Noninferiority Trials Is a New Treatment Almost as Effective as Another?

Sometimes the goal of comparing a new treatment with a stan-dard treatment is not to find an approach that ismore effective but to findatherapythathasotheradvantages, suchas lowercost, fewer adverse effects, or greater con-venience with at least similar efficacy to the standard treat-ment.With other advantages, a treatment that is almost as effective as a standard treatmentmight bepreferred inpractice or for somepatients. Thepurposeof a non-inferiority trial is to rigorously evaluate a new treatment against an accepted and effective treatment with the goal of demonstrating that it is at least almost as good (ie, not inferior). In this issue of JAMA, Salminen et al describe the results of a multicenter noninferiority trial of 530 adults with computed tomography–confirmed acute appendicitis who were randomize