Objective： To evaluate the effectiveness and safety of lyophilized Salvia salt of lithospermic acid powder for injection （SSLA） in treating coronary heart diseases angina pectoris （CHD-AP） of Xin-blood stasis syn...Objective： To evaluate the effectiveness and safety of lyophilized Salvia salt of lithospermic acid powder for injection （SSLA） in treating coronary heart diseases angina pectoris （CHD-AP） of Xin-blood stasis syndrome type, and to conduct the non-inferiority trial with Danshen injection （丹参注射液, DSI） as positive control. Methods： An non-inferiority clinical layered, segmented, randomized, and blinded trial on three parallel and multiple centered groups was conducted in 480 patients with stable effort angina grade Ⅰ , Ⅱand Ⅲ, who had two or more times of attack every week. The 240 patients in test group A were treated with SSLA 200 mg added in 250 ml of 5% glucose solution for intravenous dripping every day; the 120 patients in test group B were treated with SSLA but the dosage doubled; and the 120 patients in the control group were treated with DSI 20 ml daily in the same method as SSLA was given. The clinical effectiveness and safety were evaluated after the patients were treated for 14 days. Results： The results showed that the markedly effective rate in test groups A, B and control group was 37.45 %, 36.75 % and 30.09 % respectively, while the total effective rate in them was 88.09%, 89.74% and 67.26% respectively. Statistical significance was shown in comparisons of the therapeutic effect between control group with test group A and test group B, with that in the two test groups superior to that in the control group, and non-inferiority trial showed eligibility （P〈0.01）. Adverse reaction appeared in 8 patients in the test groups and 2 in the control group. Conclusion： SSLA has definite therapeutic effect in treating patients with CHD-AP, with its effect not inferior to that of DSI, and no evident toxic-adverse reaction.展开更多
The NI （non-inferiority） trial design based on the likelihood ratio test eliminates the dependency on the conventional NI margin, and it explicitly uses the MCID （minimum clinical important difference） that links ...The NI （non-inferiority） trial design based on the likelihood ratio test eliminates the dependency on the conventional NI margin, and it explicitly uses the MCID （minimum clinical important difference） that links the statistical analysis to the clinical sense. Different from the conventional trial design, the new methodology is self-adaptive to the change in the sample size and overall cure rate, and it has an asymptotic property. It is shown that MCID is de-composite into constant MCID and statistical MCID. Along with this concept, the concept of the allowed inferiority does not exist, the interpretation of the trial result is more accurate and consistent to the statistical theory as well as the clinical interpretations.展开更多
Objective:To evaluate the effect of tenofovir alafenamide versus tenofovir disoproxil fumarate on antiviral efficacy in patients with hepatitis B virus infection.Methods:Randomized controlled trials were searched on C...Objective:To evaluate the effect of tenofovir alafenamide versus tenofovir disoproxil fumarate on antiviral efficacy in patients with hepatitis B virus infection.Methods:Randomized controlled trials were searched on CNKI,Wanfang,VIP,China Biomedical Literature Database,PubMed,Cochrane Library,Embase,ClinicalKey,Chinese Clinical Trial Registry and ClinicalTrials.gov from the date of inception to April 2020.The literature was screened according to the inclusion and exclusion criteria,and the efficacy evaluation index of the included RCT was set as the success rate of reaching the endpoint of viral suppression and achieving normalized ALT values at 48 weeks of treatment.Intentionality analysis was adopted and the analysis results were taken as the final conclusion.RevMan 5.3 software was used for this Meta-analysis.Meanwhile,VassarStats was used to evaluate the non-inferiority of TAF and calculate the difference of virus inhibition efficiency rate and 95%confidence interval between experimental group and the control group of each RCT.Results:After the literature search,411 potential articles were found,5 studies were finally included according to the criteria,and 2,120 patients were included.Intentionality analysis showed that TAF regimen and TDF regimen had similar viral suppression success rates(RR=0.97,95%CI:0.94~1.01,P=0.19).The ALT normalization rate in the TAF treatment group was higher than that in the TDF treatment group,and the difference was statistically significant(RR=1.35,95%CI:1.20-1.53,P<0.00001).The non-inferiority margin was set at 10%,and it was found that three RCT studies in the international multi-center all showed that TAF was not inferior to TDF in controlling HBV viral load,while two RCT studies in China's Mainland failed to achieve non-inferiority after calculation.Conclusions:At 48 weeks of treatment,TAF was similar to TDF in controlling HBV viral load.However,the efficacy of TAF in controlling HBV viral load may vary among different populations,which requires further confirmation by more clinical trial evidence.Based on AASLD criteria,the ALT normalization rate of the TAF group was higher than that of the TDF group at 48 weeks of treatment,showing an obvious advantage.展开更多
