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To investigate this phenomenon, we examined a cohort of 396 published oncology trials from 4 journals (2022-2025) to assess the differential pretreatment withdrawal rates. We found that in 35 open-label trials with 2:1 randomization, patients were, on average, 3.72 times more likely to withdraw from the control arm (95% CI = 2.66 to 5.22). This rate poses a larger relative risk than was seen in the 181 open-label trials with 1:1 randomization (relative risk = 1.99, 95% CI = 1.67 to 2.37). To avoid differential withdrawal, trials should be blinded when possible.<\/jats:p>","DOI":"10.1093\/jnci\/djag351","type":"journal-article","created":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T11:33:36Z","timestamp":1790508816000},"source":"Crossref","is-referenced-by-count":0,"title":["Two-to-one randomization is associated with increased control-arm patient withdrawal"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2359-8063","authenticated-orcid":false,"given":"Boris","family":"Freidlin","sequence":"first","affiliation":[{"name":"Biometric Research Program, National Cancer Institute , Bethesda, MD,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3298-437X","authenticated-orcid":false,"given":"Edward L","family":"Korn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026110309063565200_djag351-B1","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1093\/jnci\/djae028","article-title":"Association of differential censoring with survival and suboptimal control arms among oncology clinical trials","volume":"116","author":"Hsu","year":"2024","journal-title":"J Natl Cancer Inst"},{"key":"2026110309063565200_djag351-B2","doi-asserted-by":"publisher","first-page":"3783","DOI":"10.1200\/JCO-24-01200","article-title":"Equipoise lost? 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