AutoCriteria: a generalizable clinical trial eligibility criteria extraction system powered by large language models

OBJECTIVES

We aim to build a generalizable information extraction system leveraging large language models to extract granular eligibility criteria information for diverse diseases from free text clinical trial protocol documents. We investigate the model's capability to extract criteria entities along with contextual attributes including values, temporality, and modifiers and present the strengths and limitations of this system.

MATERIALS AND METHODS

The clinical trial data were acquired from https://ClinicalTrials.gov/. We developed a system, AutoCriteria, which comprises the following modules: preprocessing, knowledge ingestion, prompt modeling based on GPT, postprocessing, and interim evaluation. The final system evaluation was performed, both quantitatively and qualitatively, on 180 manually annotated trials encompassing 9 diseases.

RESULTS

AutoCriteria achieves an overall F1 score of 89.42 across all 9 diseases in extracting the criteria entities, with the highest being 95.44 for nonalcoholic steatohepatitis and the lowest of 84.10 for breast cancer. Its overall accuracy is 78.95% in identifying all contextual information across all diseases. Our thematic analysis indicated accurate logic interpretation of criteria as one of the strengths and overlooking/neglecting the main criteria as one of the weaknesses of AutoCriteria.

DISCUSSION

AutoCriteria demonstrates strong potential to extract granular eligibility criteria information from trial documents without requiring manual annotations. The prompts developed for AutoCriteria generalize well across different disease areas. Our evaluation suggests that the system handles complex scenarios including multiple arm conditions and logics.

CONCLUSION

AutoCriteria currently encompasses a diverse range of diseases and holds potential to extend to more in the future. This signifies a generalizable and scalable solution, poised to address the complexities of clinical trial application in real-world settings.

Named Entity Recognition and Normalization for Alzheimer's Disease Eligibility Criteria

Alzheimer's Disease (AD) is a complex neurodegenerative disorder that affects millions of people worldwide. Finding effective treatments for this disease is crucial. Clinical trials play an essential role in developing and testing new treatments for AD. However, identifying eligible participants can be challenging, time-consuming, and costly. In recent years, the development of natural language processing (NLP) techniques, specifically named entity recognition (NER) and named entity normalization (NEN), have helped to automate the identification and extraction of relevant information from the eligibility criteria (EC) more efficiently, in order to facilitate semi-automatic patient recruitment and enable data FAIRness for clinical trial data. Nevertheless, most current biomedical NER models only provide annotations for a restricted set of entity types that may not be applicable to the clinical trial data. Additionally, accurately performing NEN on entities that are negated using a negative prefix currently lacks established techniques. In this paper, we introduce a pipeline designed for information extraction from AD clinical trial EC, which involves preprocessing of the EC data, clinical NER, and biomedical NEN to Unified Medical Language System (UMLS). Our NER model can identify named entities in seven pre-defined categories, while our NEN model employs a combination of exact match and partial match search strategies, as well as customized rules to accurately normalize entities with negative prefixes. To evaluate the performance of our pipeline, we measured the precision, recall, and F1 score for the NER component, and we manually reviewed the top five mapping results produced by the NEN component. Our evaluation of the pipeline's performance revealed that it can successfully normalize named entities in clinical trial ECs with optimal accuracies. The NER component achieved a overall F1 of 0.816, demonstrating its ability to accurately identify seven types of named entities in clinical text. The NEN component of the pipeline also demonstrated impressive performance, with customized rules and a combination of exact and partial match strategies leading to an accuracy of 0.940 for normalized entities.

A human-computer collaborative approach to identifying common data elements in clinical trial eligibility criteria

OBJECTIVE

To identify Common Data Elements (CDEs) in eligibility criteria of multiple clinical trials studying the same disease using a human-computer collaborative approach.

DESIGN

A set of free-text eligibility criteria from clinical trials on two representative diseases, breast cancer and cardiovascular diseases, was sampled to identify disease-specific eligibility criteria CDEs. In this proposed approach, a semantic annotator is used to recognize Unified Medical Language Systems (UMLSs) terms within the eligibility criteria text. The Apriori algorithm is applied to mine frequent disease-specific UMLS terms, which are then filtered by a list of preferred UMLS semantic types, grouped by similarity based on the Dice coefficient, and, finally, manually reviewed.

MEASUREMENTS

Standard precision, recall, and F-score of the CDEs recommended by the proposed approach were measured with respect to manually identified CDEs.

RESULTS

Average precision and recall of the recommended CDEs for the two diseases were 0.823 and 0.797, respectively, leading to an average F-score of 0.810. In addition, the machine-powered CDEs covered 80% of the cardiovascular CDEs published by The American Heart Association and assigned by human experts.

CONCLUSION

It is feasible and effort saving to use a human-computer collaborative approach to augment domain experts for identifying disease-specific CDEs from free-text clinical trial eligibility criteria.