Background:An evidence gap still exists regarding the efficacy and safety of tegoprazan in patients with erosive esophagitis(EE)in China.This study aimed to verify the efficacy and safety of tegoprazan vs.esomeprazole...Background:An evidence gap still exists regarding the efficacy and safety of tegoprazan in patients with erosive esophagitis(EE)in China.This study aimed to verify the efficacy and safety of tegoprazan vs.esomeprazole in patients with EE in China.Methods:This study was a multicenter,randomized,double-blind,parallel,active-controlled,non-inferiority phase III trial of patients with EE randomized 1:1 to tegoprazan 50 mg/day vs.esomeprazole 40 mg/day.This study was conducted in 32 sites between October 24,2018 and October 18,2019.The primary endpoint was the cumulative endoscopic healing rate at week 8.The secondary endpoint included endoscopic healing rate at week 4,changes in the reflux disease questionnaire(RDQ)and gastroesophageal reflux disease health-related quality of life(GERD-HRQL)scores,and symptom improvement.Results:A total of 261 patients were randomized:132 to the tegoprazan group and 129 to the esomeprazole group.The cumulative endoscopic healing rate at 8 weeks in the tegoprazan group was non-inferior to that of the esomeprazole group(91.1%vs.92.8%,difference:-1.7%,95%confidence interval[CI]:-8.5%,5.0%,P=0.008).There were no statistically significant differences in the changes in RDQ(total,severity,and frequency)and GERD-HRQL scores between the two groups(all P>0.05).The percentages of days without symptoms,including daytime and nighttime symptoms based on patients'diaries,were similar between the two groups(all P>0.05).In the tegoprazan and esomeprazole groups,71.5%(93/130)and 61.7%(79/128)of the participants reported adverse events(AEs),2.3%and 0 experienced serious AEs,while 70.0%and 60.2%had treatment-emergent AEs,respectively.Conclusion:Tegoprazan 50 mg/day demonstrated non-inferior efficacy in healing EE,symptom improvement,and quality of life,and it has similar tolerability compared with esomeprazole 40 mg/day.展开更多
Objective The determination of non-inferiority margin is an important and confusing issue which directly influences the acceptability of a new medication. We reviewed the published literature, International Conference...Objective The determination of non-inferiority margin is an important and confusing issue which directly influences the acceptability of a new medication. We reviewed the published literature, International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use （ICH） Guidelines and Committee for Proprietary Medicinal Products （CPMP） papers on the selection of non-inferiority margin and the corresponding statistical tests in clinical trials, in order to provide practical recommendations and suggestions for establishing reference criteria for the non-inferiority margin in China. Data sources The literature on the selection of a non-inferiority margin and statistical tests was mainly extracted from relevant English articles on non-inferior clinical trials published from 1990 to 2007. The starting point （1990） was chosen due to lack of such papers published prior to 1990. This literature was searched via PubMed, Medline and Chinese Knowledge Information （CNKI）. ICH guidelines and CPMP papers were downloaded from their official websites. The keywords ＂clinical trial＂, ＂non-inferiority＂ and ＂non-inferiority margin＂ were used. Study selection Forty-three original articles and critical reviews, ICH El0 guideline and CPMP papers were selected. Results The non-inferiority testing with treatment difference and ratio are commonly used, where the non-inferiority margin is determined with and without historical data. Traditionally, this margin is treated as a fixed value, while developed methods take the variation into account in the determination of this margin, on which the test depends is more convincing. The mixed margin consisting of a margin based on treatment difference and a margin based on treatment ratio can exactly control the type I error at the desirable level and obtain a better power. In this review, we also provide some recommendations and suggestions for the selection of the non-inferiority margin in the western countries and China. Conclusions Besides the magnitude and variability of the standard control and placebo effects, the determination of the margin depends on other factors, such as, the safety profiles of the two comparative therapies, method of administration and product cost. Hence the margin should be made specifically for a certain case. Reference criteria for different medications should be given to avoid the arbitrary conclusion.展开更多
