What does it mean when a trial shows treatment B is “not noninferior” to treatment A? Why the convoluted wording?

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I always have trouble making sense of noninferiority studies. If treatment B is noninferior to A, I can understand that. But when it says B is NOT noninferior to A, why can’t they just say B is inferior to A? What’s the difference?

Example of such a trial: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00537-2/fulltext

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Anonymous 0 Comments

It’s complicated, but non-inferiority trials are done when it would be unethical to give people placebos. For example, consider a promising new cancer drug. In a standard superiority test, you’d compare the efficacy of the drug to a placebo. It would be unethical, however, to give sugar pills to cancer patients. So you do a study (often a meta study) to show that the new drug is *at least* not inferior to existing treatments.

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