Research Article (preprint): “Automation of Systematic Reviews with Large Language Models”

Title

Automation of Systematic Reviews with Large Language Models

Authors

Christian Cao (University of Toronto), Et al.

Source

medRxiv
(June 13, 2025)

DOI: 10.1101/2025.06.13.25329541

Abstract

Systematic reviews (SRs) inform evidence-based decision making. Yet, they take over a year to complete, are prone to human error, and face challenges with reproducibility; limiting access to timely and reliable information. We developed otto-SR, an end-to-end agentic workflow using large language models (LLMs) to support and automate the SR workflow from initial search to analysis. We found that otto-SR outperformed traditional dual human workflows in SR screening (otto-SR: 96.7% sensitivity, 97.9% specificity; human: 81.7% sensitivity, 98.1% specificity) and data extraction (otto-SR: 93.1% accuracy; human: 79.7% accuracy). Using otto-SR, we reproduced and updated an entire issue of Cochrane reviews (n=12) in two days, representing approximately 12 work-years of traditional systematic review work. Across Cochrane reviews, otto-SR incorrectly excluded a median of 0 studies (IQR 0 to 0.25), and found a median of 2.0 (IQR 1 to 6.5) eligible studies likely missed by the original authors. Meta-analyses revealed that otto-SR generated newly statistically significant conclusions in 2 reviews and negated significance in 1 review. These findings demonstrate that LLMs can autonomously conduct and update systematic reviews with superhuman performance, laying the foundation for automated, scalable, and reliable evidence synthesis.

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