Background:The pharmacokinetic and clinical behaviors of many proton pump inhibitors(PPIs)in peptic ulcer treatment are altered by CYP2C19 genetic polymorphisms.This non-inferiority study evaluated the efficacy and sa...Background:The pharmacokinetic and clinical behaviors of many proton pump inhibitors(PPIs)in peptic ulcer treatment are altered by CYP2C19 genetic polymorphisms.This non-inferiority study evaluated the efficacy and safety of the novel PPI anaprazole compared with rabeprazole.We also explored the influence of Helicobacter pylori(H.pylori)infection status and CYP2C19 polymorphism on anaprazole.Methods:In this multicenter,randomized,double-blind,double-dummy,positive-drug parallel-controlled,phase Ⅲ study,Chinese patients with duodenal ulcers were randomized 1:1 to receive rabeprazole 10 mg+anaprazole placebo or rabeprazole placebo+anaprazole 20 mg once daily for 4 weeks.The primary efficacy endpoint was the 4-week ulcer healing rate assessed by blinded independent review.Secondary endpoints were the proportion of patients with improved overall and individual duodenal ulcer symptoms at 4 weeks.Furthermore,exploratory subgroup analysis of the primary endpoint by H.pylori status and CYP2C19 polymorphism was conducted.Adverse events were monitored for safety.Non-inferiority analysis was conducted for the primary endpoint.Results:The study enrolled 448 patients(anaprazole,n=225;rabeprazole,n=223).The 4-week healing rates were 90.9%and 93.7%for anaprazole and rabeprazole,respectively(difference,-2.8%[95%confidence interval,-7.7%,2.2%]),demonstrating non-inferiority of anaprazole to rabeprazole.Overall duodenal ulcer symptoms improved in 90.9%and 92.5%of patients,respectively.Improvement rates of individual symptoms were similar between the groups.Healing rates did not significantly differ by H.pylori status or CYP2C19 genotype for either treatment group.The incidence of treatment-emergent adverse events was similar for anaprazole(72/220,32.7%)and rabeprazole(84/219,38.4%).Conclusions:The efficacy of anaprazole is non-inferior to that of rabeprazole in Chinese patients with duodenal ulcers.Registration:ClinicalTrials.gov,NCT04215653.展开更多
Context: In recent years there has been increasing interest on publication bias and on initiatives to decrease bias, in- cluding trial registration. Objective: To test whether there has been an increase in reports of ...Context: In recent years there has been increasing interest on publication bias and on initiatives to decrease bias, in- cluding trial registration. Objective: To test whether there has been an increase in reports of randomized control trials (RCT’s) with negative outcomes in major journals and to identify factors associated with these reports. Design: Retrospective review of reports of RCT’s published in the Journal of the American Medical Association, The Lancet and the New England Journal of Medicine before (2002-’03, pre-registration era) and after (2007-’08, registration era) the institution of mandatory trial registration. Main Outcome Measure: The primary outcome was the proportion of RCT reports with negative outcomes compared across the two eras. Secondary outcome includes other factors affecting pub-lication. Results: We identified 917 reports of RCT’s published in the two study eras. No publications in the pre-registration era reported trial registration compared with 94.4% in the registration era (p 0.001). There was a non-significant increase in negative trials from the pre-registration to the registration era (29.1% vs. 34.1%, p = 0.10, OR 1.26, 95% CI 0.96 - 1.67). Study characteristics associated with negative outcomes include trials of drugs (OR 1.62, 95% CI 1.08 - 2.43), procedures or devices (OR 2.08, 95% CI 1.29 - 3.35), explicit identification of a single primary endpoint (OR 1.70, 95% CI 1.40 - 2.47), and increasing sample size (OR 3.08, 95% CI 1.78 - 5.34). Non-inferiority study design was associated with a decreased likelihood of a negative outcome (OR 0.13, 95% CI 0.05 - 0.31). Conclusions: The proportion of published RCT reports with negative outcomes in three major medical journals has not significantly increased since the mandatory clinical trial registration policy. The observed prevalence of negative trials is associated with increases in sample size and greater specificity in trial endpoints.展开更多
AIM:To evaluate nanosilver eye patches versus Atrauman nanosilver dressings for ocular surface trauma.METHODS:This randomized non-inferiority trial(November 2024-April 2025)enrolled 60 patients assessed pre-treatment ...AIM:To evaluate nanosilver eye patches versus Atrauman nanosilver dressings for ocular surface trauma.METHODS:This randomized non-inferiority trial(November 2024-April 2025)enrolled 60 patients assessed pre-treatment and on days 1,7,and 14 post-treatment.The patients were then randomized into treatment(nanosilver eye patches)and control groups(Atrauman nanosilver dressings).Outcomes included wound healing,comfort(Ocular Comfort Index,OCI),and safety.Statistical analyses used t-tests,non-inferiority tests,and Chi-square tests.RESULTS:Patient baseline characteristics were comparable between groups,with a mean age of 60.633±10.934 in the treatment group versus 64.933±9.606 in controls,and similar gender distribution(20/10 vs 17/13 male/female).Both groups showed comparable baseline OCI scores(treatment group:6.100±2.187 vs control group:6.267±2.303,P=0.775).Following treatment,scores increased significantly at day 1(treatment group:9.367±2.251;control group:9.067±2.212,both P<0.001 vs baseline).Marked improvement was observed by day 7(treatment group:4.067±1.929;control group:3.900±1.918,P<0.001 vs baseline),with complete resolution at day 14(0.467±0.860 vs 0.467±1.008,P<0.001).The non-inferiority criterion was met.The treatment group showed greater improvement in Grade A wound healing rates(76.67%to 93.33%)compared to controls(80.00%to 86.67%)between 1 and 7d post-treatment.By 14d posttreatment,all patients achieved Grade A healing in both groups,with no Grade C cases observed throughout the study period.No adverse events were reported.CONCLUSION:Nanosilver eye patches are non-inferior to Atrauman dressings,offering effective,safe emergency care for ocular trauma.展开更多
