# Eligibility-Aware Evidence Synthesis: An Agentic Framework for Clinical Trial Meta-Analysis

arXiv: https://arxiv.org/abs/2604.02678 · HTML: https://mlsanity.com/paper/2604.02678/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 9 of its 38 references that are in the map.
- First posted on arXiv 3 Apr 2026.

## Builds on (most cited first, 9 of 9)

- [Toolformer: Language Models Can Teach Themselves to Use Tools](https://mlsanity.com/paper/2302.04761/) (2023)
- [BioBERT: a pre-trained biomedical language representation model for biomedical text mining](https://mlsanity.com/paper/1901.08746/) (2019)
- [BioGPT: Generative Pre-trained Transformer for Biomedical Text Generation and Mining](https://mlsanity.com/paper/2210.10341/) (2022)
- [A Survey of LLM-based Agents in Medicine: How far are we from Baymax?](https://mlsanity.com/paper/2502.11211/) (2025)
- [Matching Patients to Clinical Trials with Large Language Models](https://mlsanity.com/paper/2307.15051/) (2023)
- [Zero-Shot Clinical Trial Patient Matching with LLMs](https://mlsanity.com/paper/2402.05125/) (2024)
- [Automatically Extracting Numerical Results from Randomized Controlled Trials with Large Language Models](https://mlsanity.com/paper/2405.01686/) (2024)
- [AlpaPICO: Extraction of PICO Frames from Clinical Trial Documents Using LLMs](https://mlsanity.com/paper/2409.09704/) (2024)
- [Empowering Meta-Analysis: Leveraging Large Language Models for Scientific Synthesis](https://mlsanity.com/paper/2411.10878/) (2024)

## Abstract (arXiv)

Clinical evidence synthesis requires identifying relevant trials from large registries and aggregating results that account for population differences. While recent LLM-based approaches have automated components of systematic review, they do not support end-to-end evidence synthesis. Moreover, conventional meta-analysis weights studies by statistical precision without considering clinical compatibility reflected in eligibility criteria. We propose EligMeta, an agentic framework that integrates automated trial discovery with eligibility-aware meta-analysis, translating natural-language queries into reproducible trial selection and incorporating eligibility alignment into study weighting to produce cohort-specific pooled estimates. EligMeta employs a hybrid architecture separating LLM-based reasoning from deterministic execution: LLMs generate interpretable rules from natural-language queries and perform schema-constrained parsing of trial metadata, while all logical operations, weight computations, and statistical pooling are executed deterministically to ensure reproducibility. The framework structures eligibility criteria and computes similarity-based study weights reflecting population alignment between target and comparator trials. In a gastric cancer landscape analysis, EligMeta reduced 4,044 candidate trials to 39 clinically relevant studies through rule-based filtering, recovering all 13 guideline-cited trials. In an olaparib adverse events meta-analysis across four trials, eligibility-aware weighting shifted the pooled risk ratio from 2.18 (95% CI: 1.71-2.79) under conventional Mantel-Haenszel estimation to 1.97 (95% CI: 1.76-2.20), demonstrating quantifiable impact of incorporating eligibility alignment. EligMeta bridges automated trial discovery with eligibility-aware meta-analysis, providing a scalable and reproducible framework for evidence synthesis in precision medicine.