Network meta-analysis

Systolic blood pressure change

Type 2 diabetes (adults)

weeks 36 to 64 (target week 52)While on treatmentEach dose separatelyMean difference

Randomized trials

Treatments

3,030

Participants

Trial arms

In plain language

Across 4 trials with 3,030 participants, 0 of 7 treatments had a clearly better result than placebo on systolic blood pressure change, and for 7 the evidence could not tell them apart from placebo. The most favorable estimate was for Semaglutide oral once daily (original tablet), flexible dose: 3, 7 or 14 mg adjusted by HbA1c and tolerability: mean difference -5.73 mmHg (95% credible interval -14.57 to 4.33).

Lower values favor the treatment. "Clearly" means the 95% credible interval excludes no difference. These are averages across trials; they do not say how any one person will respond. Not medical advice.

Network of trials

Each circle is a treatment; each line joins treatments that were randomized against each other in at least one trial.

Node area shows participants; line width shows trials comparing two treatments directly. Blue: GLP-1 receptor agonist containing treatments; grey: comparators. Hover over or tab to a node or line for details.

Effects compared with Placebo

Mean difference in mmHg. Lower values favor the treatment.

Versus Placebo. Blue: Bayesian random effects posterior median with 95% credible interval (thick) and 95% prediction interval (dashed). Amber diamond: frequentist estimate with 95% confidence interval. Hover over or tab to a row for its values.

Effects of each treatment versus Placebo
Treatment	Bayesian MD (95% CrI)	95% prediction interval	Frequentist MD (95% CI)	Verdict
Semaglutide oral once daily (original tablet), flexible dose: 3, 7 or 14 mg adjusted by HbA1c and tolerability SEMA_PO_FLEX_QD	-5.73 (-14.57 to 4.33)	-15.87 to 5.42	-5.99 (-11.12 to -0.85)	Unclear
Dulaglutide 0.75 mg subcutaneous once weekly DULA_SC_0p75MG_QW	-3.75 (-11.23 to 4.51)	-12.57 to 6.52	-4.04 (-8.48 to 0.41)	Unclear
Semaglutide 7 mg oral once daily (original tablet) SEMA_PO_7MG_QD	-3.45 (-9.41 to 3.71)	-11.45 to 5.68	-3.75 (-6.88 to -0.62)	Unclear
Liraglutide 1.8 mg subcutaneous once daily LIRA_SC_1p8MG_QD	-2.89 (-8.32 to 2.87)	-10.67 to 4.90	-3.00 (-5.62 to -0.38)	Unclear
Semaglutide 14 mg oral once daily (original tablet) SEMA_PO_14MG_QD	-2.84 (-7.83 to 3.22)	-9.94 to 5.26	-3.00 (-5.69 to -0.31)	Unclear
Semaglutide 3 mg oral once daily (original tablet) SEMA_PO_3MG_QD	-2.14 (-8.51 to 4.79)	-10.14 to 6.42	-2.24 (-5.40 to 0.92)	Unclear
Sitagliptin SITAGLIPTIN	-0.79 (-7.48 to 6.67)	-9.06 to 8.23	-0.99 (-4.20 to 2.23)	Unclear

Ranking

How likely each treatment is to be among the best. Rankings ignore the size of differences and their certainty, so read them with the effects above.

League table

Every treatment against every other: mean difference of the row treatment versus the column treatment, posterior median and 95% credible interval. Green: row clearly better; red: row clearly worse.