Objective:To evaluate the non-inferiority of pramipexole extended-release(ER)versus immediate-release(IR)in Chinese patients with Parkinson’s disease(PD)in a double-blind,randomized,parallel-group study.Methods:Subje...Objective:To evaluate the non-inferiority of pramipexole extended-release(ER)versus immediate-release(IR)in Chinese patients with Parkinson’s disease(PD)in a double-blind,randomized,parallel-group study.Methods:Subjects were Chinese patients with idiopathic PD with diagnosis≥2 years prior to trial,age≥30 years old at diagnosis,and Modified Hoehn and Yahr score 2-4 during‘on’-time.Subjects received treatment with pramipexole ER(n=234)or IR(n=239).Non-inferiority was based on the primary endpoint,the change from baseline to end of maintenance(week 18)in the UPDRS(Parts II+III)total score.Results:For the primary endpoint,the adjusted mean changes(standard error)of UPDRS Parts II+III at week 18 were−13.81(0.655)and−13.05(0.643)for ER and IR formulations,respectively,using ANCOVA adjusted for treatment and centre(fixed effect)and baseline(covariate).The adjusted mean between group difference was 0.8 for the 2-sided 95%CI(−1.047,2.566).Since the lower limit of the 2-sided 95%CI(−1.047)for treatment difference was higher than the non-inferiority margin of−4,non-inferiority between pramipexole ER and IR was demonstrated.The incidence of adverse events(AEs)was 68.8%in the ER arm and 73.6%in the IR arm with few severe AEs(ER:2.1%;IR:3.8%).Conclusion:Based on the UPDRS II+III score,pramipexole ER was non-inferior to pramipexole IR.The safety profiles of pramipexole ER and IR were similar.These results were based on comparable mean daily doses and durations of treatment for both formulations.展开更多
Purpose:This study aimed to determine the therapeutic effectiveness of different machines in intense pulsed light(IPL)treatment of meibomian gland dysfunction(MGD).Methods:213 subjects diagnosed with MGD underwent thr...Purpose:This study aimed to determine the therapeutic effectiveness of different machines in intense pulsed light(IPL)treatment of meibomian gland dysfunction(MGD).Methods:213 subjects diagnosed with MGD underwent three sessions of IPL treatment in a control(M22)treatment group or experimental(OPL-I)treatment group and were followed up three to four weeks after each session.Tear breakup time(TBUT),meibomian gland secretion scores(MGSS),meibomian gland meibum scores(MGMS),corneal fluorescein staining(CFS)scores,and the Standard Patient Evaluation of Eye Dryness(SPEED)was used to assess eye dryness signs and symptoms at baseline and follow-up visits.Results:Two machines had the same working principles except that experimental(OPL-I)group consist of a dual filter system.Both groups showed significant improvements(P<0.0001)in TBUT,MGSS,MGMS,CFS scores and SPEED scores.Non-inferiority analysis showed no statistically significant differences in any result between the two groups.Various defects appeared on the filter with the extension of usage time.Spectrophotometry showed that light intensity decreased to 93.5%±0.46%past the first filter.Conclusions:IPL treatment completed with different machines have the same effect on improving the symptoms and signs of MGD.The dual filter system in the IPL machine reduces light intensity by approximately 6.5%without affecting its therapeutic effect.It is a feasible measure to ensure double safety and has the significance of popularization not only for MGD but also in other IPL treatment scenarios.展开更多
In multiobjective optimization, trade-off analysis plays an important role in determining most preferred solution. This paper presents an explicit interactive trade-off analysis based on the surrogate worth trade-off ...In multiobjective optimization, trade-off analysis plays an important role in determining most preferred solution. This paper presents an explicit interactive trade-off analysis based on the surrogate worth trade-off function to determine the best compromised solution. In the multiobjective framework thermal power dispatch problem is undertaken in which four objectives viz. cost, NOx emission, SOx emission and COx emission are minimized simultaneously. The interactive process is implemented using a weighting method by regulating the relative weights of objectives in systematic manner. Hence the weighting method facilitates to simulate the trade-offrelation between the conflicting objectives in non-inferior domain. Exploiting fuzzy decision making theory to access the indifference band, interaction with the decision maker is obtained via surrogate worth trade-off （SWT） functions of the objectives. The surrogate worth trade-off functions are constructed in the functional space and then transformed into the decision space, so the surrogate worth trade-off functions of objectives relate the decision maker＇s preferences to non-inferior solutions through optimal weight patterns. The optimal solution of thermal power dispatch problem is obtained by considering real and reactive power losses. Decoupled load flow analysis is performed to find the transmission losses. The validity of the proposed method is demonstrated on 11-bus, 17-lines IEEE system, comprising of three generators.展开更多
