• Maria Elena Flacco, Lamberto Manzoli, Stefania Boccia, Lorenzo Capasso, Katina Aleksovska, Annalisa Rosso, Giacomo Scaioli, Corrado De Vito, Roberta Siliquini, Paolo Villari, and John P A Ioannidis.
• Department of Medicine and Aging Sciences, University of Chieti, Via dei Vestini 5, 66013 Chieti, Italy; Regional Healthcare Agency of the Abruzzo Region, Via Attilio Monti 9, 65127 Pescara, Italy.
• J Clin Epidemiol. 2015 Jul 1; 68 (7): 811-20.

ObjectivesTo map the current status of head-to-head comparative randomized evidence and to assess whether funding may impact on trial design and results.Study Design And SettingFrom a 50% random sample of the randomized controlled trials (RCTs) published in journals indexed in PubMed during 2011, we selected the trials with ≥ 100 participants, evaluating the efficacy and safety of drugs, biologics, and medical devices through a head-to-head comparison.ResultsWe analyzed 319 trials. Overall, 238,386 of the 289,718 randomized subjects (82.3%) were included in the 182 trials funded by companies. Of the 182 industry-sponsored trials, only 23 had two industry sponsors and only three involved truly antagonistic comparisons. Industry-sponsored trials were larger, more commonly registered, used more frequently noninferiority/equivalence designs, had higher citation impact, and were more likely to have "favorable" results (superiority or noninferiority/equivalence for the experimental treatment) than nonindustry-sponsored trials. Industry funding [odds ratio (OR) 2.8; 95% confidence interval (CI): 1.6, 4.7] and noninferiority/equivalence designs (OR 3.2; 95% CI: 1.5, 6.6), but not sample size, were strongly associated with "favorable" findings. Fifty-five of the 57 (96.5%) industry-funded noninferiority/equivalence trials got desirable "favorable" results.ConclusionThe literature of head-to-head RCTs is dominated by the industry. Industry-sponsored comparative assessments systematically yield favorable results for the sponsors, even more so when noninferiority designs are involved.Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

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