Randomization is widely acknowledged to be one of the more, if not the most, important parts of a properly planned and designed clinical trial. Flaws at a randomization level might lead to systematic imbalances in the allocation of patients to treatment groups, ultimately resulting in a lack of control of the overall type I error (i.e.: the pre-specified α level used as a reference for hypothesis testing). Whilst generation of randomization lists based on ‘static’ algorithms (e.g. stratified algorithms) is a relatively easy and standard process that can be done using standard software, a new type of method, that we’ll refer to as ‘dynamic’ randomization, is also increasingly used. This requires more complex algorithms to be embedded in the Interactive Web Response System (IWRS) integrated with the study database. The reason for this is that whilst with common algorithms the list of treatment allocations is fully determined a priori, i.e.: before we know the characteristic of the subjects that will be randomized, dynamic methods generate the randomization list case-wise, that is only when a new patients come in, using minimization algorithms to make sure that the groups are balanced with respect to specific characteristics not only when all subjects have been recruited, but during the whole recruitment process.
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