medRxiv submission for a clinical paper requires ethics/IRB approval documentation, a trial ID from an ICMJE-recognised registry, and mandatory disclaimer language warning against clinical use — none of which bioRxiv’s basic-science workflow asks for. The two servers share the same submission portal and screening infrastructure, but medRxiv layers on health-research-specific checks that authors coming from bioRxiv, or submitting to a preprint server for the first time, often miss.
medRxiv is a preprint server for complete, unpublished manuscripts in medicine, clinical research and related health sciences, operated by the non-profit openRxiv alongside its sister site bioRxiv. This guide sets out exactly what is different about the clinical submission path, so administrators and authors can prepare the right documentation before they open the submission form.
- What makes medRxiv submission different from bioRxiv?
- How do you submit a clinical manuscript to medRxiv?
- What ethics approval, trial registration and disclaimer does medRxiv require?
- Common questions about medRxiv submission
- What this means for research administrators and authors
What Makes medRxiv Submission Different From bioRxiv?
medRxiv and bioRxiv run on the same manuscript-processing system and both charge no submission fee, but their scope and screening checks diverge sharply. medRxiv exists for research involving human health outcomes; bioRxiv is scoped to the life sciences and states it is “not intended for clinical research.” That scope distinction drives every requirement below.
The clearest technical marker of the split shows up in the DOI itself. Under medRxiv’s submission guide, DOIs assigned after 11 December 2019 carry an eight-digit suffix with a date stamp, while bioRxiv’s equivalent DOIs use a six-digit suffix — a small but genuine artefact of the two platforms being built as parallel, not identical, systems.
| Requirement | medRxiv | bioRxiv |
|---|---|---|
| Scope | Human health, clinical and medical research | Life sciences; explicitly excludes clinical research |
| Ethics/IRB statement | Required for any study using human subjects, samples or data | Not a stated submission requirement |
| Clinical trial registration | Mandatory ICMJE-recognised trial ID for prospective interventional studies | Not applicable to scope |
| Case reports/case series | Explicitly out of scope, declined | Not a defined exclusion category |
| DOI suffix (post 11 Dec 2019) | Eight digits | Six digits |
| Article categories | ~50 subject categories, one per preprint | New / Confirmatory / Contradictory Results |
| Direct-to-journal transfer | 144+ partner journals (M2J) | Separate B2J partner list |
How Do You Submit a Clinical Manuscript to medRxiv?
The mechanics — register, upload, declare, await screening — mirror any preprint server. What differs is the depth of declarations medRxiv demands before it accepts a health-research file.
- Register and log in. First-time authors create a free account at submit.medrxiv.org, typically via ORCID, before entering the Author Area.
- Prepare the manuscript. Upload a single PDF containing text, figures and tables, or a Word file plus separate figure files that medRxiv’s engine converts automatically. LaTeX must be pre-converted to PDF.
- Select one subject category from medRxiv’s roughly 50 health-science categories — only one may be chosen per preprint.
- Complete the ethics, trial-registration, competing-interest and funding declarations described in the next section — this is the step with no bioRxiv equivalent.
- Submit for screening. A manuscript is checked for plagiarism, non-scientific content, identifying patient information, and — specifically for medRxiv — ethical oversight and trial registration.
- Posting. Once approved, the preprint receives a DOI and posts as PDF; full-text HTML and XML typically follow within two days.
Case reports, narrative reviews, editorials, veterinary studies and preclinical work are out of scope for medRxiv and are declined at screening — a stricter filter than bioRxiv applies, reflecting the risk of premature clinical information reaching patients or the media.
What Ethics Approval, Trial Registration and Disclaimer Does medRxiv Require?
This is the section that defines “clinical” preprint workflow. medRxiv submission for any study using human subjects, samples or data requires a statement of ethical oversight from an independent body — an Ethics Committee, Institutional Review Board (IRB), or equivalent — covering the entire study and every human sample, dataset and cohort involved.
medRxiv’s policy is unusually specific about what does not count. Its FAQ states the platform will not accept approval decisions from online tools such as the UK Health Research Authority’s Decision Tool, nor from audit bodies, Caldicott Guardians, biosafety committees or Research & Development departments — only a dedicated ethics oversight body qualifies.
