Intention-to-treat concept: A review

SandeepK Gupta · Perspectives in Clinical Research · 2011 · statistics · 10.4103/2229-3485.83221 · record gupta2011-intention-treat-concept-review
tag layer · index · concepts · authors · עברית
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Other fields define these differently the same word, defined another way in another discipline
sample size 5 fields · heterogeneity 3 fields

Tags on this paper

Every tag the record carries, each linking to every other paper in the corpus that carries it. A tag appears here whether or not its words occur in the article — the spans below are only the ones a sentence in this paper licenses. Of the 13 concept tags on this paper, all 13 are grounded in a quoted sentence. All carry the tagger's gloss of what the term means in this paper, which is not something the article can license.
intention-to-treat ITT analysis per-protocol modified ITT full analysis set noncompliance prognostic balance type II error sample size last observation carried forward noninferiority superiority trial heterogeneity analysis population a bias and a power loss that are the same property seen twice review
Method, as described: narrative review of the ITT principle and the regulatory guidance around it - FDA, CPMP and ICH E9 - written to introduce the concept to clinical research beginners

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relation to other workclaim_relationshow this paper stands to another: agrees, contradicts, extends, qualifies
claim typeclaim_typethe shape of the claim: existence, mechanism, method, critique, prediction, null
concept edgeconcept_edgesan asserted relation between two concepts, with the sentence asserting it
conceptconceptsan idea the paper works with, quoted where the paper uses it
content tagcontent_tagsa finding, definition, quantity, statistic or variable named in the paper
contributioncontributionwhat the paper claims to add
controlcontrolsan experiment run to eliminate a rival explanation
limitationlimitationswhat the paper says its evidence cannot support
mechanismmechanismshow the reported effect is said to come about
methodmethodhow the paper produced its evidence
object of studyobject_of_studywhat the paper is about — the thing it investigates
phenomenonphenomenonthe effect or regularity under study
research questionresearch_questionthe question the paper sets itself
sensesensesa distinct use of a term, quoted where the paper fixes it
transfertransfersa method or concept carried in from another field

The paper

The full text is not reproduced here. This article is not cleared for redistribution, so the page carries the tag layer only. Its evidence sentences are withheld; the grounding status remains with each tag, and the article itself is at https://doi.org/10.4103/2229-3485.83221. The reading view exists for the papers whose licence permits it.

Every tag on this page

claim_relations 3 · claim_type 1 · concept_edges 2 · concepts 13 · content_tags 14 · contribution 1 · controls 3 · limitations 5 · mechanisms 8 · method 1 · object_of_study 1 · phenomenon 1 · research_question 1 · senses 5 · transfers 2

Relations on this page carry a quotation for the claim. Where a relation was separately evidenced — and so tested against the vocabulary for its type — the row says so; 2 of 2 relations here carry that mark. The rest are the tagger’s reading of the sentence quoted beside them.

