In this solo episode of "In the Interim...", Scott Berry, President and Senior Statistical Scientist at Berry Consultants, addresses deep-rooted confusion in the field of adaptive clinical trial design surrounding the concept of “spending alpha.” Drawing on practical experience and rigorous statistical foundations, Berry addresses the prevailing language and myths that conflate interim analysis with loss of type I error. He clarifies that, with planned and transparent allocation of alpha, interim analyses enable more power with more efficient design, and robust clinical trials—without sacrificing statistical validity. This is a precise and fact-driven examination for those demanding technical clarity, not marketing gloss.

Key Highlights

• Explains the basics of hypothesis testing in superiority trials, highlighting why a one-sided 2.5% alpha is the operational standard despite persistent use of two-sided 5% language in clinical protocols.
• Refutes the widespread belief that reviewing interim data costs available alpha, making clear that statistical error is not “penalized”—it is allocated, with potential efficiencies in average sample size and, in thoughtfully extended designs, gains in operating characteristics such as power.
• Describes real-world examples, including the SEPSIS-ACT (selepressin) trial sponsored by Ferring Pharmaceuticals, which incorporated more than 20 interim analyses while maintaining a pre-specified final alpha of 0.025; underscores the necessity of transparent, prospective design and explicit documentation for regulatory acceptance.
• Distinguishes between interim actions—such as futility analyses or response-adaptive randomization, which require no alpha adjustment, and early efficacy analyses, which must be precisely modeled to preserve type I error.
• Challenges terminology like “penalty” and “spending alpha,” asserting that imprecise language fosters misunderstanding and leads to missed opportunities in adaptive trial efficiency.
• Emphasizes the crucial role of prospective, simulation-based planning and clear protocol definition at every interim, anchoring statistical practice in measured evidence, not historical convention.