Monitoring boundaries for adverse effects in long-term clinical trials

The typical long-term trial has a data monitoring committee. A primary responsibility of this committee is maintenance of patient safety. In this role, this committee is likely to recommend stopping a trial when a new treatment appears worse than the control even when the difference is not statistically significant or if it appears that the new treatment will not be clearly beneficial. Several approaches, including the use of conditional power, can be used to help the monitoring committee decide if a study should be stopped early because of a harmful or insufficiently effective treatment. These monitoring approaches have altered the way in which we view one-sided or two-sided tests of significance.