facettagfieldconf.whose words
object_of_studythe analysis population of a randomised trial - which subjects are counted when compliance and follow-up fail - and the several incompatible definitions the regulators and the literature give it
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object_of_studythe paper's words
research_questionwhat the intention-to-treat principle is, what it buys, what it costs, and where the guidelines disagree about applying it
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research_questionthe paper's words
contributionassembles the definitions of ITT, per-protocol, modified ITT and the full analysis set side by side with the regulator that issues each, and reports that the modified variant has no consistent definition at all
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contributionthe paper's words
claim_typecritique
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claim_typethe paper's words
phenomenonone analysis population with four names in circulation, each attached to a different regulator, and a modified variant defined case by case
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phenomenonthe paper's words
methodreview
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also in: review
methodthe paper's words
mechanismsTHE DEFINITION IS A TRIPLE REFUSAL TO CONDITION ON ANYTHING THAT HAPPENED AFTER RANDOMISATION - `regardless of their adherence with the entry criteria, regardless of the treatment they actually received, and regardless of subsequent withdrawal from treatment or deviation from the protocol`
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mechanisms[0]0.95the tagger's words
mechanismsand the reason is that the alternative destroys what randomisation bought: `If noncompliant subjects and dropouts are excluded from the final analysis, it might create important prognostic differences among treatment groups` - and subjects `may be noncompliant or may drop out due to their response of treatment`
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mechanisms[1]0.95the tagger's words
mechanismsTHE COST IS PAID IN THE SAME COIN. `In ITT analysis, estimate of treatment effect is generally CONSERVATIVE because of DILUTION due to noncompliance` - the property that makes it unbiased is the property that makes it small
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mechanisms[2]0.95the tagger's words
mechanismsso the criticism is symmetrical: ITT `has been criticized for being too cautious and thus being more susceptible to type II error`
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mechanisms[3]0.95the tagger's words
mechanismsAND THE TWO POPULATIONS FAIL IN OPPOSITE DIRECTIONS, WHICH IS WHY THE CHOICE IS NOT NEUTRAL. `ITT tends to make the two treatments look similar, whereas the PP removes patients who do not complete treatment and is more able to reflect treatment differences`
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mechanisms[4]0.95the tagger's words
mechanismsTHE MODIFIED VARIANT HAS NO STABLE DEFINITION AT ALL - `the definition given to the modified ITT (mITT) in randomized controlled trial has been found to be irregular and arbitrary because there is a lack of consistent guidelines for its application. The mITT analysis allows a subjective approach in entry criteria`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[5]0.95the tagger's words
mechanismsand it is not one population but many: `multiple mITT populations can be defined for a single study such as clinical mITT and microbiological mITT`
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mechanisms[6]0.95the tagger's words
mechanismsTHE SAME OBJECT CARRIES A THIRD NAME FROM A THIRD AUTHORITY - ICH E9 `uses the term FULL ANALYSIS SET to describe the analysis set which is as complete as possible and as close as possible to the ITT ideal`
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mechanisms[7]0.95the tagger's words
limitationsThe guidelines do not agree about where the principle applies. `Whereas the importance of the ITT population analysis in superiority designs has been well accepted, however there is no consensus about its role in non-inferiority trials`
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limitations[0]0.95the tagger's words
limitationsand the proposed resolution is to require both and hope they agree - `noninferiority should be concluded only if both ITT and PP analyses permit that` - which is a procedure rather than a principle, and the paper notes the conservative effect of PP on such trials `has not been thoroughly explored`
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limitations[1]0.95the tagger's words
limitationsthe remedy offered for the missing data ITT cannot ignore is itself contested - last observation carried forward, `whereby the LAST AVAILABLE MEASUREMENT for each individual at the time point prior to withdrawal IS RETAINED in the analysis`, presented here without its known bias
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limitations[2]0.85the tagger's words
limitationsThis is a narrative review for beginners, not a systematic one. No search strategy, no inclusion criteria and no synthesis are reported; the claims about what the literature finds - including the central one about mITT - are carried by citation
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limitations[3]0.85the tagger's words
limitationsand the practical advice at the end withdraws the problem rather than solving it: `Anyone who follows these principles intelligently and has a vision to minimize bias should not worry further about 'INTENTION TO TREAT'`
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limitations[4]0.95the tagger's words
transfersintention-to-treat is a statistical concept imported into the conduct and reporting of randomized controlled trials to handle noncompliance and missing outcomes
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transfers[0]0.95the tagger's words
transfersthe analysis set is defined by the randomized assignment rather than by the treatment actually received, which is what preserves the randomization
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transfers[1]0.95the tagger's words
controlsrandomisation itself - allocating subjects to arms after eligibility is assessed but before the intervention is given
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eliminates: systematic difference between the groups at baseline; ITT exists to protect this and per-protocol analysis is what spends it · outcome: held
controls[0]0.95the tagger's words
controlsrequiring full reporting of every deviation from random allocation and every missing response, as CONSORT does
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
eliminates: an ITT label attached to an analysis whose exclusions the reader cannot see; the guideline makes the departures visible rather than forbidding them · outcome: held
controls[1]0.95the tagger's words
controlsrequiring the ITT and per-protocol analyses to agree before a non-inferiority claim is made
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
eliminates: a conclusion that depends on which population was chosen - the two are known to fail in opposite directions, so agreement between them is informative · outcome: partial
controls[2]0.95the tagger's words
conceptsintention-to-treat
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concepts[0]0.95the paper's words
conceptsITT analysis
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also in: ITT analysis
concepts[1]0.95the paper's words
conceptsper-protocol