In the paper, it is discussed that the method on how to transform the multi-person bilevel multi-objective decision making problem into the equivalent generalized multi-objective decision making problem by using Kuhn-...In the paper, it is discussed that the method on how to transform the multi-person bilevel multi-objective decision making problem into the equivalent generalized multi-objective decision making problem by using Kuhn-Tucker sufficient and necessary condition. In order to embody the decision maker′s hope and transform it into single-objective decision making problem with the help of ε-constraint method. Then we can obtain the global optimal solution by means of simulated annealing algorithm.展开更多
基金Supported by the Fund of National Project of High.technicResearch and Development,(No.2003AA223269)
文摘Objective： To evaluate the effectiveness and safety of lyophilized Salvia salt of lithospermic acid powder for injection （SSLA） in treating coronary heart diseases angina pectoris （CHD-AP） of Xin-blood stasis syndrome type, and to conduct the non-inferiority trial with Danshen injection （丹参注射液, DSI） as positive control. Methods： An non-inferiority clinical layered, segmented, randomized, and blinded trial on three parallel and multiple centered groups was conducted in 480 patients with stable effort angina grade Ⅰ , Ⅱand Ⅲ, who had two or more times of attack every week. The 240 patients in test group A were treated with SSLA 200 mg added in 250 ml of 5% glucose solution for intravenous dripping every day; the 120 patients in test group B were treated with SSLA but the dosage doubled; and the 120 patients in the control group were treated with DSI 20 ml daily in the same method as SSLA was given. The clinical effectiveness and safety were evaluated after the patients were treated for 14 days. Results： The results showed that the markedly effective rate in test groups A, B and control group was 37.45 %, 36.75 % and 30.09 % respectively, while the total effective rate in them was 88.09%, 89.74% and 67.26% respectively. Statistical significance was shown in comparisons of the therapeutic effect between control group with test group A and test group B, with that in the two test groups superior to that in the control group, and non-inferiority trial showed eligibility （P〈0.01）. Adverse reaction appeared in 8 patients in the test groups and 2 in the control group. Conclusion： SSLA has definite therapeutic effect in treating patients with CHD-AP, with its effect not inferior to that of DSI, and no evident toxic-adverse reaction.
文摘The NI （non-inferiority） trial design based on the likelihood ratio test eliminates the dependency on the conventional NI margin, and it explicitly uses the MCID （minimum clinical important difference） that links the statistical analysis to the clinical sense. Different from the conventional trial design, the new methodology is self-adaptive to the change in the sample size and overall cure rate, and it has an asymptotic property. It is shown that MCID is de-composite into constant MCID and statistical MCID. Along with this concept, the concept of the allowed inferiority does not exist, the interpretation of the trial result is more accurate and consistent to the statistical theory as well as the clinical interpretations.
基金General Project of the National Natural Science Foundation of China(No.81572007)。
文摘Objective:To evaluate the effect of tenofovir alafenamide versus tenofovir disoproxil fumarate on antiviral efficacy in patients with hepatitis B virus infection.Methods:Randomized controlled trials were searched on CNKI,Wanfang,VIP,China Biomedical Literature Database,PubMed,Cochrane Library,Embase,ClinicalKey,Chinese Clinical Trial Registry and ClinicalTrials.gov from the date of inception to April 2020.The literature was screened according to the inclusion and exclusion criteria,and the efficacy evaluation index of the included RCT was set as the success rate of reaching the endpoint of viral suppression and achieving normalized ALT values at 48 weeks of treatment.Intentionality analysis was adopted and the analysis results were taken as the final conclusion.RevMan 5.3 software was used for this Meta-analysis.Meanwhile,VassarStats was used to evaluate the non-inferiority of TAF and calculate the difference of virus inhibition efficiency rate and 95%confidence interval between experimental group and the control group of each RCT.Results:After the literature search,411 potential articles were found,5 studies were finally included according to the criteria,and 2,120 patients were included.Intentionality analysis showed that TAF regimen and TDF regimen had similar viral suppression success rates(RR=0.97,95%CI:0.94~1.01,P=0.19).The ALT normalization rate in the TAF treatment group was higher than that in the TDF treatment group,and the difference was statistically significant(RR=1.35,95%CI:1.20-1.53,P<0.00001).The non-inferiority margin was set at 10%,and it was found that three RCT studies in the international multi-center all showed that TAF was not inferior to TDF in controlling HBV viral load,while two RCT studies in China's Mainland failed to achieve non-inferiority after calculation.Conclusions:At 48 weeks of treatment,TAF was similar to TDF in controlling HBV viral load.However,the efficacy of TAF in controlling HBV viral load may vary among different populations,which requires further confirmation by more clinical trial evidence.Based on AASLD criteria,the ALT normalization rate of the TAF group was higher than that of the TDF group at 48 weeks of treatment,showing an obvious advantage.
