Intention to treat and per protocol analysis in clinical trials
Open accessAbstract
In clinical epidemiology, experimental studies usually take the form of randomized controlled clinical trials (RCTs). The data analysis of an RCT can be performed by using two complementary strategies, that is according to the intention to treat (ITT) principle and the per protocol (PP) analysis. By using the ITT approach, investigators aim to assess the effect of assigning a drug whereas by adopting the PP analysis, researchers investigate the effect of receiving the assigned treatment, as specified in the protocol. Both ITT and PP analyses are essentially valid but they have different scopes and interpretations dependent on the context.
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The intention-to-treat (ITT) approach provides an unbiased estimate to treatment effect.
“As suggested, the ITT will be used as the main method of analysis to determine effectiveness as it provides an unbiased estimate to treatment effect”
From A randomised controlled trial comparing internet-delivered cognitive behavioural therapy (iCBT) with and without main carer access versus treatment-as-usual for depression and anxiety among breast cancer survivors: Study protocol (2021) · cites this paper as Tripepi et al., 2020
Section 2 (ITT AND PP APPROACHES) says ITT preserves comparability between randomized groups and aims to avoid selection bias. Section 4 (CONCLUSIONS) says it reduces bias and estimates the effect of assigning treatment, not that it provides an unbiased estimate of treatment effect generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIntent-to-treat analyses were conducted with all randomized participants included.
“For all analyses, we conducted intent-to-treat (ITT) analyses (Tripepi et al., 2020), with all randomized participants included.”
From Distress tolerance as a mediator of mindfulness-based intervention for anxiety and depression: Evidence from two randomized controlled trials (2024) · cites this paper as Tripepi et al., 2020
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- Authors
- Tripepi, G., Chesnaye, N. C., Dekker, F. W., Zoccali, C., & Jager, K. J.
- Affiliations
- CNR‐IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension Reggio Calabria Italy
- Amsterdam UMC Location University of Amsterdam (NL)
- Leiden University Medical Center (NL)
- Corresponding author
- Tripepi, Giovanni
- Venue
- Nephrology
- Publisher
- Wiley
- Published
- 2020-03-15
- Volume
- 25
- Issue
- 7
- Pages
- 513-517
- ISSN
- 1320-5358 (ISSN-L)
- 1440-1797
- OpenAlex
- W3010995490
- Cited by
- 284
- References
- 10
- Citations by year
- 2026: 47 · 2025: 69 · 2024: 66 · 2023: 53 · 2022: 30 · 2021: 18 · 2020: 1
- FWCI
- 17.98
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amc.nl
- Licence
- Locations
- Nephrology (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Keywords
- intention-to-treat analysis, per-protocol analysis, randomized controlled trials, treatment effect estimation, protocol adherence, clinical trial data analysis
- MeSH terms
- Clinical Protocols, Humans, Reproducibility of Results, Randomized Controlled Trials as Topic, Intention to Treat Analysis
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