Rapid Assessment of Prior Evidence Before Initiating New Clinical Trials: Interpretation of the REVEAL Guidance and Recommendations for Application in China

Reviewing existing evidence before initiating a clinical trial helps assess the necessity of the study, reduce unnecessary duplication, and optimize trial design; however, conducting a full systematic review is often constrained by time, personnel, and methodological capacity. In 2026, BMJ published the prior evidence for new trials (REVEAL) guidance, which proposes a two-stage process that prioritizes searching for systematic reviews and, when necessary, proceeds to search published, unpublished, and ongoing trials, accompanied by a structured reporting template. This article interprets REVEAL’s methodological positioning, core workflow, and the basis for determining the necessity of a new trial. It highlights time-saving mechanisms, including evidence reuse, need-based progression, restricted update windows, and task stratification, and illustrates key application points using a worked example from the original guidance. It also analyzes the guidance’s limitations and risks of misuse. On this basis, and in light of China’s literature environment and research management needs, we propose application recommendations: supplementing Chinese-language literature and registry information, aligning personnel and review intensity with trial risk, using review results for ethics review, funding applications, and trial protocol justification, and conducting local pilot evaluations. REVEAL provides an actionable pre-initiation evidence review pathway for resource-limited teams; however, its simplified review findings should not be equated with the conclusions of a full systematic review, and its local applicability and actual impact on research decisions require further validation.