基金This study was supported by the grant from Shanghai Excellent Academic Leaders Program(No.21XD1404900)Shanghai Public Health Key Discipline Project(No.GWVI-11.1-21)
文摘Background:An evidence gap still exists regarding the efficacy and safety of tegoprazan in patients with erosive esophagitis(EE)in China.This study aimed to verify the efficacy and safety of tegoprazan vs.esomeprazole in patients with EE in China.Methods:This study was a multicenter,randomized,double-blind,parallel,active-controlled,non-inferiority phase III trial of patients with EE randomized 1:1 to tegoprazan 50 mg/day vs.esomeprazole 40 mg/day.This study was conducted in 32 sites between October 24,2018 and October 18,2019.The primary endpoint was the cumulative endoscopic healing rate at week 8.The secondary endpoint included endoscopic healing rate at week 4,changes in the reflux disease questionnaire(RDQ)and gastroesophageal reflux disease health-related quality of life(GERD-HRQL)scores,and symptom improvement.Results:A total of 261 patients were randomized:132 to the tegoprazan group and 129 to the esomeprazole group.The cumulative endoscopic healing rate at 8 weeks in the tegoprazan group was non-inferior to that of the esomeprazole group(91.1%vs.92.8%,difference:-1.7%,95%confidence interval[CI]:-8.5%,5.0%,P=0.008).There were no statistically significant differences in the changes in RDQ(total,severity,and frequency)and GERD-HRQL scores between the two groups(all P>0.05).The percentages of days without symptoms,including daytime and nighttime symptoms based on patients'diaries,were similar between the two groups(all P>0.05).In the tegoprazan and esomeprazole groups,71.5%(93/130)and 61.7%(79/128)of the participants reported adverse events(AEs),2.3%and 0 experienced serious AEs,while 70.0%and 60.2%had treatment-emergent AEs,respectively.Conclusion:Tegoprazan 50 mg/day demonstrated non-inferior efficacy in healing EE,symptom improvement,and quality of life,and it has similar tolerability compared with esomeprazole 40 mg/day.
基金This study was supported by a grant from the National Natural Science Foundation of China （No. 30371253）.
文摘Objective The determination of non-inferiority margin is an important and confusing issue which directly influences the acceptability of a new medication. We reviewed the published literature, International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use （ICH） Guidelines and Committee for Proprietary Medicinal Products （CPMP） papers on the selection of non-inferiority margin and the corresponding statistical tests in clinical trials, in order to provide practical recommendations and suggestions for establishing reference criteria for the non-inferiority margin in China. Data sources The literature on the selection of a non-inferiority margin and statistical tests was mainly extracted from relevant English articles on non-inferior clinical trials published from 1990 to 2007. The starting point （1990） was chosen due to lack of such papers published prior to 1990. This literature was searched via PubMed, Medline and Chinese Knowledge Information （CNKI）. ICH guidelines and CPMP papers were downloaded from their official websites. The keywords ＂clinical trial＂, ＂non-inferiority＂ and ＂non-inferiority margin＂ were used. Study selection Forty-three original articles and critical reviews, ICH El0 guideline and CPMP papers were selected. Results The non-inferiority testing with treatment difference and ratio are commonly used, where the non-inferiority margin is determined with and without historical data. Traditionally, this margin is treated as a fixed value, while developed methods take the variation into account in the determination of this margin, on which the test depends is more convincing. The mixed margin consisting of a margin based on treatment difference and a margin based on treatment ratio can exactly control the type I error at the desirable level and obtain a better power. In this review, we also provide some recommendations and suggestions for the selection of the non-inferiority margin in the western countries and China. Conclusions Besides the magnitude and variability of the standard control and placebo effects, the determination of the margin depends on other factors, such as, the safety profiles of the two comparative therapies, method of administration and product cost. Hence the margin should be made specifically for a certain case. Reference criteria for different medications should be given to avoid the arbitrary conclusion.