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: per-protocol
concepts[2]0.95the paper's words
conceptsmodified ITT
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: modified ITT
concepts[3]0.95the paper's words
conceptsfull analysis set
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[4]0.95the paper's words
conceptsnoncompliance
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: noncompliance
concepts[5]0.95the paper's words
conceptsprognostic balance
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[6]0.95the paper's words
conceptstype II error
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: type II error
concepts[7]0.95the paper's words
conceptssample size
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: sample size
concepts[8]0.95the paper's words
conceptslast observation carried forward
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[9]0.95the paper's words
conceptsnoninferiority
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concepts[10]0.95the paper's words
conceptssuperiority trial
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[11]0.95the paper's words
conceptsheterogeneity
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also in: heterogeneity
concepts[12]0.95the paper's words
senses`intention-to-treat` (Fisher et al. 1990) - all randomised patients in their assigned groups, `regardless of their adherence with the entry criteria, regardless of the treatment they actually received, and regardless of subsequent withdrawal`
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senses[0]0.95the tagger's words
senses`intention-to-treat` (the slogan) - `once randomized, always analyzed`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[1]0.95the tagger's words
senses`full analysis set` (ICH E9) - the analysis set `as complete as possible and as close as possible to the ITT ideal` - the same object under a third name
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senses[2]0.95the tagger's words
senses`modified ITT` - a subset with exclusions `in a justified way`, whose definition the literature finds `irregular and arbitrary`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[3]0.95the tagger's words
senses`ITT` as a whole-trial strategy - `better regarded as a complete trial strategy for design, conduct and analysis rather than as an approach to analysis alone`
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senses[4]0.95the tagger's words
claim_relationscritiques → the modified ITT population as used in randomised trials, whose definition the paper reports as irregular, arbitrary and lacking consistent guidelines
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claim_relations[0]0.95the tagger's words
claim_relationssupports → the CONSORT requirement that participants be analysed by the intention-to-treat principle and that deviations be fully reported
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claim_relations[1]0.95the tagger's words
claim_relationsconcedes → that ITT dilutes the treatment effect and is more susceptible to type II error - the arguments against it 'appear valid'
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claim_relations[2]0.95the tagger's words
concept_edgesITT analysis —distinct-from→ per-protocol
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'ITT tends to…' Not two views of one number - two numbers, and the analyst picks which before seeing either. · the relation stated: ITT keeps the noncompliers and dilutes the difference; per-protocol removes them and shows it - so the choice of population moves the answer, in a direction that is known in advance
concept_edges[0]0.95the tagger's words
concept_edgessuperiority trial —distinct-from→ noninferiority
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'WHEREAS the importance…' The same method, the same population, and its authority is a property of the question being asked - which is why 'use ITT' is not an instruction. · the relation stated: ITT's standing depends on what the trial is trying to show: settled as primary in a superiority design, unsettled in a non-inferiority one Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but the span writes 'non-inferiority', and the ITT role differs between the two designs; distinct-from is loose.
concept_edges[1]0.95the tagger's words
content_tagsTHE DEFINITION IS A TRIPLE `regardless of` - all randomised patients in their assigned groups `regardless of their adherence with the entry criteria, regardless of the treatment they actually received, and regardless of subsequent withdrawal`
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content_tags.findings[0]0.95the tagger's words
content_tagsAND IT HAS A SLOGAN THAT IS SHORTER THAN THE DEFINITION - ITT analysis `is usually described as once randomized, always analyzed`
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content_tags.findings[1]0.95the tagger's words
content_tagsTHE MODIFIED VARIANT'S DEFINITION IS IRREGULAR AND ARBITRARY, AND THE PAPER SAYS SO - `there is a lack of consistent guidelines for its application. The mITT analysis allows a subjective approach in entry criteria, which may lead to confusion, inaccurate results and bias`
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content_tags.findings[2]0.95the tagger's words
content_tagsAND ONE STUDY CAN HOLD SEVERAL OF THEM - `multiple mITT populations can be defined for a single study such as clinical mITT and microbiological mITT`
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content_tags.findings[3]0.95the tagger's words
content_tagsICH E9 calls it the full analysis set: as complete as possible and as close as possible to the ITT ideal
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content_tags.findings[4]0.95the tagger's words
content_tagsITT tends to make treatments look similar, while per-protocol analysis better reflects treatment differences
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content_tags.findings[5]0.95the tagger's words
content_tagsITS AUTHORITY DEPENDS ON THE QUESTION - settled as primary in superiority designs, and `there is no consensus about its role in non-inferiority trials`
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content_tags.findings[6]0.95the tagger's words
content_tagsITT analysis
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also in: ITT analysis
content_tags.definitions[0]0.95the tagger's words
content_tagsfull analysis set
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content_tags.definitions[1]0.95the tagger's words
content_tagsmodified ITT
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also in: modified ITT
content_tags.definitions[2]0.95the tagger's words
content_tagslast observation carried forward
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content_tags.definitions[3]0.95the tagger's words
content_tagscomplications ITT exists to absorb
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content_tags.quantities[0]0.95the tagger's words
content_tagsITT `gives an unbiased estimate of treatment effect` and its estimate `is generally CONSERVATIVE because of DILUTION due to noncompliance`. Both sentences are true and they describe one mechanism - keeping the noncompliers is what preserves the randomisation and what shrinks the difference. A reader who quotes either alone has quoted half of it.
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content_tags.statistics[0]0.95the tagger's words
content_tagsanalysis population
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content_tags.variables[0]0.95the tagger's words

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