Every treatment in a row compared with every treatment in a column
Row versus column	PLACEBO	SEMA_PO_FLEX_QD	DULA_SC_0p75MG_QW	SEMA_PO_7MG_QD	LIRA_SC_1p8MG_QD	SEMA_PO_14MG_QD	SEMA_PO_3MG_QD	SITAGLIPTIN
PLACEBO	PLACEBO	5.73 -4.33 to 14.57	3.75 -4.51 to 11.23	3.45 -3.71 to 9.41	2.89 -2.87 to 8.32	2.84 -3.22 to 7.83	2.14 -4.79 to 8.51	0.79 -6.67 to 7.48
SEMA_PO_FLEX_QD	-5.73 -14.57 to 4.33	SEMA_PO_FLEX_QD	-2.00 -10.50 to 7.11	-2.29 -9.92 to 5.35	-2.83 -11.95 to 7.00	-2.90 -10.35 to 4.89	-3.62 -11.19 to 4.41	-4.99 -11.16 to 1.57
DULA_SC_0p75MG_QW	-3.75 -11.23 to 4.51	2.00 -7.11 to 10.50	DULA_SC_0p75MG_QW	-0.36 -5.98 to 5.31	-0.85 -8.47 to 7.40	-0.95 -6.47 to 4.72	-1.63 -7.19 to 4.15	-2.99 -9.38 to 3.36
SEMA_PO_7MG_QD	-3.45 -9.41 to 3.71	2.29 -5.35 to 9.92	0.36 -5.31 to 5.98	SEMA_PO_7MG_QD	-0.56 -6.79 to 6.81	-0.62 -4.38 to 3.58	-1.34 -4.94 to 2.85	-2.64 -7.22 to 2.33
LIRA_SC_1p8MG_QD	-2.89 -8.32 to 2.87	2.83 -7.00 to 11.95	0.85 -7.40 to 8.47	0.56 -6.81 to 6.79	LIRA_SC_1p8MG_QD	-0.06 -6.18 to 5.15	-0.78 -8.07 to 6.13	-2.10 -9.53 to 4.86
SEMA_PO_14MG_QD	-2.84 -7.83 to 3.22	2.90 -4.89 to 10.35	0.95 -4.72 to 6.47	0.62 -3.58 to 4.38	0.06 -5.15 to 6.18	SEMA_PO_14MG_QD	-0.71 -4.65 to 3.44	-2.05 -6.90 to 2.69
SEMA_PO_3MG_QD	-2.14 -8.51 to 4.79	3.62 -4.41 to 11.19	1.63 -4.15 to 7.19	1.34 -2.85 to 4.94	0.78 -6.13 to 8.07	0.71 -3.44 to 4.65	SEMA_PO_3MG_QD	-1.34 -6.26 to 3.36
SITAGLIPTIN	-0.79 -7.48 to 6.67	4.99 -1.57 to 11.16	2.99 -3.36 to 9.38	2.64 -2.33 to 7.22	2.10 -4.86 to 9.53	2.05 -2.69 to 6.90	1.34 -3.36 to 6.26	SITAGLIPTIN

Heterogeneity, fit and convergence

Bayesian random effects (primary)

Heterogeneity (tau): 1.241 (95% CrI 0.056 to 6.743)
Residual deviance: 11.4 for 12 data points
DIC: 22.5 (pD 11.1)
Largest R-hat: 1.005
Smallest ESS: bulk 1,431, tail 1,798
Divergent transitions: 0
Convergence: All criteria met
Priors: PR01 N(0, 60^2); PR03 N(0, 30^2); PR07 half normal(0, 6^2) on tau

Frequentist check (netmeta)

Method: inverse variance, REML, MD
Tau: 0.000
I squared: 0%
Q (total): 1.09 on 2 df, P = 0.580
Q (between designs): 1.09, P = 0.580

Inconsistency

Do trials comparing two treatments directly agree with the indirect evidence through other treatments?

No comparison here has both direct and indirect evidence, so inconsistency cannot be checked by node splitting; the between designs Q above is the global check.

Small study effects

A comparison adjusted funnel plot: each point is one trial comparison, centered on its own network estimate. Asymmetry can signal that small trials with unfavorable results are missing.

Fewer than ten trial comparisons, too few to judge funnel plot asymmetry.

Baseline characteristics of the trials

The baseline value of each effect modifier or prognostic factor that applies here, per trial: mean or percent over arms, weighted by the number randomized. A note under a value names a stand in (a median for a mean, 100 minus the male share, Asian subgroup rows, an all Asian site list); "not reported" means no source of the trial prints it.

Baseline effect modifiers and prognostic factors per trial
Trial	Baseline BMI or body weight (kg/m2) effect modifier, prognostic factor; 3 of 4
PIONEER 4 S000133	32.94
PIONEER 10 S000234	26.26
PIONEER 7 S001153	31.19
PIONEER 3 S002267	not reported

Comparability of the trials

Checked across designs (the set of treatments each trial compares) for eligibility, outcome definition and assessment, and the baseline factors above. Flags point to possible intransitivity; notes describe variation that is not tied to design.