文摘Background:The pharmacokinetic and clinical behaviors of many proton pump inhibitors(PPIs)in peptic ulcer treatment are altered by CYP2C19 genetic polymorphisms.This non-inferiority study evaluated the efficacy and safety of the novel PPI anaprazole compared with rabeprazole.We also explored the influence of Helicobacter pylori(H.pylori)infection status and CYP2C19 polymorphism on anaprazole.Methods:In this multicenter,randomized,double-blind,double-dummy,positive-drug parallel-controlled,phase Ⅲ study,Chinese patients with duodenal ulcers were randomized 1:1 to receive rabeprazole 10 mg+anaprazole placebo or rabeprazole placebo+anaprazole 20 mg once daily for 4 weeks.The primary efficacy endpoint was the 4-week ulcer healing rate assessed by blinded independent review.Secondary endpoints were the proportion of patients with improved overall and individual duodenal ulcer symptoms at 4 weeks.Furthermore,exploratory subgroup analysis of the primary endpoint by H.pylori status and CYP2C19 polymorphism was conducted.Adverse events were monitored for safety.Non-inferiority analysis was conducted for the primary endpoint.Results:The study enrolled 448 patients(anaprazole,n=225;rabeprazole,n=223).The 4-week healing rates were 90.9%and 93.7%for anaprazole and rabeprazole,respectively(difference,-2.8%[95%confidence interval,-7.7%,2.2%]),demonstrating non-inferiority of anaprazole to rabeprazole.Overall duodenal ulcer symptoms improved in 90.9%and 92.5%of patients,respectively.Improvement rates of individual symptoms were similar between the groups.Healing rates did not significantly differ by H.pylori status or CYP2C19 genotype for either treatment group.The incidence of treatment-emergent adverse events was similar for anaprazole(72/220,32.7%)and rabeprazole(84/219,38.4%).Conclusions:The efficacy of anaprazole is non-inferior to that of rabeprazole in Chinese patients with duodenal ulcers.Registration:ClinicalTrials.gov,NCT04215653.
文摘Context: In recent years there has been increasing interest on publication bias and on initiatives to decrease bias, in- cluding trial registration. Objective: To test whether there has been an increase in reports of randomized control trials (RCT’s) with negative outcomes in major journals and to identify factors associated with these reports. Design: Retrospective review of reports of RCT’s published in the Journal of the American Medical Association, The Lancet and the New England Journal of Medicine before (2002-’03, pre-registration era) and after (2007-’08, registration era) the institution of mandatory trial registration. Main Outcome Measure: The primary outcome was the proportion of RCT reports with negative outcomes compared across the two eras. Secondary outcome includes other factors affecting pub-lication. Results: We identified 917 reports of RCT’s published in the two study eras. No publications in the pre-registration era reported trial registration compared with 94.4% in the registration era (p 0.001). There was a non-significant increase in negative trials from the pre-registration to the registration era (29.1% vs. 34.1%, p = 0.10, OR 1.26, 95% CI 0.96 - 1.67). Study characteristics associated with negative outcomes include trials of drugs (OR 1.62, 95% CI 1.08 - 2.43), procedures or devices (OR 2.08, 95% CI 1.29 - 3.35), explicit identification of a single primary endpoint (OR 1.70, 95% CI 1.40 - 2.47), and increasing sample size (OR 3.08, 95% CI 1.78 - 5.34). Non-inferiority study design was associated with a decreased likelihood of a negative outcome (OR 0.13, 95% CI 0.05 - 0.31). Conclusions: The proportion of published RCT reports with negative outcomes in three major medical journals has not significantly increased since the mandatory clinical trial registration policy. The observed prevalence of negative trials is associated with increases in sample size and greater specificity in trial endpoints.
基金Supported by High and New Technology Project of Hainan Key Research and Development Plan(No.ZDYF2024GXJS032)Health Care Special Project of PLA Logistics Research Fund(No.23BJZ37)Scientific Research Project of Health Industry in Hainan Province(No.22A200351).
文摘AIM:To evaluate nanosilver eye patches versus Atrauman nanosilver dressings for ocular surface trauma.METHODS:This randomized non-inferiority trial(November 2024-April 2025)enrolled 60 patients assessed pre-treatment and on days 1,7,and 14 post-treatment.The patients were then randomized into treatment(nanosilver eye patches)and control groups(Atrauman nanosilver dressings).Outcomes included wound healing,comfort(Ocular Comfort Index,OCI),and safety.Statistical analyses used t-tests,non-inferiority tests,and Chi-square tests.RESULTS:Patient baseline characteristics were comparable between groups,with a mean age of 60.633±10.934 in the treatment group versus 64.933±9.606 in controls,and similar gender distribution(20/10 vs 17/13 male/female).Both groups showed comparable baseline OCI scores(treatment group:6.100±2.187 vs control group:6.267±2.303,P=0.775).Following treatment,scores increased significantly at day 1(treatment group:9.367±2.251;control group:9.067±2.212,both P<0.001 vs baseline).Marked improvement was observed by day 7(treatment group:4.067±1.929;control group:3.900±1.918,P<0.001 vs baseline),with complete resolution at day 14(0.467±0.860 vs 0.467±1.008,P<0.001).The non-inferiority criterion was met.The treatment group showed greater improvement in Grade A wound healing rates(76.67%to 93.33%)compared to controls(80.00%to 86.67%)between 1 and 7d post-treatment.By 14d posttreatment,all patients achieved Grade A healing in both groups,with no Grade C cases observed throughout the study period.No adverse events were reported.CONCLUSION:Nanosilver eye patches are non-inferior to Atrauman dressings,offering effective,safe emergency care for ocular trauma.
基金Boehringer lngelheim lnternational GmbH sponsored this study.
