Costs will be calculated for the base year

2012. Unit costs of other base years will be price-indexed. Safety monitoring An independent Data and Safety Monitoring Board (DSMB), consisting of three members (2 physicians and 1 clinical epidemiologist), is installed for this trial. On regular intervals, this committee will review accumulating trial data and provide advice on the conduct of the trial to the trial leader Inhibitors,research,lifescience,medical and Steering Committee. The DSMB will focus both on safety and effectiveness data. Standard Operating Procedures (SOP) will be used with respect to the schedule and format of DSMB meetings and with respect to the format and timing of presenting data. The DSMB can recommend the Steering Committee to terminate Inhibitors,research,lifescience,medical the trial when there is clear and substantial evidence of harm. Safety and efficacy monitoring The role of the DSMB is to perform an interim review of the

trial’s progress including updated figures on main outcomes and safety data. This review would include, but not be restricted to, the following: • monitor compliance Inhibitors,research,lifescience,medical with the protocol by participants and investigators; • monitor evidence for treatment differences in the main efficacy outcome measures; • monitor evidence for treatment harm (e.g. SAEs, deaths); • decide whether to recommend that the trial continues to recruit participants or whether recruitment should be terminated either for everyone or for some treatment groups and/or some participant subgroups; • suggest additional data analyses; • monitor compliance with previous DSMB recommendations; • consider the ethical implications of any recommendations made by the DSMB; • assess the impact and relevance of external Inhibitors,research,lifescience,medical evidence as supplied by the Chief Investigator. The DSMB will evaluate these safety and Inhibitors,research,lifescience,medical efficacy parameters at regular

intervals. After 275 (25%), 550 (50%) and 700 (65%) included patients, non-blinded interim-analyses for evaluation of safety rules will be performed. No formal stopping rules based on statistical criteria alone will be used. The DSMB decides after evaluation of all necessary interim data whether the trial will be continued or terminated. Other investigators, designated by the Board of Direct of the AMC to control the trial will have the authority to gain insight in all the confidential Thalidomide data relevant for the trial as well. Ethics This trial is conducted in accordance with the principles of the Declaration of Helsinki [30], the Medical Research Involving Human Subjects Act (WMO) and ‘Good Clinical Practice’ guidelines. The Medical Ethical Committee of the Academic Medical Center in Amsterdam has approved the protocol on January 6 2011. The Ethical Committees of the participating centers approved for local feasibility.