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Adjustment for baseline covariates can increase power and precision of estimated effects. However, inconsistently applying covariate adjustment throughout the stages of a group sequential trial can result in inflation of type I error, biased point estimates, and anticonservative confidence intervals. We propose methods for performing correct interim monitoring, estimation, and inference in this setting that avoid these issues. We focus on two\u2010arm trials with simple, balanced randomization and continuous outcomes. We study the performance of our boundary, estimation, and inference adjustments in simulation studies. We end with recommendations about the application of covariate adjustment in group sequential designs.<\/jats:p>","DOI":"10.1002\/sim.70082","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T12:15:37Z","timestamp":1747397737000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Accounting for Inconsistent Use of Covariate Adjustment in Group Sequential Trials"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6279-5978","authenticated-orcid":false,"given":"Marlena S.","family":"Bannick","sequence":"first","affiliation":[{"name":"Department of Biostatistics University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonya L.","family":"Heltshe","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8985-2474","authenticated-orcid":false,"given":"Noah","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of Washington  Seattle Washington USA"},{"name":"Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1198\/000313001753272466"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6507"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","unstructured":"K.Van Lancker A.Vandebosch andS.Vansteelandt \u201cImproving Interim Decisions in Randomized Trials by Exploiting Information on Short\u2010Term Outcomes and Prognostic Baseline 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