文摘Objective:To evaluate the non-inferiority of pramipexole extended-release(ER)versus immediate-release(IR)in Chinese patients with Parkinson’s disease(PD)in a double-blind,randomized,parallel-group study.Methods:Subjects were Chinese patients with idiopathic PD with diagnosis≥2 years prior to trial,age≥30 years old at diagnosis,and Modified Hoehn and Yahr score 2-4 during‘on’-time.Subjects received treatment with pramipexole ER(n=234)or IR(n=239).Non-inferiority was based on the primary endpoint,the change from baseline to end of maintenance(week 18)in the UPDRS(Parts II+III)total score.Results:For the primary endpoint,the adjusted mean changes(standard error)of UPDRS Parts II+III at week 18 were−13.81(0.655)and−13.05(0.643)for ER and IR formulations,respectively,using ANCOVA adjusted for treatment and centre(fixed effect)and baseline(covariate).The adjusted mean between group difference was 0.8 for the 2-sided 95%CI(−1.047,2.566).Since the lower limit of the 2-sided 95%CI(−1.047)for treatment difference was higher than the non-inferiority margin of−4,non-inferiority between pramipexole ER and IR was demonstrated.The incidence of adverse events(AEs)was 68.8%in the ER arm and 73.6%in the IR arm with few severe AEs(ER:2.1%;IR:3.8%).Conclusion:Based on the UPDRS II+III score,pramipexole ER was non-inferior to pramipexole IR.The safety profiles of pramipexole ER and IR were similar.These results were based on comparable mean daily doses and durations of treatment for both formulations.
基金supported by the National Natural Science Foundation of China:[grant numbers:82171013,81870624]Major Science and Technology Projects of Zhejiang Province[grant numbers:2022C03173].
文摘Purpose:This study aimed to determine the therapeutic effectiveness of different machines in intense pulsed light(IPL)treatment of meibomian gland dysfunction(MGD).Methods:213 subjects diagnosed with MGD underwent three sessions of IPL treatment in a control(M22)treatment group or experimental(OPL-I)treatment group and were followed up three to four weeks after each session.Tear breakup time(TBUT),meibomian gland secretion scores(MGSS),meibomian gland meibum scores(MGMS),corneal fluorescein staining(CFS)scores,and the Standard Patient Evaluation of Eye Dryness(SPEED)was used to assess eye dryness signs and symptoms at baseline and follow-up visits.Results:Two machines had the same working principles except that experimental(OPL-I)group consist of a dual filter system.Both groups showed significant improvements(P<0.0001)in TBUT,MGSS,MGMS,CFS scores and SPEED scores.Non-inferiority analysis showed no statistically significant differences in any result between the two groups.Various defects appeared on the filter with the extension of usage time.Spectrophotometry showed that light intensity decreased to 93.5%±0.46%past the first filter.Conclusions:IPL treatment completed with different machines have the same effect on improving the symptoms and signs of MGD.The dual filter system in the IPL machine reduces light intensity by approximately 6.5%without affecting its therapeutic effect.It is a feasible measure to ensure double safety and has the significance of popularization not only for MGD but also in other IPL treatment scenarios.
文摘In multiobjective optimization, trade-off analysis plays an important role in determining most preferred solution. This paper presents an explicit interactive trade-off analysis based on the surrogate worth trade-off function to determine the best compromised solution. In the multiobjective framework thermal power dispatch problem is undertaken in which four objectives viz. cost, NOx emission, SOx emission and COx emission are minimized simultaneously. The interactive process is implemented using a weighting method by regulating the relative weights of objectives in systematic manner. Hence the weighting method facilitates to simulate the trade-offrelation between the conflicting objectives in non-inferior domain. Exploiting fuzzy decision making theory to access the indifference band, interaction with the decision maker is obtained via surrogate worth trade-off （SWT） functions of the objectives. The surrogate worth trade-off functions are constructed in the functional space and then transformed into the decision space, so the surrogate worth trade-off functions of objectives relate the decision maker＇s preferences to non-inferior solutions through optimal weight patterns. The optimal solution of thermal power dispatch problem is obtained by considering real and reactive power losses. Decoupled load flow analysis is performed to find the transmission losses. The validity of the proposed method is demonstrated on 11-bus, 17-lines IEEE system, comprising of three generators.
基金This project is supported by National Natural Science Foundation of China( 6 9874 0 0 9) and theNatural Science Foundation of Heilongjiang Province( A0 0 0 4 )
文摘In the paper, it is discussed that the method on how to transform the multi-person bilevel multi-objective decision making problem into the equivalent generalized multi-objective decision making problem by using Kuhn-Tucker sufficient and necessary condition. In order to embody the decision maker′s hope and transform it into single-objective decision making problem with the help of ε-constraint method. Then we can obtain the global optimal solution by means of simulated annealing algorithm.
