Oliver N. Keene | Searcharxiv

arXiv2026

Estimands and the Choice of Non-Inferiority Margin under ICH E9(R1)

Since the release of the ICH E9(R1) addendum on estimands, its application in non-inferiority trials has received far less attention than in superiority settings. A key conclusion from Lynggaard et al. was that the "choice of non-inferiority margin must reflect the chosen estimand." However, current regulatory guidance predates ICH E9(R1) and therefore does not reflect how the estimand influences the historical evidence and constancy assumption (assay sensitivity) used to derive the non-inferiority margin. This paper investigates the degree to which the non-inferiority margin depends on the estimand. Using simulated patient journeys in a weight-management setting, we illustrate how different intercurrent event strategies and variations in the intercurrent event frequency affect the estimand, and consequently the estimated treatment effect. These results emphasize that the historical treatment effect of the reference treatment versus placebo, and thus the margin $M_{1}$, is specific to an estimand and may differ even when trials formally target similar questions. We further illustrate the process of determining the non-inferiority margin using two examples in non-inferiority trials for a new theoretical weight management treatment. In the first example, we focus on the setting where the historical clinical trials use the estimand framework highlighting that even when they include the estimand framework, determining the non-inferiority margin can be challenging in case the historical trials target an estimand different from the one in the planned study. A second example highlights challenges when historical trials did not employ the estimand framework and the targeted estimand cannot be fully reconstructed.

stat.AP↗

arXiv2024

The Estimand Framework and Causal Inference: Complementary not Competing Paradigms

The creation of the ICH E9 (R1) estimands framework has led to more precise specification of the treatment effects of interest in the design and statistical analysis of clinical trials. However, it is unclear how the new framework relates to causal inference, as both approaches appear to define what is being estimated and have a quantity labelled an estimand. Using illustrative examples, we show that both approaches can be used to define a population-based summary of an effect on an outcome for a specified population and highlight the similarities and differences between these approaches. We demonstrate that the ICH E9 (R1) estimand framework offers a descriptive, structured approach that is more accessible to non-mathematicians, facilitating clearer communication of trial objectives and results. We then contrast this with the causal inference framework, which provides a mathematically precise definition of an estimand, and allows the explicit articulation of assumptions through tools such as causal graphs. Despite these differences, the two paradigms should be viewed as complementary rather than competing. The combined use of both approaches enhances the ability to communicate what is being estimated. We encourage those familiar with one framework to appreciate the concepts of the other to strengthen the robustness and clarity of clinical trial design, analysis, and interpretation.

stat.ME↗