FlagBaseline, Baseline BMI or body weight: not reported by 1 of 4 trials
FlagBaseline, Baseline BMI or body weight: design means range from 26.3 (DULA_SC_0p75MG_QW vs SEMA_PO_14MG_QD vs SEMA_PO_3MG_QD vs SEMA_PO_7MG_QD) to 32.9 (LIRA_SC_1p8MG_QD vs PLACEBO vs SEMA_PO_14MG_QD) kg/m2; threshold 3
NoteOutcome assessment, analysis set: mixed: full_analysis 2, other 1, safety 1
NoteOutcome assessment, intercurrent events (discontinuation): mixed: not stated 1, treatment_policy 3
NoteOutcome assessment, intercurrent events (rescue): mixed: not stated 1, treatment_policy 3
NoteRisk of bias, blinding: mixed: double_blind 2, open_label 1, single_blind 1

Comparability items per trial
Trial	time weeks	analysis set	definition	instrument	adjudicated	proportion method	intercurrent events (discontinuation)	intercurrent events (rescue)	blinding	funding	start year	Eligibility
PIONEER 4	52	other	not stated	not stated	not stated	not stated	treatment_policy	treatment_policy	double_blind	industry	2016	Age 18 or older; T2D on metformin with or without SGLT2i; HbA1c 7.0 to 9.5 percent; eGFR 60 or more
PIONEER 10	52	full_analysis	not stated	not stated	not stated	not stated	treatment_policy	treatment_policy	single_blind	industry	2017	Japanese adults 20 or older; T2D; HbA1c 7.0 to 10.5 percent on one oral glucose lowering drug
PIONEER 7	52	safety	not stated	not stated	not stated	not stated	not stated	not stated	open_label	industry	2016	age 18 or more; HbA1c 7.5 to 9.5 percent; one or two oral glucose lowering drugs
PIONEER 3	52	full_analysis	not stated	not stated	not stated	not stated	treatment_policy	treatment_policy	double_blind	industry	2016	adults with T2D; HbA1c 7.0 to 10.5 percent; metformin with or without sulfonylurea

Trial data

What each trial contributes. Arm rows give the arm value with its standard error, or events over participants; contrast rows give the mean difference on the analysis scale against the trial's first row. Flags mark converted, combined or approximated inputs.

Trial data entering this analysis
Trial	Arm	Treatment	Week	Data	Value	SE	Events / N	Source
PIONEER 4	A1	SEMA_PO_14MG_QD	52	arm, change	-3.000	0.829	285	registry:outcomes
PIONEER 4	A2	LIRA_SC_1p8MG_QD	52	arm, change	-3.000	0.771	284	registry:outcomes
PIONEER 4	A3	PLACEBO	52	arm, change	0.000	1.091	142	registry:outcomes
PIONEER 10	A1	SEMA_PO_3MG_QD	52	arm, change	-2.000	1.223	131	registry:outcomes
PIONEER 10	A2	SEMA_PO_7MG_QD	52	arm, change	-2.000	1.132	132	registry:outcomes
PIONEER 10	A3	SEMA_PO_14MG_QD	52	arm, change	-2.000	1.140	130	registry:outcomes
PIONEER 10	A4	DULA_SC_0p75MG_QW	52	arm, change	-3.000	1.612	65	registry:outcomes
PIONEER 7	A3	SEMA_PO_FLEX_QD	52	contrast, md	-5.000	2.041		R0023369:Supplement Table S11
PIONEER 7	A4	SITAGLIPTIN	52	contrast, md				R0023369:Supplement Table S11
PIONEER 3	A1	SEMA_PO_3MG_QD	52	arm, change	-2.000	0.695	466	registry:outcomes
PIONEER 3	A2	SEMA_PO_7MG_QD	52	arm, change	-4.000	0.650	464	registry:outcomes
PIONEER 3	A3	SEMA_PO_14MG_QD	52	arm, change	-3.000	0.696	465	registry:outcomes
PIONEER 3	A4	SITAGLIPTIN	52	arm, change	-1.000	0.649	466	registry:outcomes

Rerun this analysis yourself

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