact that regulatory agencies often require that a placebo group be evaluated along with a new experimental drug and an active control. The authors discuss likelihood ratio tests for binary endpoints and various noninferiority hypotheses. They find that, depending on the particular hypothesis, the test reduces asymptotically either to the intersection-union test or to a test which follows asymptotically a mixture of generalized chi-squared distributions. They investigate the performance of this asymptotic test and provide an exact modification. They show that this test considerably outperforms multiple testing methods such as the Bonferroni adjustment with respect to power. They illustrate their methods with a cancer study to compare antiemetic agents. Finally, they discuss the extension of the results to other settings, such as Gaussian endpoints.