Tool for Implementing TArget Trial emulatioN (TITAN): first version of an open-access design assistant
Target trial emulation offers a structured framework to reduce bias in observational studies by emulating the design of a hypothetical target randomised controlled trial. Despite a growing interest for this framework, the implementation of target trial emulation is often inconsistent, with design flaws frequently introducing avoidable biases.
We developed TITAN, Tool for Implementing TArget Trial emulatioNs through an iterative process with two rounds of pilot testing and subsequent refinement by a multidisciplinary steering committee.
TITAN provides guidance to emulate a pragmatic two-arm trial assessing a pharmacological intervention. The tool is organized in two main sections. First, the users define the research question and the target trial. Then, they emulate the target trial using the available observational data. The tool provides warnings, in addition to suggestions, to potentially minimize avoidable biases and major methodological errors, particularly focusing on the alignment of study time points (eligibility, treatment assignment, and start of follow-up) and related biases. The tool’s output is a synthesis that includes a summary of the target trial, design of its emulation, and possible biases and solutions.
TITAN could help researchers ensure that observational studies follow the key principles of target trial emulation.
- The tool can be accessed here: https://clinicalepidemio.fr/target_trial/.
- DOI: https://doi.org/10.1016/j.jclinepi.2026.112476
By Sally Yaacoub
On behalf of the co-authors: Malamati Voulgaridou, Isabelle Boutron, Raphaël Porcher, Viet-Thi Tran, Elodie Perrodeau, Anna Pellat, Philippe Ravaud
