Evidence mapPaperPMID 39961105Full record

ArticleAnnals of internal medicine2025

The Target Trial Framework for Causal Inference From Observational Data: Why and When Is It Helpful?

Miguel A Hernán, Issa J Dahabreh, Barbra A Dickerman, Sonja A Swanson

2 registry-linked trialsAbstract read
In one paragraph

Article in Annals of internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It reports registered trial NCT07465926. Cited by 73 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
73citing papers in PubMed, 3 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07465926 completed

Associations of Early Add-On GLP-1 Receptor Agonist and SGLT2 Inhibitor Therapy With Mortality and Kidney Outcomes in Adults With Obesity and Type 2 Diabetes Across Cardiovascular-Kidney-Metabolic Stages 2-3: A Target-Trial Emulation

Ran2017Enrolled451,036Registered outcomes12Posted comparisons0ConditionsCardiovascular Disease Risk Factor, Cardiovascular-kidney-metabolic Syndrome, Kidney Disease, Obesity & OverweightArmsGLP-1 receptor agonist, SGLT2 inhibitor
Open the trial in the graph
NCT07513259 completednot on this map

Pre-Diagnosis GLP-1 Receptor Agonist Use and Post-Cancer Mortality in Adults With Obesity and Type 2 Diabetes: A Target Trial Emulation

TypeobservationalSponsorChung Shan Medical UniversityRan2018 to 2025Enrolled203,424ConditionsObesity & Overweight, Diabetes Mellitus Type 2, Neoplasms
3 · Its place in the literature

Who cites it

73 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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  20. Active monitoring versus surgical excision for atypical ductal hyperplasia.Cancer prevention research (Philadelphia, Pa.) · 2026
    Article

13 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Miguel A HernánCAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (M.A.H.).ORCID 0000-0003-1619-8456
Issa J DahabrehCAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health; Department of Biostatistics, Harvard T.H. Chan School of Public Health; and Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (I.J.D.).ORCID 0000-0002-2215-9931
Barbra A DickermanCAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (B.A.D.).
Sonja A SwansonDepartment of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania (S.A.S.).

Funding

Dynamic Strategies for the clinical management of HIV diseaseR37AI102634 · NIAID · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · 2023 to 2025
$1.3M
Use of Registries, Claims and Health System Data to Enhance the Evaluation of Cardiovascular DevicesR01HL136708 · BETH ISRAEL DEACONESS MEDICAL CENTER · 2025 to 2025
$737k
Identifying optimal dynamic strategies for prostate cancer controlR00CA248335 · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · 2025 to 2025
$200k
NCI NIH HHS R00 CA248335NHLBI NIH HHS R01 HL136708NIAID NIH HHS R37 AI102634
6 · The paper itself

Abstract

When randomized trials are not available to answer a causal question about the comparative effectiveness or safety of interventions, causal inferences are drawn using observational data. A helpful 2-step framework for causal inference from observational data is 1) specifying the protocol of the hypothetical randomized pragmatic trial that would answer the causal question of interest (the target trial), and 2) using the observational data to attempt to emulate that trial. The target trial framework can improve the quality of observational analyses by preventing some common biases. In this article, we discuss the utility and scope of applications of the framework. We clarify that target trial emulation resolves problems related to incorrect design but not those related to data limitations. We also describe some settings in which adopting this approach is advantageous to generate effect estimates that can close the gaps that randomized trials have not filled. In these settings, the target trial framework helps reduce the ambiguity of causal questions.

Indexed as

CausalityData Interpretation, StatisticalObservational Studies as TopicPragmatic Clinical Trials as TopicHumansResearch Design

Identifiers

PMID39961105
PMCPMC11936718

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.