Redefining the Hierarchy of Evidence in Medicine in the Era of the Next Generation Clinical Trials and Real World Evidence: A Critical Review and the Next Generation Hierarchy

2025/11/11 by Reida El Oakley, Khairya K. Elmuttardi, Adel Altawaty +12 · 1 voice
Decision Sciences · Health Professions · Mathematics · #Health Policy Implementation Science #Meta-analysis and systematic reviews #Statistical Methods in Clinical Trials

paper · pdf · doi:10.63720/v1i2005

openalex publication_date 2025/11/11 · openalex created_date 2025/11/14 · openalex updated_date 2026/07/29

Abstract

Innovative evidence modalities—such as OMICS-guided clinical trials, causally interpretable meta-analyses (CMAs), and real-world evidence (RWE)—are increasingly recognized by leading professional organisations and regulatory authorities. A PubMed review revealed gaps in integrating these modalities into the current evidence hierarchies, underscoring the urgent need for a next-generation hierarchy that recognises modern science and regulatory standards. To address this, a new A+ level of evidence

Citations

• The next generation of evidence-based medicine

Discussions

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