A sequential test procedure for monitoring a singular safety and efficacy outcome

In this note we describe a modification of the sequential probability ratio test (SPRT) developed for the purpose of “flagging” a significant increase in the mortality rate of a treatment relative to a control while ensuring that double-blinding and the Type I error for the primary test of efficacy, also based on mortality rates, is not compromised.

Key words: Interim analysis; safety monitoring; sequential testing.