Yin MoCherry LimJames A. WatsonNicholas J. WhiteBen S. CooperNational University Hospital, SingaporeNational University of SingaporeMahidol UniversityNuffield Department of Medicine2020-08-252020-08-252020-07-01The BMJ. Vol.370, (2020)17561833095981462-s2.0-85087472907https://repository.li.mahidol.ac.th/handle/123456789/58100© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ. Non-adherence in non-inferiority trials can affect treatment effect estimates and often increases the chance of claiming non-inferiority under the standard intention-to-treat analysis. This article discusses the implications of different patterns of non-adherence in non-inferiority trials and offers practical recommendations for trial design, alternative analysis strategies, and outcome reporting to reduce bias in treatment estimates and improve transparency in reporting.Mahidol UniversityMedicineArticleSCOPUS10.1136/bmj.m2215