- Trial registration: any prospective interventional study — one that assigns people to an intervention to study a health outcome — must carry a trial ID from an ICMJE-recognised registry such as ClinicalTrials.gov. Studies without a trial ID at submission must register retrospectively before posting.
- Novel drug/device exemptions: emergency-use products cleared under the US FDA’s Investigational New Drug (IND) or Investigational Device Exemption (IDE) mechanisms may be exempt from standard registration where public disclosure is precluded.
- Competing-interest and funding statements: authors must disclose any payments or services received in the past 36 months that could be perceived to influence the work, and detail all funding that supported it.
- Patient identifiability: images or combinations of details (exact ages, dates, geographic locations, direct quotes) that could identify a patient must be removed before submission; blurring or pixelation alone is not accepted.
Every accepted preprint also carries a fixed disclaimer, displayed on the page and stamped on the PDF: “Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.” Authors do not write this text themselves — it is applied automatically to every medRxiv posting, but institutions should brief clinical authors that it will appear, since press or clinician-facing communications referencing the preprint should carry the same caveat.
Screening that checks all of the above against a manuscript takes longer than a basic scientific-content check. medRxiv’s own FAQ states that article screening typically completes within two to four days, longer over a weekend or holiday, or where ethics or registration documentation needs following up — a direct consequence of the clinical-specific checks bioRxiv’s screening does not perform.
Common Questions About medRxiv Submission
How much does it cost to submit a manuscript to medRxiv?
There is no fee for registration or manuscript deposition on medRxiv. The platform is funded by contributions from organisations including Cold Spring Harbor Laboratory, the Chan Zuckerberg Initiative and several partner universities, not by author charges.
Is medRxiv peer reviewed?
No. Manuscripts on medRxiv are not certified by peer review, edited or typeset before posting; they undergo a basic screening for plagiarism, scientific content, ethics documentation and patient-identifying information only, not expert evaluation of methods or conclusions.
Is medRxiv indexed in PubMed?
Only partially. medRxiv preprints are indexed by Google Scholar, Crossref, Semantic Scholar, Europe PMC and the Preprint Citation Index (linked to Web of Science) as standard, but PubMed indexing is limited to preprints reporting NIH-funded research.
What is medRxiv’s impact factor?
medRxiv has no Journal Impact Factor, because it is a preprint server, not a peer-reviewed journal — a distinction medRxiv’s own FAQ states directly. Citation and attention metrics (views, downloads, Altmetric scores) are tracked instead.
What This Means for Research Administrators and Authors
For research administrators supporting clinical investigators, the practical takeaway is procedural: a clinical manuscript cannot move through medRxiv’s submission form as quickly as a bioRxiv basic-science paper, because the ethics-oversight statement and registry ID need to exist — correctly formatted — before submission starts, not be assembled during screening.
Authors citing a medRxiv preprint in an NIH application can do so directly; per NIH’s Reporting Preprints and Other Interim Research Products guidance (NOT-OD-17-050), the agency “encourages investigators to use interim research products, such as preprints, to speed the dissemination and enhance the rigor of their work.” The same DOI-based citation applies whether the preprint later transfers to one of medRxiv’s 144-plus M2J partner journals or is revised independently.
medRxiv also provides free bulk access to full text and metadata via APIs, separate from the author-facing login system, for institutions building preprint-tracking workflows. Given the added ethics and registration burden, clinical teams should budget documentation time ahead of any submission deadline rather than assume medRxiv mirrors bioRxiv’s lighter screening.
Sound documentation practice — consistent contributorship records, clear authorship and consent decisions agreed before submission, and coordination with research administration offices on ethics paperwork — reduces the single biggest cause of delay: manuscripts returned to authors for missing ethics statements, trial IDs or competing-interest disclosures that should have been resolved before the file was uploaded.