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  <front>
    <journal-meta>
      <journal-id journal-id-type="iso-abbrev">Pharmacophore</journal-id>
      <journal-id journal-id-type="publisher-id">pharmacophorejournal.com</journal-id>
      <journal-id journal-id-type="publisher-id">Pharmacophore</journal-id>
      <journal-title-group>
        <journal-title>Pharmacophore</journal-title>
      </journal-title-group>
      <issn pub-type="epub">2229-5402</issn>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">pharmacophorejournal.com-6997</article-id>
      <article-id pub-id-type="doi">10.51847/Wji0HKFBSn</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Original research</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Preserving the Clinical Question When Artificial Intelligence Reshapes Trial Participation: A Methodological Framework Linking Eligibility Optimization, Treatment-Effect Heterogeneity, Estimand Integrity, and Transportability</article-title>
      </title-group>
                    <contrib-group>
                      <contrib contrib-type="author">
              <name>
                <surname>Sharma</surname>
                <given-names>Rajiv</given-names>
              </name>
                              <xref rid="aff1" ref-type="aff">1</xref>
                                        </contrib>
                      <contrib contrib-type="author">
              <name>
                <surname>Dubois</surname>
                <given-names>Sophie</given-names>
              </name>
                              <xref rid="aff2" ref-type="aff">2</xref>
                                                            <xref rid="cor1" ref-type="corresp" />
                          </contrib>
                      <contrib contrib-type="author">
              <name>
                <surname>Nakamura</surname>
                <given-names>Kenji</given-names>
              </name>
                              <xref rid="aff3" ref-type="aff">3</xref>
                                        </contrib>
                      <contrib contrib-type="author">
              <name>
                <surname>Nair</surname>
                <given-names>Priya</given-names>
              </name>
                              <xref rid="aff4" ref-type="aff">4</xref>
                                        </contrib>
                  </contrib-group>
                  <aff id="aff1">
            <label>1</label>Department of Clinical Trials and AI-Based Patient Selection, Indian Institute of Management Calcutta, Kolkata, India.
          </aff>
                  <aff id="aff2">
            <label>2</label>Department of Biostatistics and Causal Inference, HEC Paris, Paris, France.
          </aff>
                  <aff id="aff3">
            <label>3</label>Department of Clinical Epidemiology and Trial Methodology, Hitotsubashi University, Tokyo, Japan.
          </aff>
                  <aff id="aff4">
            <label>4</label>Department of Pharmaceutical Data Science and Clinical Trials, Indian Institute of Technology Bombay, Mumbai, India.
          </aff>
                          <author-notes>
            <corresp id="cor1">
              <bold>Address for correspondence:</bold> Prof. Wael Abu Dayyih, Department of
              Pharmaceutical Chemistry, Faculty of Pharmacy, Mutah University, Al-Karak 61710, Jordan.
                              E-mail: <email xlink:href="sophie.dubois@hec.fr">sophie.dubois@hec.fr</email>
                          </corresp>
          </author-notes>
                    <pub-date pub-type="epub">
        <day>28</day>
        <month>10</month>
        <year>2026</year>
      </pub-date>
      <volume>17</volume>
      <issue>5</issue>
      <fpage>140</fpage>
      <lpage>150</lpage>
      <permissions>
        <copyright-statement>
          Copyright: &#x000a9; 2026 Pharmacophore
        </copyright-statement>
        <copyright-year>2026</copyright-year>
        <license>
          <ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/"
            specific-use="textmining" content-type="ccbyncsalicense">
            https://creativecommons.org/licenses/by-nc-sa/4.0/</ali:license_ref>
          <license-p>This is an open access journal, and articles are distributed under the terms of
            the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows
            others to remix, tweak, and build upon the work non-commercially, as long as appropriate
            credit is given and the new creations are licensed under the identical terms.</license-p>
        </license>
      </permissions>
      <abstract>
        <title>A<sc>BSTRACT</sc></title>
        <p>Artificial intelligence is increasingly capable of extracting eligibility criteria, matching patients to clinical trials, ranking potential participants, and supporting protocol-level decisions about enrollment. These capabilities are usually evaluated as problems of screening accuracy, recruitment efficiency, or operational scalability. Yet optimizing who enters a trial can also alter the population in which treatment effects are observed and, consequently, the clinical question the trial can legitimately answer. This article develops a methodological framework for preserving that question when artificial intelligence influences trial participation. The analysis links four domains that are commonly treated separately: eligibility design, treatment-effect heterogeneity, estimand specification, and transportability. The central distinction is between operational optimization that leaves the intended inferential target substantively intact and selection that changes the distribution of treatment-effect modifiers, narrows empirical support for the target population, or creates discordance between the population named in the estimand and the population represented by enrolled participants. Eligibility optimization is therefore treated as a scientific intervention on the evidence-generating population rather than as a neutral administrative improvement. The framework distinguishes legitimate enrichment, transparent redefinition of the target question, and unacknowledged clinical-question drift. It further separates model-level validation of matching or eligibility decisions from inferential validation of the resulting trial population. The resulting approach places population–estimand alignment, heterogeneity assessment, and transportability considerations upstream in the design of AI-supported recruitment rather than leaving them to post hoc interpretation.</p>
      </abstract>
      <kwd-group>
                <kwd>Clinical trial eligibility</kwd>
                <kwd>Artificial intelligence</kwd>
                <kwd>Treatment-effect heterogeneity</kwd>
                <kwd>Estimand</kwd>
                <kwd>Transportability</kwd>
                <kwd>External validity</kwd>
              </kwd-group>
    </article-meta>
  </front>
</article>
